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Khorrami-Nejad M, Akbari MR, Azizi E, Fareed Tarik F, Yousefi R, Masoomian B. Clinical features and refractive profile of Brown syndrome. Clin Exp Optom 2024; 107:622-626. [PMID: 37759378 DOI: 10.1080/08164622.2023.2256323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
CLINICAL SIGNIFICANCE Understanding the refractive profile, amblyopia prevalence, binocular status, and head position in patients with Brown syndrome help clinicians become more familiar with this syndrome. BACKGROUND Brown syndrome is identified as an active and passive restricted elevation of the eye in adduction. There is little information on clinical features, including refractive status, amblyopia, abnormal head posture (AHP), and types of deviation in these patients. METHODS This study retrospectively evaluated records of 100 Brown syndrome patients from 2015 to 2022 at Farabi Eye Hospital, Iran. RESULTS The mean age was 6.99 ± 6.33 years, including 48 (48%) males. A congenital source was found in 74 (74%) and 96 (96%) patients had unilateral involvement. The mean CDVA for the affected and non-affected eyes were 0.05 ± 0.11 and 0.03 ± 0.06 logMAR, respectively (P = 0.31). In unilateral cases, hyperopia, myopia, and emmetropia were observed in 55 (57.29%), 2 (2.08%), and 39 (40.63%) affected eyes, respectively. The most common type of deviation was pure hypotropia, which was found in 53 (53%) cases, followed by 'combined exotropia and hypotropia' observed in 26 (26%) patients. The mean angle of hypotropia and horizontal deviation in the primary position at distance was 12.10 ± 8.50 and 8 ± 13.20 prism dioptre, respectively. A V-pattern was found in 76 (76%) patients. Amblyopia was observed in 13 (21.67%) of 60 cooperative patients, and AHP was noticed in 66 (66%) patients, in which "combined chin up and contralateral face turn" was the most common type. CONCLUSION About 75% of cases were congenital, 50% had pure hypotropia, 75% showed V-pattern, 20% had amblyopia, and AHP was observed in 67% of patients. The remarkable prevalence of amblyopia alongside the high occurrence of AHP should alert clinicians to carefully assess patients with Brown syndrome for sensory fusion and amblyopia.
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Affiliation(s)
- Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Optometry Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Reza Akbari
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Azizi
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Farah Fareed Tarik
- Optometry Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yousefi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Masoomian
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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Akbari MR, Alghurab A, Khorrami-Nejad M, Azizi E, Masoomian B. Sensory exotropia versus sensory esotropia: A comparative clinical features study. JOURNAL OF OPTOMETRY 2024; 17:100516. [PMID: 38663271 PMCID: PMC11064616 DOI: 10.1016/j.optom.2024.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE This study aimed to compare the preoperative clinical features of patients with sensory esotropia (ET) and sensory exotropia (XT). METHODS In a retrospective study, the medical records of 13,252 patients who underwent strabismus surgery were reviewed at the Farabi Eye Hospital, Iran, from 2012 to March 2022. There were 1017 patients with sensory horizontal strabismus whose, in their worse eye, had corrected distance visual acuity (CDVA) equal to or <20/160 tested with the Snellen chart. RESULTS The mean age of patients was 29.0 ± 12.4 years [574 (56.4%) males and 443 (43.6%) females]. Sensory XT and ET were observed in 717 (70.5%) and 300 (29.5%) patients, respectively (P<.001). The mean CDVA in the strabismic and non-strabismic eyes was 1.40 ± 0.75 and 0.05 ± 0.13, respectively (P<.001). Also, the CDVA in the strabismic eyes was significantly worse in the patients with sensory XT than in the patients with sensory ET (P<.001). Sphere and spherical equivalent (SE) components were more hyperopic in both eyes of patients with sensory ET than sensory XT (P<.001). In sensory ET group, the mean horizontal deviation at far and near was significantly higher than the sensory XT group (both P<.001). The prevalence of moderate and severe amblyopia among all patients with sensory strabismus was 274 (26.9%) and 727 (71.5%), respectively (P<.001). There were 398 (39.1%) patients who needed more than one surgery. CONCLUSION The frequency of sensory XT was about 2.5 times more than the sensory ET. Most patients with sensory ET were operated at a younger age, had better CDVA, more hyperopic spherical and SE, and higher angle of deviation compared with patients with sensory XT. The chance of reoperation in patients with sensory strabismus was about 40%.
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Affiliation(s)
- Mohammad Reza Akbari
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alaa Alghurab
- Optometry Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Optometry Department, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
| | - Elham Azizi
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Babak Masoomian
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Birch EE, Duffy KR. Leveraging neural plasticity for the treatment of amblyopia. Surv Ophthalmol 2024:S0039-6257(24)00046-8. [PMID: 38763223 DOI: 10.1016/j.survophthal.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Amblyopia is a form of visual cortical impairment that arises from abnormal visual experience early in life. Most often, amblyopia is a unilateral visual impairment that can develop as a result of strabismus, anisometropia, or a combination of these conditions that result in discordant binocular experience. Characterized by reduced visual acuity and impaired binocular function, amblyopia places a substantial burden on the developing child. Although frontline treatment with glasses and patching can improve visual acuity, residual amblyopia remains for most children. Newer binocular-based therapies can elicit rapid recovery of visual acuity and may also improve stereoacuity in some children. Nevertheless, for both treatment modalities full recovery is elusive, recurrence of amblyopia is common, and improvements are negligible when treatment is administered at older ages. Insights derived from animal models about the factors that govern neural plasticity have been leveraged to develop innovative treatments for amblyopia. These novel therapies exhibit efficacy to promote recovery, and some are effective even at ages when conventional treatments fail to yield benefit. Approaches for enhancing visual system plasticity and promoting recovery from amblyopia include altering the balance between excitatory and inhibitory mechanisms, reversing the accumulation of proteins that inhibit plasticity, and harnessing the principles of metaplasticity. Although these therapies have exhibited promising results in animal models, their safety and ability to remediate amblyopia need to be evaluated in humans.
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Affiliation(s)
- Eileen E Birch
- Crystal Charity Ball Pediatric Vision Laboratory, Retina Foundation, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Kevin R Duffy
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Bullimore MA, Jong M, Brennan NA. Myopia control: Seeing beyond efficacy. Optom Vis Sci 2024; 101:134-142. [PMID: 38546754 DOI: 10.1097/opx.0000000000002119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
SIGNIFICANCE The availability of a range of effective myopia control modalities enables the clinician to exercise judgment when discussing the treatment plan with the patient and their parents. This article outlines important considerations beyond efficacy.Clinically meaningful myopia control may be attained with some spectacle lenses, select soft contact lenses, some concentrations of atropine, and overnight orthokeratology. Given that satisfactory efficacy can be achieved with a range of modalities, other factors should be considered when deciding upon the best intervention for a given child. Four key factors-compliance, quality of vision, quality of life, and safety-are discussed in this review. Compliance directly impacts efficacy regardless of the modality and is the most important consideration, as it is influenced by quality of vision and comfort. Daily disposal myopia control contact lenses and overnight orthokeratology are generally associated with high compliance, provide better vision-related quality of life than spectacles, and carry a very low risk when used appropriately. A further benefit of overnight orthokeratology is the elimination of a need for optical correction during the day.
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Horwood A, Heijnsdijk E, Kik J, Sloot F, Carlton J, Griffiths HJ, Simonsz HJ. A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven. Strabismus 2023; 31:220-235. [PMID: 37870065 DOI: 10.1080/09273972.2023.2268128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE/BACKGROUND Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4 years and 4-5 years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. CONCLUSIONS All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
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Affiliation(s)
- Anna Horwood
- Department of Psychology, University of Reading, Reading, UK
| | - Eveline Heijnsdijk
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Kik
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Aljohani S, Wang J, Scheiman M, Tan QQ, Xu H, Almutairi N, Alshammeri S. The Feasibility of an Educational Cartoon Video for Improving Adherence with Amblyopia Treatment in Children. Clin Ophthalmol 2023; 17:1639-1646. [PMID: 37309368 PMCID: PMC10257930 DOI: 10.2147/opth.s415892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
Background Previous studies have shown that it is necessary to evaluate adherence during the treatment process, using educational intervention methods which have been shown to improve adherence with patching treatment. A previous study reported that an educational cartoon had significantly improved adherence with patching. However, this black-white cartoon is not commercially available. Objective This study investigates the feasibility of a 4-minute educational cartoon video in improving adherence with patching therapy for amblyopic children. Methods Children (3 to 10 years old) with unilateral amblyopia who were prescribed 2 hours or 6 hours of patching per day were enrolled. Objective adherence to the treatment was tracked using a microsensor. Children returned after 4 weeks ± 2 days to measure adherence. Participants with adherence ≤50% were eligible to watch the educational cartoon video. They continued with the previously prescribed treatment (2 hours or 6 hours patching) for an additional week to evaluate the follow-up adherence. Results A total of 27 participants were enrolled. The mean age (SD) was 6.6 (1.5) years. Twenty-two participants (12 in the 2 hours patching group and 10 in the 6 hours patching group) had adherence ≤50% and watched our cartoon video. The cartoon video improved mean adherence (SD) from 29.6% (11.9%) to 56.8% (12.1%) in all 22 participants from both regimens (paired 2-tailed t-test, t= -11, P < 0.000). Conclusion The Educational cartoon video is feasible for use in a clinical setting. These data showed a trend of improvement in adherence with both patching regimens in children after watching the educational cartoon video.
