## 4 Discussion
Several factors may have contributed to this, including some level of neuroadaptation, which has been demonstrated to be initiated during the first weeks after the use of a multifocal optical device [33] or the stabilization of the CL with the wearing period. In any case, this potential visual improvement with the CL wear must be considered with care as the mean value obtained of one line of visual acuity improvement could be also due to the inherent variability of the visual acuity measurements. For this reason, changes in VA with this CL must be investigated further in future trials with larger sample sizes to extract more consistent conclusions. Concerning the accommodative response, a trend to a reduction in the accommodative response was observed, with a mean value of change of 0.30 D at the end of the follow-up. With EDOF CLs, only two previous studies evaluated the accommodative function, reporting a good accommodation performance [30] and an improvement in accommodative flexibility [34], but not measuring specifically the accommodative response. However, other studies have evaluated the accommodative response after the use of other designs of myopia control CLs. [PERSON] et al. [17] found a decrease in the accommodative LAG after one year of wear of a radial refractive gradient CL, while [PERSON] et al. [19] did not find significant variations in the accommodative LAG after two years of wear of a concentric ring design CL, although it should be considered that measurements in this last study were taken without the CL. According to the data obtained in the current series, the EDOF CL evaluated seems to induce some changes in the accommodative response in the short term, although with limited clinical relevance (small magnitude). It is well-known that the use of an addition (in this case represented by the increase in the depth-of-focus) reduces the LAG of accommodation, and this can be one of the main factors contributing to this [35]. Furthermore, the limitations of the methods used for measuring the accommodative response, which were subjective methods, Nott and MEM, should also be noted. These methods have been demonstrated to have a limited repeatability, as demonstrated by [PERSON] et al. [36]. This could have introduced some level of variability which is inherent to the measurement procedure, although the same experienced examiner obtained all measurements. Considering this, future studies should confirm this reduction in the accommodative LAG with objective methods and if it is maintained in the long term. Concerning the impact of myopia control CLs on binocularity, only two previous studies have evaluated this issue, reporting a slight increase in exophora at near without alteration of stereopsis [19; 30]. These results are consistent with those obtained in the current series. However, to our knowledge, no study has investigated the impact of myopia control CL wear on fusional ergences. In our study, a trend to improvement was observed in positive FV at near, suggesting a potentially greater ability to converge with the CL. This increase could be due to the vergence-accommodation synergy and consequently could be associated with the decrease in the accommodative LAG. This should be investigated further in future studies. Concerning the minimal variations of the measurements obtained with the cover test, it may be associated with the inherent variability of the measurement of the phoria, especially in this reduced sample [37]. Besides VA, accommodation and binocular evaluation, an analysis of the impact of the wearing of the EDOF CL evaluated on ocular aberrations and perception of photic phenomena was also performed. To date, few studies have evaluated changes in ocular aberrations with CLs for myopia control [17; 20; 38; 39].