Fig. 1

a Manifest refraction of both eyes at far distance is approximately − 2.5 D myopia under relaxed eye state (far relax) and emmetropia under strained eye state (far strain). Both eyes have approximately − 3.0 D myopia in the relaxed state at near distance (33 cm; near relax) and emmetropia under cycloplegic refraction (CR). b Pupil diameter shows no significant change according to the patient’s eye state, except during the CR state (Kruskal-Wallis test; P = .59). L = left; R = right