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Affiliation(s)
- Saeed Aljohani
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia
| | | | | | - Qing-Qing Tan
- Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | | | - Nawaf Almutairi
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia
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Takigawa R, Sasaki K, Hirota M, Nakagawa M, Sasaki K, Mihashi T, Mizuno Y, Mizota A, Matsuoka K. Evaluation of Aniseikonia in Patients with Successfully Treated Anisometropic Amblyopia Using Spatial Aniseikonia Test. J Clin Med 2023; 12:jcm12113766. [PMID: 37297961 DOI: 10.3390/jcm12113766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Anisometropic amblyopia is decreased visual acuity in one eye, and treatment consists of wearing complete corrective spectacles. Aniseikonia occurs with complete correction of anisometropia using spectacles. Aniseikonia has been ignored when treating pediatric anisometropic amblyopia because of the prevailing belief that anisometropic symptoms are suppressed by adaptation. However, the conventional direct comparison method for evaluating aniseikonia significantly underestimates the degree of aniseikonia. This study investigated whether the adaptation occurs due to long-term anisometropic amblyopia treatment in patients who have had successful amblyopia treatment using a spatial aniseikonia test with high accuracy and repeatability compared with the conventional direct comparison method. The amount of aniseikonia was not significantly different between the patients with successful amblyopia treatment and individuals with anisometropia without a history of amblyopia. In both groups, the aniseikonia per 1.00 D of anisometropia and the aniseikonia per 1.00 mm of aniso-axial length were comparable. The repeatability of the amount of aniseikonia using the spatial aniseikonia test did not differ significantly between the two groups, indicating a high degree of agreement. These findings suggest that aniseikonia is not adapted to amblyopia treatment and that aniseikonia increases as the difference between spherical equivalent and axial length increases.
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Affiliation(s)
- Ryusei Takigawa
- Division of Orthoptics, Graduate School of Medical Care and Technology, Teikyo University, Itabashi, Tokyo 173-8605, Japan
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Kakeru Sasaki
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo 173-8605, Japan
- Department of Ophthalmology, School of Medicine, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Masakazu Hirota
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo 173-8605, Japan
- Department of Ophthalmology, School of Medicine, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Maki Nakagawa
- Department of Ophthalmology, School of Medicine, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Kozue Sasaki
- Department of Ophthalmology, School of Medicine, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Toshifumi Mihashi
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Yoshinobu Mizuno
- Department of Ophthalmology, School of Medicine, Teikyo University, Itabashi, Tokyo 173-8605, Japan
| | - Atsushi Mizota
- Department of Ophthalmology, School of Medicine, Teikyo University, Itabashi, Tokyo 173-8605, Japan
- Nishikasai Inouye Eye Hospital, Edogawa-Ku, Tokyo 134-0088, Japan
| | - Kumiko Matsuoka
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University, Itabashi, Tokyo 173-8605, Japan
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Chaturvedi I, Jamil R, Sharma P. Binocular vision therapy for the treatment of Amblyopia-A review. Indian J Ophthalmol 2023; 71:1797-1803. [PMID: 37203032 PMCID: PMC10391509 DOI: 10.4103/ijo.ijo_3098_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Amblyopia is a monocular or binocular reduction in visual acuity that results from prolonged visual deprivation in the early years of life. It is second only to refractive error as a cause of poor vision in children. The gold standard treatment of amblyopia includes patching and, less commonly, atropine penalization and filters. These therapies are aimed at improvements in the visual acuity of the amblyopic eye alone. They have compliance and psychosocial issues and gains are accrued after prolonged periods. Experimental studies have demonstrated the presence of binocular cortical communication even in amblyopes and neural plasticity in late childhood as well as adulthood. On this basis, binocular vision therapy aimed at the stimulation of both eyes rather than forced use of the amblyopic eye was developed. Such therapies involve visual tasks designed in such a way that they can be completed only by binocular viewing. These tasks vary from simple game play using red-green glasses, to engaging 3D games and movie viewing. Preliminary data suggest that binocular vision therapy has led to lasting improvements in visual acuity and can be a useful adjunct, if not replacement, to the conventional treatment of amblyopia. In this article, we aim to describe the various binocular vision therapies and review the available literature on the same.
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Affiliation(s)
- Isha Chaturvedi
- Comprehensive Services, Centre for Sight Eye Institute, Dwarka, New Delhi, India
| | - Rana Jamil
- Comprehensive Services, Centre for Sight Eye Institute, Dwarka, New Delhi, India
| | - Pradeep Sharma
- Strabismus Pediatric and Neuro-Ophthalmology Services, Centre for Sight, Safdarjung Enclave, New Delhi, India
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Hutchinson AK, Morse CL, Hercinovic A, Cruz OA, Sprunger DT, Repka MX, Lambert SR, Wallace DK. Pediatric Eye Evaluations Preferred Practice Pattern. Ophthalmology 2023; 130:P222-P270. [PMID: 36543602 PMCID: PMC10680450 DOI: 10.1016/j.ophtha.2022.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Amy K Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Oscar A Cruz
- Department of Ophthalmology and Department of Pediatrics, Saint Louis University Medical Center, Saint Louis, Missouri
| | - Derek T Sprunger
- Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - David K Wallace
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
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Bui Quoc E, Kulp MT, Burns JG, Thompson B. Amblyopia: A review of unmet needs, current treatment options, and emerging therapies. Surv Ophthalmol 2023; 68:507-525. [PMID: 36681277 DOI: 10.1016/j.survophthal.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Amblyopia is a global public health issue with extensive, multifaceted impacts on vision and quality of life (QoL) for both patients and families. Geographical variation exists in the management of amblyopia, with traditional mainstay treatments, optical correction, and fellow eye occlusion most successful when implemented at an early age. In recent years, however, studies demonstrating meaningful improvements in older children and adults have challenged the concept of a complete loss of visual processing plasticity beyond the critical period of visual development, with growing evidence supporting the potential efficacy of emerging, more engaging, binocular therapies in both adults and children. Binocular approaches aim to restore deficits in amblyopia that extend beyond monocular visual acuity impairment, including binocular fusion and visuomotor skills. In view of this, incorporating outcome measures that evaluate the visual performance and functional ability of individuals with amblyopia will provide a clearer understanding of the effect of amblyopia on QoL and a more comprehensive evaluation of amblyopia therapies.
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Affiliation(s)
- Emmanuel Bui Quoc
- Ophthalmology Department, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
| | | | | | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Canada; Centre for Eye and Vision Research, Hong Kong
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Asare AO, Maurer D, Wong AMF, Saunders N, Ungar WJ. Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada. JAMA Netw Open 2023; 6:e2249384. [PMID: 36598785 PMCID: PMC9857467 DOI: 10.1001/jamanetworkopen.2022.49384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. OBJECTIVE To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. MAIN OUTCOMES AND MEASURES For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. RESULTS School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. CONCLUSIONS AND RELEVANCE In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.
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Affiliation(s)
- Afua Oteng Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes M. F. Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J. Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Jia Y, Liu J, Ye Q, Zhang S, Feng L, Xu Z, Zhuang Y, He Y, Zhou Y, Chen X, Yao Y, Jiang R, Thompson B, Li J. Factors predicting regression of visual acuity following successful treatment of anisometropic amblyopia. Front Med (Lausanne) 2022; 9:1013136. [PMID: 36388932 PMCID: PMC9659723 DOI: 10.3389/fmed.2022.1013136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/17/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To identify factors associated with visual acuity regression following successful treatment of anisometropic amblyopia. Design and method This was a retrospective cohort study. Database records for 100 and 61 children with anisometropic amblyopia who met at least one criterion for successful treatment proposed by the Pediatric Eye Disease Investigator Group (PEDIG) and had at least 1 year of follow-up data available after the criterion was met were analyzed. The study sample was split into two groups, those who regressed within 1 year of successful treatment (no longer met any of the PEDIG criteria for successful treatment) and those who did not. A two-step analysis involving a least absolute shrinkage and selection operator (LASSO) regression and a logistic regression were used to identify predictor variables for increased risk of regression. A broad range of clinical, perceptual, and demographic variables were included in the analyses. Results Sixty-eight (42.5%) children regressed within 1 year of successful treatment. Among the 27 predictor variables considered within the statistical modeling process, the three most important for predicting treatment regression were the extent of amblyopic eye visual acuity improvement, age at first hospital visit and sex. Specifically, lower risk of regression was associated with larger amblyopic eye visual acuity improvement with treatment, younger age at initiation of treatment and female sex. Conclusion Patients who received treatment at a younger age and responded well to treatment had a lower risk of treatment regression. This pattern of results suggests that early detection of amblyopia and strategies that enhance treatment adherence may reduce the risk of treatment regression. The higher risk of regression in boys than girls that we observed may reflect known sex differences in brain development and /or sex differences in environment within our sample of children from South China.
