Purpose: Myopia in school-age children has become increasingly prevalent in industrialized countries, especially in Asia. A large population of school-age children still suffers from low visual acuity. We have developed a novel, safe and noninvasive training method to activate a pupillary constriction response during far accommodation that results in improved visual acuity. Methods: Myopic children (n = 95) were treated for 3-minute sessions up to twice a week for 12-106 weeks. We stimulated

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... ck cycles of near/far accommodation by displaying a visual object on a LCD screen and moving the screen in cycles from a near (25 cm) to a far (70 cm) point and back, while keeping the retinal projection size and brightness of the object constant. Results: Mechanistically, we noted pupillary constriction upon far accommodation in trained myopic children, which was not seen in normal subjects or in untrained myopic children. Eighty five percent (52/61) of trained myopic right eyes with two sessions weekly experienced improved visual acuity (VA) by more than 0.1 logMAR units with an average improvement of 0.30 ± 0.03 standard error of mean (SEM) logMAR units. With maintained training, most eyes' improved VA stayed almost constant, for more than 50 weeks in the case of 12 long trained subjects. Conclusions: This simple, short and safe accommodation training greatly improves the quality of vision in a large population suffering from refractive abnormalities.