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Affiliation(s)
- Yu Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Centre for Eye and Vision Research, Hong Kong, Hong Kong SAR, China
| | - Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Shenglan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Benjamin Thompson
- Centre for Eye and Vision Research, Hong Kong, Hong Kong SAR, China
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Benjamin Thompson
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Jinrong Li
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Huang YT, Lin HJ, Liao WL, Tsai YY, Hsieh YC. Effects of Vision Therapy on Bilateral Amblyopia Unresponsive to Conventional Treatment: A Retrospective Comparative Study. CHILDREN 2022; 9:children9020205. [PMID: 35204925 PMCID: PMC8870234 DOI: 10.3390/children9020205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
Abstract
Background: In this study we aim to determines the effect of our vision therapy program for 7- to 10-year-old patients who exhibit bilateral amblyopia that is no longer responsive to conventional treatment. Methods: Children with bilateral amblyopia between the ages of 7 and 10 treated with vision therapy at the China Medical University Hospital between 2016 and 2019 were retrospectively reviewed. Age and visual acuity-matched bilateral amblyopes are included as a control group. The visual acuity for both groups showed no improvement for more than 3 months with part-time patching and full refraction correction. The initial and final visual acuity, stereopsis, and refractive status were analyzed. Results: Here, 15 cases were included as the treatment group and 16 cases as a control group. At the endpoint, the study group shows a significant improvement in BCVA, with a mean of 0.32 ± 0.15 logMAR (3 lines improvement) versus 0.003 ± 0.19 logMAR (nearly no improvement) for the control group (p < 0.001). The benefits of treatment are most obvious in the first 3 months after treatment (p < 0.001) and last until the end point. Stereoacuity also improves from 190.00 ± 163.34 to 85.00 ± 61.24 arc seconds, which is a 55.26% improvement. Conclusions: Vision therapy, comprising orthoptic therapy, perceptual learning and dichoptic training, is a successful program for increasing visual acuity and stereoacuity in 7- to 10-year-old children with bilateral amblyopia that is unresponsive to conventional treatment.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan; (Y.-T.H.); (H.-J.L.); (Y.-Y.T.)
| | - Hui-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan; (Y.-T.H.); (H.-J.L.); (Y.-Y.T.)
| | - Wen-Ling Liao
- Center for Personalized Medicine, China Medical University Hospital, Taichung 40447, Taiwan;
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40447, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan; (Y.-T.H.); (H.-J.L.); (Y.-Y.T.)
| | - Yi-Ching Hsieh
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan; (Y.-T.H.); (H.-J.L.); (Y.-Y.T.)
- Correspondence: ; Tel.: +886-4-22052121 (ext. 1141)
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14
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Jia Y, Ye Q, Zhang S, Feng L, Liu J, Xu Z, Zhuang Y, He Y, Zhou Y, Chen X, Yao Y, Jiang R, Thompson B, Li J. Contrast Sensitivity and Stereoacuity in Successfully Treated Refractive Amblyopia. Invest Ophthalmol Vis Sci 2022; 63:6. [PMID: 34989762 PMCID: PMC8742522 DOI: 10.1167/iovs.63.1.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia. Methods A retrospective review of 487 patients diagnosed with refractive amblyopia whose visual acuity improved to 0.08 logMAR or better in both eyes following optical treatment was conducted. Measurements of monocular contrast sensitivity and stereoacuity had been made when visual acuity normalized. All patients had been treated with refractive correction for approximately 2 years following diagnosis. No other treatments were provided. Monocular contrast sensitivity was measured using the CSV-1000E chart for children 6 years of age or younger and a psychophysical technique called the quick contrast sensitivity function in older children. Stereoacuity was measured using the Random Dot Test that includes monocular cues and the Randot Stereoacuity Test that does not have monocular cues. Results Statistically significant interocular differences in contrast sensitivity were observed. These differences tended to occur at higher spatial frequencies (12 and 18 cycles per degree). Stereoacuity within the age-specific normal range was achieved by 47.4% of patients for the Random Dot Test and only 23.1% of patients for the Randot Stereoacuity Test. Conclusions Full recovery of visual acuity following treatment for refractive amblyopia does not equalize interocular contrast sensitivity or restore normal stereopsis. Alternative therapeutic approaches that target contrast sensitivity and/or binocular vision are required.
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Affiliation(s)
- Yu Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye and Vision Research, 17W Science Park, Hong Kong
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shenglan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Benjamin Thompson
- Centre for Eye and Vision Research, 17W Science Park, Hong Kong.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Xiao S, Angjeli E, Wu HC, Gaier ED, Gomez S, Travers DA, Binenbaum G, Langer R, Hunter DG, Repka MX. Randomized Controlled Trial of a Dichoptic Digital Therapeutic for Amblyopia. Ophthalmology 2021; 129:77-85. [PMID: 34534556 DOI: 10.1016/j.ophtha.2021.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Digital therapeutics are a new class of interventions that are software driven and are intended to treat various conditions. We developed and evaluated a dichoptic digital therapeutic for amblyopia, a neurodevelopmental disorder for which current treatments may be limited by poor adherence and residual vision deficits. DESIGN Randomized controlled trial. PARTICIPANTS One hundred five children 4 to 7 years of age with amblyopia were enrolled at 21 academic and community sites in the United States. Participants were randomized 1:1 to the treatment or comparison group, stratified by site. METHODS We conducted a phase 3 randomized controlled trial to evaluate the safety and efficacy of a dichoptic digital therapeutic for amblyopia. Participants in the treatment group used the therapeutic at home for 1 hour per day, 6 days per week and wore glasses full-time. Participants in the comparison group continued wearing glasses full-time alone. MAIN OUTCOME MEASURES The primary efficacy outcome was change in amblyopic eye visual acuity (VA) from baseline at 12 weeks, and VA was measured by masked examiners. Safety was evaluated using the frequency and severity of study-related adverse events. Primary analyses were conducted using the intention-to-treat population. RESULTS Between January 16, 2019, and January 15, 2020, 105 participants were enrolled; 51 were randomized to the treatment group and 54 were randomized to the comparison group. At 12 weeks, amblyopic eye VA improved by 1.8 lines (95% confidence interval [CI], 1.4-2.3 lines; n = 45) in the treatment group and by 0.8 lines (95% CI, 0.4-1.3 lines; n = 45) in the comparison group. At the planned interim analysis (adjusted α = 0.0193), the difference between groups was significant (1.0 lines; P = 0.0011; 96.14% CI, 0.33-1.63 lines) and the study was stopped early for success, according to the protocol. No serious adverse events were reported. CONCLUSIONS Our findings support the value of the therapeutic in clinical practice as an effective treatment. Future studies should evaluate the therapeutic compared with other methods and in additional patient populations.
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Affiliation(s)
- Scott Xiao
- Luminopia, Inc, Cambridge, Massachusetts
| | | | - Hank C Wu
- Luminopia, Inc, Cambridge, Massachusetts
| | - Eric D Gaier
- Luminopia, Inc, Cambridge, Massachusetts; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | | | - Gil Binenbaum
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert Langer
- Department of Chemical Engineering and the Koch Institute, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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16
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Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology 2021; 128:1561-1579. [PMID: 33961969 DOI: 10.1016/j.ophtha.2021.04.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/09/2023] Open
Abstract
PURPOSE The prevalence of myopia is increasing around the world, stimulating interest in methods to slow its progression. The primary justification for slowing myopia progression is to reduce the risk of vision loss through sight-threatening ocular pathologic features in later life. The article analyzes whether the potential benefits of slowing myopia progression by 1 diopter (D) justify the potential risks associated with treatments. METHODS First, the known risks associated with various methods of myopia control are summarized, with emphasis on contact lens wear. Based on available data, the risk of visual impairment and predicted years of visual impairment are estimated for a range of incidence levels. Next, the increased risk of potentially sight-threatening conditions associated with different levels of myopia are reviewed. Finally, a model of the risk of visual impairment as a function of myopia level is developed, and the years of visual impairment associated with various levels of myopia and the years of visual impairment that could be prevented with achievable levels of myopia control are estimated. RESULTS Assuming an incidence of microbial keratitis between 1 and 25 per 10 000 patient-years and that 15% of cases result in vision loss leads to the conclusion that between 38 and 945 patients need to be exposed to 5 years of wear to produce 5 years of vision loss. Each additional 1 D of myopia is associated with a 58%, 20%, 21%, and 30% increase in the risk of myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment, respectively. The predicted mean years of visual impairment ranges from 4.42 in a person with myopia of -3 D to 9.56 in a person with myopia of -8 D, and a 1-D reduction would lower these by 0.74 and 1.21 years, respectively. CONCLUSIONS The potential benefits of myopia control outweigh the risks: the number needed to treat to prevent 5 years of visual impairment is between 4.1 and 6.8, whereas fewer than 1 in 38 will experience a loss of vision as a result of myopia control.
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Affiliation(s)
| | - Eric R Ritchey
- College of Optometry, University of Houston, Houston, Texas
| | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom; Ophthalmic and Vision Sciences Research Group, Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Nicolas Leveziel
- Service d'ophtalmologie, Centre Hospitalier Universitaire (CHU) Poitiers, Poitiers, France; University of Poitiers, Poitiers, France; Centre d'Investigation Clinique (CIC 1402), Poitiers, France; Institut National de la Santé et de la Recherche Médicale (INSERM 1084), Poitiers, France; Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rupert R A Bourne
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom; Department of Ophthalmology, Cambridge University Hospital, Cambridge, United Kingdom
| | - D Ian Flitcroft
- Department of Ophthalmology, Children's University Hospital, Dublin, Ireland; Centre for Eye Research Ireland, School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
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18
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19
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Pang Y, Allen M, Robinson J, Frantz KA. Contrast sensitivity of amblyopic eyes in children with myopic anisometropia. Clin Exp Optom 2021; 102:57-62. [PMID: 30054940 DOI: 10.1111/cxo.12817] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/15/2018] [Accepted: 06/27/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yi Pang
- Illinois College of Optometry, Chicago, Illinois, USA
| | - Megan Allen
- Illinois College of Optometry, Chicago, Illinois, USA
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20
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Xiao S, Gaier ED, Wu HC, Angjeli E, Nuth PL, Bohra LI, Miller AM, Mazow ML, Stout AU, Morse CL, Blumenfeld LC, Glaser SR, Crouch E, Ekdawi NS, Lyon DW, Silbert DI, Hunter DG. Digital therapeutic improves visual acuity and encourages high adherence in amblyopic children in open-label pilot study. J AAPOS 2021; 25:87.e1-87.e6. [PMID: 33905837 DOI: 10.1016/j.jaapos.2020.11.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effectiveness of amblyopia therapy can be limited by poor adherence. Dichoptic therapies are a new approach, but recent trials have demonstrated difficulty maintaining high adherence over extended periods of at-home treatment. We evaluated the efficacy and adherence of Luminopia One-a dichoptic treatment that applies therapeutic modifications to streaming content chosen by the patient. METHODS This single-arm, multicenter prospective pilot study enrolled children aged 4-12 with anisometropic, strabismic, or mixed amblyopia at 10 pediatric ophthalmic and optometric practices across the United States. The therapeutic was prescribed for 1 hour/day, 6 days/week for 12 weeks of at-home use. The primary endpoint was best-corrected visual acuity (BCVA) at the 12-week follow-up visit. RESULTS In total, 90 participants (mean age, 6.7 ± 2.0 years) were enrolled, and 73/90 participants (81%) had prior treatment beyond refractive correction. For those who completed the 12-week visit, mean amblyopic eye BCVA improved from 0.50 logMAR to 0.35 logMAR (1.5 logMAR lines; 95% CI, 1.2-1.8 lines; P < 0.0001). Mean stereoacuity improved by 0.28 log arcsec (95% CI, 0.14-0.42 log arcsec; P < 0.0001). Median adherence was 86% (interquartile range, 70%-97%). CONCLUSIONS In our study cohort, adherence over the 12-week study period was high, and participants demonstrated clinically and statistically significant improvements in visual acuity and stereoacuity.
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Affiliation(s)
- Scott Xiao
- Luminopia Inc, Cambridge, Massachusetts.
| | - Eric D Gaier
- Luminopia Inc, Cambridge, Massachusetts; Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge
| | - Hank C Wu
- Luminopia Inc, Cambridge, Massachusetts
| | | | | | - Lisa I Bohra
- Children's Eye Care, PC, West Bloomfield, Michigan; Department of Ophthalmology, Wayne State University, Detroit, Michigan; Department of Ophthalmology, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan
| | - Aaron M Miller
- Houston Eye Associates, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | | | | | | | | | | | - Eric Crouch
- Virginia Pediatric Eye Center, Virginia Beach, Virginia
| | | | - Don W Lyon
- Indiana University School of Optometry, Bloomington
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21
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Kadhum A, Simonsz‐Tóth B, Rosmalen J, Pijnenburg SJM, Janszen BM, Simonsz HJ, Loudon SE. Long-term follow-up of an amblyopia treatment study: change in visual acuity 15 years after occlusion therapy. Acta Ophthalmol 2021; 99:e36-e42. [PMID: 32657530 PMCID: PMC7891344 DOI: 10.1111/aos.14499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/14/2020] [Indexed: 12/03/2022]
Abstract
Purpose To determine change in visual acuity (VA) in the population of a previous amblyopia treatment study (Loudon 2006) and assess risk factors for VA decrease. Methods Subjects treated between 2001 and 2003 were contacted between December 2015 and July 2017. Orthoptic examination was conducted under controlled circumstances and included subjective refraction, best corrected VA, reading acuity, binocular vision, retinal fixation, cover‐uncover and alternating cover test. As a measure for degree of amblyopia, InterOcular VA Difference (IOD) at the end of occlusion therapy was compared with IOD at the follow‐up examination using Wilcoxon’s signed‐rank test. Regression analysis was conducted to determine the influence of clinical and socio‐economic factors on changes in IOD. Results Out of 303 subjects from the original study, 208 were contacted successfully, 59 refused and 15 were excluded because of non‐amblyopic cause of visual impairment. Mean IOD at end of therapy (mean age 6.4 years) was 0.11 ± 0.16 logMAR, and IOD at follow‐up examination (mean age 18.3 years) was 0.09 ± 0.21 logMAR; this difference was not significant (p = 0.054). Degree of anisometropia (p = 0.008; univariable analysis), increasing anisometropia (p = 0.009; multivariable), eccentric fixation (p < 0.001; univariable and multivariable); large IOD (p < 0.001; univariable and multivariable) and non‐compliance during therapy (p = 0.028; univariable) were associated with IOD increase. Conclusion Long‐term results of occlusion therapy were good. High or increasing anisometropia, eccentric fixation and non‐compliance during occlusion therapy were associated with long‐term VA decrease. Subjects with poor initial VA had a larger increase despite little patching, but often showed long‐term VA decrease.
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Affiliation(s)
- Aveen Kadhum
- Department of Ophthalmology Erasmus University Medical Center Rotterdam The Netherlands
| | - Brigitte Simonsz‐Tóth
- Department of Ophthalmology Haaglanden Medical Center Westeinde Hospital The Hague The Netherlands
| | - Joost Rosmalen
- Department of Biostatistics Erasmus University Medical Center Rotterdam The Netherlands
| | - Sanne J. M. Pijnenburg
- Department of Optometry and Orthoptics University of Applied Sciences Utrecht The Netherlands
| | - Bronte M. Janszen
- Department of Optometry and Orthoptics University of Applied Sciences Utrecht The Netherlands
| | - Huibert J. Simonsz
- Department of Ophthalmology Erasmus University Medical Center Rotterdam The Netherlands
| | - Sjoukje E. Loudon
- Department of Ophthalmology Erasmus University Medical Center Rotterdam The Netherlands
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Vision Screening in Belgian Children: Too Much or Not Enough? Ophthalmic Epidemiol 2020; 27:364-375. [DOI: 10.1080/09286586.2020.1767151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wang J, Malik A, Jin J, Pang Y, Yin K, Allen M, Grigorian A, Scombordi B, Bailey J, Aljohani S, Funari K, Shoge R, Meiyeppen S, Myung J, Soni A, Neely DE. Intense versus standard regimens of intermittent occlusion therapy for unilateral moderate amblyopia in children: study protocol for a randomized controlled trial. Trials 2020; 21:361. [PMID: 32345348 PMCID: PMC7189599 DOI: 10.1186/s13063-020-04284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background We reported that in our previous study that wearing intermittent occlusion therapy glasses (IO-therapy) for 4 hours (h) was non-inferior to patching for 2 h in 3 to 8-year-old children with amblyopia. We hypothesize that an intense regimen of 12-h IO-therapy per day for 4 weeks could be as effective as the standard regimen of 4-h IO-therapy per day for 12 weeks in treating moderate amblyopia in 3 to 8-year-old children. Methods/Design A total of 56 children between 3 and 8 years of age with amblyopia in association with anisometropia and/or strabismus will be enrolled. All participants will be prescribed IO-therapy glasses (Amblyz™), set at 30-s opaque/transparent intervals (i.e., occluded 50% of wear time). They will be randomized to receive the standard regimen for 12 weeks or the intense regimen for 4 weeks. Adherence to using the IO-therapy glasses will be objectively monitored in each participant by means of a microsensor dose monitor. The primary study objective is to compare the effectiveness of an intense regimen to a standard regimen of IO-therapy in 3 to 8-year-old children with moderate amblyopia. The secondary study objectives are to determine whether adherence differs between an intense regimen and a standard regimen of IO-therapy, and to determine the dose-response relationship of IO-therapy. Discussion In addition to testing the effectiveness, this study will test for the first time the association between treatment adherence and the visual outcome of IO-therapy, which will enhance our understanding of the dose-response relationship of IO-therapy. If an intense regimen is shown to be effective, it would alter amblyopia treatment strategies and improve visual outcomes. Trial registration ClinicalTrials.gov: NCT02767856. Registered on 10 May 2016.
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Affiliation(s)
- Jingyun Wang
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA.
| | - Ayesha Malik
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jing Jin
- Nemours. Alfred I. duPont Hospital of Children, Wilmington, DE, USA.,Wills Eye Hospital, Philadelphia, PA, USA
| | - Yi Pang
- Illinois College of Optometry, Chicago, IL, USA
| | - Kelly Yin
- Illinois College of Optometry, Chicago, IL, USA
| | - Megan Allen
- Illinois College of Optometry, Chicago, IL, USA
| | | | - Brandy Scombordi
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Joann Bailey
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Saeed Aljohani
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Katharine Funari
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Ruth Shoge
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Siva Meiyeppen
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Jenny Myung
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Ajay Soni
- Penn State Eye Center, Hershey, PA, USA
| | - Daniel E Neely
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
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Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading? Ophthalmic Physiol Opt 2020; 40:254-270. [DOI: 10.1111/opo.12686] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022]
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Gopal SKS, Kelkar J, Kelkar A, Pandit A. Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review. Indian J Ophthalmol 2020; 67:1392-1399. [PMID: 31436180 PMCID: PMC6727694 DOI: 10.4103/ijo.ijo_11_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.
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Affiliation(s)
- Santhan K S Gopal
- Kamala Nethralaya Eye Clinic and Surgical Centre, Bengaluru, Karnataka, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Maharashtra, India
| | - Aditya Kelkar
- National Institute of Ophthalmology, Maharashtra, India
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Abstract
BACKGROUND Amblyopia is defined as impaired visual acuity in one or both eyes without demonstrable abnormality of the visual pathway, and is not immediately resolved by wearing glasses. OBJECTIVES In performing this systematic review, we aimed to synthesize the best available evidence regarding the effectiveness and safety of conventional occlusion therapy compared to atropine penalization in treating amblyopia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 8); Ovid MEDLINE; Ovid Embase; LILACS BIREME; ClinicalTrials.gov; ISRCTN; and the WHO ICTRP on 7 September 2018. SELECTION CRITERIA We included randomized/quasi-randomized controlled trials comparing conventional occlusion to atropine penalization for amblyopia. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts and full-text articles, abstracted data, and assessed risk of bias. MAIN RESULTS We included seven trials (five randomized controlled trials and two quasi-randomized controlled trials) conducted in six countries (China, India, Iran, Ireland, Spain, and the United States) with a total of 1177 amblyopic eyes. Three of these seven trials were from the original 2009 version of the review. We assessed two trials as having a low risk of bias across all domains, and the remaining five trials as having unclear or high risk of bias for some domains.As different occlusion modalities, atropine penalization regimens, and populations were used across the included trials, we did not conduct any meta-analysis due to clinical and statistical heterogeneity. Evidence from six trials (two at low risk of bias) suggests that atropine penalization is as effective as conventional occlusion in improving visual acuity. Similar improvement in visual acuity was reported at all time points at which it was assessed, ranging from five weeks (improvement of 1 line) to 10 years (improvement of greater than 3 lines). At six months, although most participants (363/522) come from a trial rated as at low risk of bias with a precise estimate (mean difference (MD) 0.03, 95% confidence interval (CI) 0.00 to 0.06), two other trials rated as at high risk of bias produced inconsistent estimates and wide confidence intervals (MD -0.02, 95% CI -0.11 to 0.07 and MD -0.14, 95% CI -0.23 to -0.05; moderate-certainty evidence). At 24 months, additional improvement was found in both groups, but there continued to be no meaningful difference between those receiving occlusion and those receiving atropine therapies (moderate-certainty evidence).We did not find any difference in ocular alignment, stereo acuity, or sound eye visual acuity between occlusion and atropine penalization groups (moderate-certainty evidence). Both treatments were well tolerated. Atropine was associated with better adherence (moderate-certainty evidence) and quality of life (moderate-certainty evidence), but also a higher reported risk of adverse events in terms of mild reduction in the visual acuity of the sound eye not requiring treatment and light sensitivity (high-certainty evidence). Skin, lid, or conjunctival irritation were more common among participants receiving patching than those receiving atropine (high-certainty evidence). Atropine penalization costs less than conventional occlusion. AUTHORS' CONCLUSIONS Both conventional occlusion and atropine penalization produce visual acuity improvement in the amblyopic eye. Atropine penalization appears to be as effective as conventional occlusion, although the magnitude of improvement differed among the trials we analyzed.
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Affiliation(s)
- Tianjing Li
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe Street, E6011BaltimoreMarylandUSA21205
| | - Riaz Qureshi
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 North Wolfe Street, E6011BaltimoreMarylandUSA21205
| | - Kate Taylor
- Royal Victoria InfirmaryDepartment of OphthalmologyClaremont WingQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
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Wang J, Jin J, Malik A, Shoge R, Meiyeppen S, Pang Y, Yin K, Allen M, Scombordi B, Soni A, Neely DE, Januschowski K. Feasibility of monitoring compliance with intermittent occlusion therapy glasses for amblyopia treatment. J AAPOS 2019; 23:205.e1-205.e5. [PMID: 31271842 PMCID: PMC7384242 DOI: 10.1016/j.jaapos.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Liquid crystal glasses use an intermittent occlusion technique and may improve compliance compared to adhesive patches. Previous studies support the effectiveness of intermittent occlusion therapy (IO therapy) glasses for amblyopia treatment. However, objective compliance for these glasses has not been measured. The purpose of this study was to investigate the feasibility of using a microsensor to monitor objective compliance with IO therapy glasses. METHODS Children 3 to ≤8 years of age with unilateral amblyopia were enrolled. All subjects had optimal refractive correction (if needed) for at least 5 weeks without improvement. Subjects were prescribed IO therapy glasses, set at 30-second opaque/transparent intervals (ie, occluded 50% of wear time). Wear time was prescribed according to amblyopia severity. For each patient, objective compliance with the IO therapy glasses was monitored by means of a microsensor. RESULTS A total of 13 subjects returned with microsensor data. Compliance varied among and within individuals. General compliance averaged 51.6% (range, 10%-97%). Mean daily compliance decreased slightly over time. On average, patients' visual acuity improved 0.14 ± 0.15 logMAR (range, -0.1 to 0.5 logMAR). No parents reported that their child had social concerns related to the attached microsensor. CONCLUSIONS Objective compliance with IO therapy glasses can be monitored by a simple microsensor reliably. In our study cohort, objective compliance with IO therapy glasses varied among individuals, but on average it declined slightly over time.
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Affiliation(s)
- Jingyun Wang
- Salus Univerisity, Elkins Park, Pennsylvania, United States.
| | - Jing Jin
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States; Wills Eye Hospital, Philadelphia, Pennsylvania, United States
| | - Ayesha Malik
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Ruth Shoge
- Salus Univerisity, Elkins Park, Pennsylvania, United States
| | - Siva Meiyeppen
- Salus Univerisity, Elkins Park, Pennsylvania, United States
| | - Yi Pang
- Illinois College of Optometry, Chicago, Illinois, United States
| | - Kelly Yin
- Illinois College of Optometry, Chicago, Illinois, United States
| | - Megan Allen
- Illinois College of Optometry, Chicago, Illinois, United States
| | | | - Ajay Soni
- Penn State Eye Center, Hershey, Pennsylvania, United States
| | - Daniel E Neely
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Kai Januschowski
- Eye Clinic Sulzbach, Sulzbach/Saar, Germany; Department for Ophthalmology, Eberhard Karls University Tuebingen, Germany
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Scaramuzzi M, Murray J, Otero-Millan J, Nucci P, Shaikh AG, Ghasia FF. Fixation instability in amblyopia: Oculomotor disease biomarkers predictive of treatment effectiveness. PROGRESS IN BRAIN RESEARCH 2019; 249:235-248. [PMID: 31325983 DOI: 10.1016/bs.pbr.2019.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Amblyopic patients are known to have fixation instability, particularly of the amblyopic eye. The stability of the fixation is affected by the presence of nystagmus, the frequency and amplitude of fixational saccades and inter-saccadic drifts. Amblyopic patients without nystagmus have increased amplitude of the fixational saccades with reduced frequency of the physiologic microsaccades and have increased inter-saccadic drifts. Amblyopia patients who have experienced a disruption in binocularity in early infancy develop fusion maldevelopment nystagmus (FMN) previously called latent nystagmus as it is more evident during monocular viewing conditions. We have found that some amblyopic patients can have nystagmus with slow phases that are not directed nasally and without the reversal in direction on ocular occlusion, features seen in patients with FMN. The current mainstay of amblyopia treatment comprises of part-time occlusion therapy of the non-amblyopic eye. The amount of patching treatment is in the range of 2-6h/day as determined by the severity of amblyopia. Despite treatment, up to 40% of patients have residual amblyopia. We analyzed the effectiveness of part-time occlusion therapy in amblyopic patients as a function of fixation instability. We categorized amblyopic patients based on their eye movement waveforms obtained during a visual fixation task into those lacking nystagmus, those with FMN and those with nystagmus but no FMN. We did a retrospective chart review to gather information about their clinical characteristics and treatment response. We found that patients with FMN require a more prolonged duration of treatment and have a poorer recovery of stereopsis compared to patients with nystagmus but no FMN and patients lacking nystagmus. This study suggests that eye movement assessment provides valuable information in the management of amblyopia.
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Affiliation(s)
- Matteo Scaramuzzi
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States; San Giuseppe Eye Clinic, Milan, Italy; University of Milan, Milan, Italy
| | - Jordan Murray
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jorge Otero-Millan
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, United States
| | - Paolo Nucci
- San Giuseppe Eye Clinic, Milan, Italy; University of Milan, Milan, Italy
| | - Aasef G Shaikh
- Daroff-Dell'Osso Ocular Motility Laboratory, Cleveland, OH, United States; Case Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Fatema F Ghasia
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States; Daroff-Dell'Osso Ocular Motility Laboratory, Cleveland, OH, United States.
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Nonsurgical Treatment of Strabismus. Strabismus 2019. [DOI: 10.1007/978-981-13-1126-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kraus CL, Culican SM. New advances in amblyopia therapy I: binocular therapies and pharmacologic augmentation. Br J Ophthalmol 2018; 102:1492-1496. [PMID: 29777043 PMCID: PMC6241622 DOI: 10.1136/bjophthalmol-2018-312172] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 12/20/2022]
Abstract
Amblyopia therapy options have traditionally been limited to penalisation of the non-amblyopic eye with either patching or pharmaceutical penalisation. Solid evidence, mostly from the Pediatric Eye Disease Investigator Group, has validated both number of hours a day of patching and days per week of atropine use. The use of glasses alone has also been established as a good first-line therapy for both anisometropic and strabismic amblyopia. Unfortunately, visual acuity equalisation or even improvement is not always attainable with these methods. Additionally, non-compliance with prescribed therapies contributes to treatment failures, with data supporting difficulty adhering to full treatment sessions. Interest in alternative therapies for amblyopia treatment has long been a topic of interest among researchers and clinicians alike. Incorporating new technology with an understanding of the biological basis of amblyopia has led to enthusiasm for binocular treatment of amblyopia. Early work on perceptual learning as well as more recent enthusiasm for iPad-based dichoptic training have each generated interesting and promising data for vision improvement in amblyopes. Use of pharmaceutical augmentation of traditional therapies has also been investigated. Several different drugs with unique mechanisms of action are thought to be able to neurosensitise the brain and enhance responsiveness to amblyopia therapy. No new treatment has emerged from currently available evidence as superior to the traditional therapies in common practice today. But ongoing investigation into the use of both new technology and the understanding of the neural basis of amblyopia promises alternate or perhaps better cures in the future.
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Affiliation(s)
- Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Bruce A, Kelly B, Chambers B, Barrett BT, Bloj M, Bradbury J, Sheldon TA. The effect of adherence to spectacle wear on early developing literacy: a longitudinal study based in a large multiethnic city, Bradford, UK. BMJ Open 2018; 8:e021277. [PMID: 29895654 PMCID: PMC6009541 DOI: 10.1136/bmjopen-2017-021277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To determine the impact of adherence to spectacle wear on visual acuity (VA) and developing literacy following vision screening at age 4-5 years. DESIGN Longitudinal study nested within the Born in Bradford birth cohort. SETTING AND PARTICIPANTS Observation of 944 children: 432 had failed vision screening and were referred (treatment group) and 512 randomly selected (comparison group) who had passed (<0.20 logarithm of the minimum angle of resolution (logMAR) in both eyes). Spectacle wear was observed in school for 2 years following screening and classified as adherent (wearing spectacles at each assessment) or non-adherent. MAIN OUTCOME MEASURES Annual measures of VA using a crowded logMAR test. Literacy was measured by Woodcock Reading Mastery Tests-Revised subtest: letter identification. RESULTS The VA of all children improved with increasing age, -0.009 log units per month (95% CI -0.011 to -0.007) (worse eye). The VA of the adherent group improved significantly more than the comparison group, by an additional -0.008 log units per month (95% CI -0.009 to -0.007) (worse eye) and -0.004 log units per month (95% CI -0.005 to -0.003) in the better eye.Literacy was associated with the VA, letter identification (ID) reduced by -0.9 (95% CI -1.15 to -0.64) for every one line (0.10 logMAR) fall in VA (better eye). This association remained after adjustment for socioeconomic and demographic factors (-0.33, 95% CI -0.54 to -0.12). The adherent group consistently demonstrated higher letter-ID scores compared with the non-adherent group, with the greatest effect size (0.11) in year 3. CONCLUSIONS Early literacy is associated with the level of VA; children who adhere to spectacle wear improve their VA and also have the potential to improve literacy. Our results suggest failure to adhere to spectacle wear has implications for the child's vision and education.
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Affiliation(s)
- Alison Bruce
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - Bette Chambers
- Institute for Effective Education, University of York, York, UK
| | - Brendan T Barrett
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Marina Bloj
- School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - John Bradbury
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Bocci T, Nasini F, Caleo M, Restani L, Barloscio D, Ardolino G, Priori A, Maffei L, Nardi M, Sartucci F. Unilateral Application of Cathodal tDCS Reduces Transcallosal Inhibition and Improves Visual Acuity in Amblyopic Patients. Front Behav Neurosci 2018; 12:109. [PMID: 29896093 PMCID: PMC5986963 DOI: 10.3389/fnbeh.2018.00109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/09/2018] [Indexed: 12/12/2022] Open
Abstract
Objective: Amblyopia is a neurodevelopmental disorder characterized by visual acuity and contrast sensitivity loss, refractory to pharmacological and optical treatments in adulthood. In animals, the corpus callosum (CC) contributes to suppression of visual responses of the amblyopic eye. To investigate the role of interhemispheric pathways in amblyopic patients, we studied the response of the visual cortex to transcranial Direct Current Stimulation (tDCS) applied over the primary visual area (V1) contralateral to the “lazy eye.” Methods: Visual acuity (logMAR) was assessed before (T0), immediately after (T1) and 60’ following the application of cathodal tDCS (2.0 mA, 20’) in 12 amblyopic patients. At each time point, Visual Evoked Potentials (VEPs) triggered by grating stimuli of different contrasts (K90%, K20%) were recorded in both hemispheres and compared to those obtained in healthy volunteers. Results: Cathodal tDCS improved visual acuity respect to baseline (p < 0.0001), whereas sham polarization had no significant effect. At T1, tDCS induced an inhibitory effect on VEPs amplitudes at all contrasts in the targeted side and a facilitation of responses in the hemisphere ipsilateral to the amblyopic eye; compared with controls, the facilitation persisted at T2 for high contrasts (K90%; Holm–Sidak post hoc method, p < 0.001), while the stimulated hemisphere recovered more quickly from inhibition (Holm–Sidak post hoc method, p < 0.001). Conclusions: tDCS is a promising treatment for amblyopia in adults. The rapid recovery of excitability and the concurrent transcallosal disinhibition following perturbation of cortical activity may support a critical role of interhemispheric balance in the pathophysiology of amblyopia.
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Affiliation(s)
- Tommaso Bocci
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Clinical Center for Neurotechnologies, Neuromodulation, and Movement Disorders, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Nasini
- Department of Surgical, Medical, and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Matteo Caleo
- CNR Institute of Neuroscience, University of Pisa, Pisa, Italy
| | - Laura Restani
- CNR Institute of Neuroscience, University of Pisa, Pisa, Italy
| | - Davide Barloscio
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gianluca Ardolino
- Clinical Center for Neurotechnologies, Neuromodulation, and Movement Disorders, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- Clinical Center for Neurotechnologies, Neuromodulation, and Movement Disorders, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Sciences, University of Milan and Ospedale San Paolo, Milan, Italy
| | - Lamberto Maffei
- CNR Institute of Neuroscience, University of Pisa, Pisa, Italy
| | - Marco Nardi
- Department of Surgical, Medical, and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Ferdinando Sartucci
- Section of Neurophysiopathology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,CNR Institute of Neuroscience, University of Pisa, Pisa, Italy
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An action video game for the treatment of amblyopia in children: A feasibility study. Vision Res 2018; 148:1-14. [PMID: 29709618 DOI: 10.1016/j.visres.2018.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/29/2018] [Accepted: 04/01/2018] [Indexed: 11/22/2022]
Abstract
The gold-standard treatment for childhood amblyopia remains patching or penalizing the fellow eye, resulting in an average of about a one line (0.1 logMAR) improvement in visual acuity following ≈120 h of patching in children 3-8 years old. However, compliance with patching and other treatment options is often poor. In contrast, fast-paced action video games can be highly engaging, and have been shown to yield broad-based improvements in vision and attention in adult amblyopia. Here, we pilot-tested a custom-made action video game to treat children with amblyopia. Twenty-one (n = 21) children (mean age 9.95 ± 3.14 [se]) with unilateral amblyopia (n = 12 anisometropic and n = 9 strabismic) completed 20 h of game play either monocularly, with the fellow eye patched (n = 11), or dichoptically, with reduced contrast to the fellow eye (n = 10). Participants were assessed for visual acuity (VA), stereo acuity and reading speed at baseline, and following 10 and 20 h of play. Additional exploratory analyses examined improvements after 6-10 weeks of completion of training (follow-up). Following 20 h of training, VA improved, on average, by 0.14 logMAR (≈38%) for the dichoptic group and by 0.06 logMAR (≈15%) for the monocular group. Similarly, stereoacuity improved by 0.07 log arcsec (≈17%) following dichoptic training, and by 0.06 log arcsec (≈15%) following monocular training. Across both treatment groups, 7 of the 12 individuals with anisometropic amblyopia showed improvement in stereoacuity, whereas only 1 of the 9 strabismic individuals improved. Most improvements were largely retained at follow-up. Our feasibility study therefore suggests that the action video game approach may be used as an effective adjunct treatment for amblyopia in children, achieving results similar to those of the gold-standard treatment in shorter duration.
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Wallace DK, Repka MX, Lee KA, Melia M, Christiansen SP, Morse CL, Sprunger DT. Amblyopia Preferred Practice Pattern®. Ophthalmology 2018; 125:P105-P142. [DOI: 10.1016/j.ophtha.2017.10.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
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Pediatric Eye Evaluations Preferred Practice Pattern®: I. Vision Screening in the Primary Care and Community Setting; II. Comprehensive Ophthalmic Examination. Ophthalmology 2017; 125:P184-P227. [PMID: 29108745 DOI: 10.1016/j.ophtha.2017.09.032] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
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Chen AM, Cotter SA. The Amblyopia Treatment Studies: Implications for Clinical Practice. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2016; 1:287-305. [PMID: 28435934 PMCID: PMC5396957 DOI: 10.1016/j.yaoo.2016.03.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Angela M Chen
- Southern California College of Optometry at Marshall B. Ketchum University, 2575 Yorba Linda Blvd. Fullerton, CA 92831, , Phone number: (714) 449-7432
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, 2575 Yorba Linda Blvd. Fullerton, CA 92831, , Phone number: (714) 449-7488
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Wang J, Neely DE, Galli J, Schliesser J, Graves A, Damarjian TG, Kovarik J, Bowsher J, Smith HA, Donaldson D, Haider KM, Roberts GJ, Sprunger DT, Plager DA. A pilot randomized clinical trial of intermittent occlusion therapy liquid crystal glasses versus traditional patching for treatment of moderate unilateral amblyopia. J AAPOS 2016; 20:326-31. [PMID: 27418249 PMCID: PMC5374510 DOI: 10.1016/j.jaapos.2016.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/30/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the effectiveness of intermittent occlusion therapy (IO therapy) using liquid crystal glasses and continuous occlusion therapy using traditional adhesive patches for treating amblyopia. METHODS Children 3-8 years of age with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/100 in the amblyopic eye) were enrolled in this randomized controlled trial. Amblyopia was associated with strabismus, anisometropia, or both. All subjects had worn any optimal refractive correction for at least 12 weeks without improvement. Subjects were randomized into two treatment groups: a 4-hour IO therapy group with liquid crystal glasses (Amblyz), set at 30-second opaque/transparent intervals (occluded 50% of wear time), and a 2-hour continuous patching group (occluded 100% of wear time). For each patient, visual acuity was measured using ATS-HOTV before and after 12 weeks of treatment. RESULTS Data from 34 patients were available for analysis. Amblyopic eye visual acuity improvement from baseline was 0.15 ± 0.12 logMAR (95% CI, 0.09-0.15) in the IO therapy group (n = 19) and 0.15 ± 0.11 logMAR (95% CI, 0.1-0.15) in the patching group (n = 15). In both groups improvement was significant, but the difference between groups was not (P = 0.73). No adverse effects were reported. CONCLUSIONS In this pilot study, IO therapy with liquid crystal glasses is not inferior to adhesive patching and is a promising alternative treatment for children 3-8 years of age with moderate amblyopia.
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Affiliation(s)
- Jingyun Wang
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania; Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis.
| | - Daniel E Neely
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Jay Galli
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Joshua Schliesser
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - April Graves
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Tina G Damarjian
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Jessica Kovarik
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - James Bowsher
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Heather A Smith
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Dana Donaldson
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Kathryn M Haider
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Gavin J Roberts
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - Derek T Sprunger
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
| | - David A Plager
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis
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Maconachie GDE, Gottlob I. The challenges of amblyopia treatment. Biomed J 2016; 38:510-6. [PMID: 27013450 PMCID: PMC6138377 DOI: 10.1016/j.bj.2015.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
The treatment of amblyopia, particularly anisometropic (difference in refractive correction) and/or strabismic (turn of one eye) amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 1998. Since this review, a number of publications have revealed new findings in the treatment of amblyopia. This includes the finding that less intensive occlusion treatments can be successful in treating amblyopia. A relationship between adherence to treatment and visual acuity has also been established and has been shown to be influenced by the use of intervention material. In addition, there is growing evidence of that a period of glasses wearing only can significantly improve visual acuity alone without any other modes of treatment. This review article reports findings since the Snowdon's report.
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Affiliation(s)
- Gail D E Maconachie
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKSCB, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Irene Gottlob
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKSCB, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
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West S, Williams C. Amblyopia in children (aged 7 years or less). BMJ CLINICAL EVIDENCE 2016; 2016:0709. [PMID: 26731564 PMCID: PMC4701128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7-8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for amblyopia in children aged 7 years or less? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 14 full publications. Of the 14 full articles evaluated, two systematic reviews were updated and three RCTs and two follow-up studies were added at this update. We performed a GRADE evaluation for nine PICO combinations. CONCLUSIONS In this systematic overview we categorised the efficacy for three interventions, based on information about the effectiveness and safety of glasses, occlusion, or penalisation with atropine.
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Høeg TB, Moldow B, Ellervik C, Klemp K, Erngaard D, la Cour M, Buch H. Danish Rural Eye Study: the association of preschool vision screening with the prevalence of amblyopia. Acta Ophthalmol 2015; 93:322-9. [PMID: 25545299 DOI: 10.1111/aos.12639] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/24/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine the prevalence of amblyopia in Denmark before and after the initiation of the Danish national preschool vision screening programme. METHODS In a population-based cross-sectional study, 3826 participants of the Danish General Suburban Population Study (GESUS) aged 20 years and older from a Danish rural municipality received a complete general health examination and an ophthalmological interview and examination. This study included a comprehensive ophthalmologic interview, measurement of best corrected visual acuity (BCVA) in each eye, Hirschberg's test for strabismus and two 45-degree retinal fundus photographs of each eye. A complete ophthalmologic examination was performed when indicated. RESULTS The prevalence of monocular visual impairment (MVI) was 4.26% (95% CI, 3.66-4.95, n = 163). Amblyopia was the most common cause, accounting for 33%. The prevalence of amblyopia was 1.44% (95% CI, 1.01-1.81, n = 55), being higher among non-preschool vision screened persons compared to those who were offered (estimated 95% attendance) preschool vision screening (1.78%, n = 41, 95% CI 1.24-2.33 versus 0.44%, n = 2, 95% CI, 0.12-1.60, p = 0.024). The leading cause of amblyopia was anisometropia (45.5%, 25/55). CONCLUSIONS Amblyopia was the most common cause of MVI. Following the initiation of the Danish national preschool vision screening programme, which has an approximate attendance rate of 95%, the prevalence of amblyopia decreased by fourfold.
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Affiliation(s)
- Tracy B. Høeg
- Department of Ophthalmology; Naestved Hospital; Naestved Denmark
- The Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Birgitte Moldow
- Department of Ophthalmology; Naestved Hospital; Naestved Denmark
| | - Christina Ellervik
- The Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Department of General Population Study; Nykøbing Falster Hospital; Nykøbing Falster Denmark
| | - Kristian Klemp
- Department of Ophthalmology; Capital Region Eye Clinic; Glostrup Hospital; University of Copenhagen; Copenhagen Denmark
| | - Ditte Erngaard
- Department of Ophthalmology; Naestved Hospital; Naestved Denmark
| | - Morten la Cour
- The Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
- Department of Ophthalmology; Capital Region Eye Clinic; Glostrup Hospital; University of Copenhagen; Copenhagen Denmark
| | - Helena Buch
- Department of Ophthalmology; Capital Region Eye Clinic; Glostrup Hospital; University of Copenhagen; Copenhagen Denmark
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Repka MX, Kraker RT, Holmes JM. Atropine vs Patching-Reply. JAMA Ophthalmol 2015; 133:619-20. [PMID: 25695639 PMCID: PMC4476506 DOI: 10.1001/jamaophthalmol.2014.6131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael X. Repka
- Wilmer Ophthalmological Institute, John Hopkins University, Baltimore, MD
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Holmes JM. Designing clinical trials for amblyopia. Vision Res 2015; 114:41-7. [PMID: 25752747 DOI: 10.1016/j.visres.2015.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/03/2015] [Accepted: 01/09/2015] [Indexed: 11/17/2022]
Abstract
Randomized clinical trial (RCT) study design leads to one of the highest levels of evidence, and is a preferred study design over cohort studies, because randomization reduces bias and maximizes the chance that even unknown confounding factors will be balanced between treatment groups. Recent randomized clinical trials and observational studies in amblyopia can be taken together to formulate an evidence-based approach to amblyopia treatment, which is presented in this review. When designing future clinical studies of amblyopia treatment, issues such as regression to the mean, sample size and trial duration must be considered, since each may impact study results and conclusions.
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Compliance and patching and atropine amblyopia treatments. Vision Res 2015; 114:31-40. [PMID: 25743080 DOI: 10.1016/j.visres.2015.02.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 02/05/2015] [Accepted: 02/16/2015] [Indexed: 02/06/2023]
Abstract
In the past 20 years, there has been a great advancement in knowledge pertaining to compliance with amblyopia treatments. The occlusion dose monitor introduced quantitative monitoring methods in patching, which sparked our initial understanding of the dose-response relationship for patching amblyopia treatment. This review focuses on current compliance knowledge and the impact it has on patching and atropine amblyopia treatment.
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Wallace DK, Lazar EL, Repka MX, Holmes JM, Kraker RT, Hoover DL, Weise KK, Waters AL, Rice ML, Peters RJ. A randomized trial of adding a plano lens to atropine for amblyopia. J AAPOS 2015; 19:42-8. [PMID: 25727586 PMCID: PMC4354879 DOI: 10.1016/j.jaapos.2014.10.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some children have residual amblyopia after treatment with atropine eyedrops for amblyopia due to strabismus and/or anisometropia. We conducted a randomized clinical trial to evaluate the effectiveness of augmenting the effect of atropine by changing the lens over the fellow eye to plano in children with residual amblyopia. METHODS A total of 73 children 3 to <8 years of age (mean, 5.8 years) with stable residual amblyopia (range, 20/32 to 20/160, mean 20/63(+1)) were enrolled after at least 12 weeks of atropine treatment of the fellow eye. Participants were randomly assigned to continuing weekend atropine alone or wearing a plano lens over the fellow eye (while continuing atropine). The primary outcome was assessed at 10 weeks, and participants were followed until improvement ceased. RESULTS At the 10-week primary outcome visit, amblyopic-eye visual acuity had improved an average of 1.1 lines with the plano lens and 0.6 lines with atropine only (difference adjusted for baseline visual acuity = + 0.5 line; 95% CI, -0.1 to +1.2). At the primary outcome or later visit when the best-measured visual acuity was observed, the mean amblyopic-eye improvement from baseline was 1.9 lines with the plano lens and 0.8 lines with atropine only. CONCLUSIONS When amblyopic-eye visual acuity stops improving with atropine treatment, there may be a small benefit to augmenting atropine therapy with a plano lens over the fellow eye. However, the effect was not statistically significant, and the large confidence interval raises the possibility of no benefit or a benefit larger than we observed. A larger study would be necessary to get a more precise estimate of the treatment effect.
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Kim M, Choi MY. Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.2.254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Moses Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Esposito Veneruso P, Ziccardi L, Magli G, Falsini B, Magli A. Short-term effects of vision trainer rehabilitation in patients affected by anisometropic amblyopia: electrofunctional evaluation. Doc Ophthalmol 2014; 129:177-89. [PMID: 25294024 DOI: 10.1007/s10633-014-9462-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the short-term effects of the vision trainer rehabilitation technique on retinal and post-retinal function in young amblyopic patients outside the critical visual developmental period. METHODS Twenty-one patients (mean age 12.2 ± 2.7 years, ranging from 9.1 to 18 years) affected by unilateral anisometropic amblyopia were studied, providing 21 amblyopic eyes (AE) and 21 sound eyes (SE). Thirty eyes from 15 age-similar normal subjects served as controls. All subjects underwent extensive ophthalmologic characterization to exclude any disease not related to amblyopia. All AE were subjected to rehabilitation sessions performed by the Retimax vision trainer (VT) program. The protocol consisted of 2 sessions per week, each lasting 10 min, for 10 consecutive weeks. Before and after the rehabilitation, electrophysiological [pattern electroretinogram (PERG) and visual evoked potential (VEP)] and psychophysical [best corrected visual acuity (BCVA) and microperimetry] data were collected from AE and SE. RESULTS When comparing baseline data with those collected at the end of the study, PERG P50-N95 amplitude and BCVA values from AE had improved significantly by the end of the study (p < 0.05). Our electrophysiological findings also showed some abnormalities in SE when the data were compared to control eyes. We found a significant correlation (p < 0.05) between PERG amplitude and VEP implicit time in SE after visual rehabilitation. CONCLUSIONS Short-term visual rehabilitation performed by the VT program ameliorated the electrofunctional and psychophysical parameters of vision in children outside the critical developmental period, thus indicating that VT might be a potential adjuvant therapy of traditional patching treatment.
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Repka MX, Kraker RT, Holmes JM, Summers AI, Glaser SR, Barnhardt CN, Tien DR. Atropine vs patching for treatment of moderate amblyopia: follow-up at 15 years of age of a randomized clinical trial. JAMA Ophthalmol 2014; 132:799-805. [PMID: 24789375 DOI: 10.1001/jamaophthalmol.2014.392] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Initial treatment for amblyopia of the fellow eye with patching and atropine sulfate eyedrops improves visual acuity. Long-term data on the durability of treatment benefit are needed. OBJECTIVE To report visual acuity at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia. DESIGN, SETTING, AND PARTICIPANTS In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40 to 20/100) were randomly assigned to patching (minimum of 6 h/d) or atropine sulfate eyedrops, 1% (1 drop daily), for 6 months. Treatment after 6 months was at the discretion of the investigator. Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up. INTERVENTION Initial treatment with patching or atropine with subsequent treatment at investigator discretion. MAIN OUTCOMES AND MEASURES Visual acuity at 15 years of age with the electronic Early Treatment Diabetic Retinopathy Study test in amblyopic and fellow eyes. RESULTS Mean visual acuity in the amblyopic eye measured in 147 participants at 15 years of age was 0.14 logMAR (approximately 20/25); 59.9% of amblyopic eyes had visual acuity of 20/25 or better and 33.3%, 20/20 or better. Mean interocular acuity difference (IOD) at 15 years of age was 0.21 logMAR (2.1 lines); 48.3% had an IOD of 2 or more lines and 71.4%, 1 or more lines. Treatment (other than spectacles) was prescribed for 9 participants (6.1%) aged 10 to 15 years. Mean IOD was similar at examinations at 10 and 15 years of age (2.0 and 2.1 logMAR lines, respectively; P = .39). Better visual acuity at the 15-year examination was achieved in those who were younger than 5 years at the time of entry into the randomized clinical trial (mean logMAR, 0.09) compared with those aged 5 to 6 years (mean logMAR, 0.18; P < .001). When we compared subgroups based on original treatment with atropine or patching, no significant differences were observed in visual acuity of amblyopic and fellow eyes at 15 years of age (P = .44 and P = .43, respectively). CONCLUSIONS AND RELEVANCE At 15 years of age, most children treated for moderate amblyopia when younger than 7 years have good visual acuity, although mild residual amblyopia is common. The outcome is similar regardless of initial treatment with atropine or patching. The results indicate that improvement occurring with amblyopia treatment is maintained until at least 15 years of age. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000170.
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Affiliation(s)
- Michael X Repka
- Wilmer Ophthalmological Institute, The John Hopkins University, Baltimore, Maryland
| | - Raymond T Kraker
- Pediatric Eye Disease Investigator Group Coordinating Center, Jaeb Center for Health Research, Tampa, Florida
| | | | | | | | | | - David R Tien
- Pediatric Ophthalmology and Strabismus Associates, Providence, Rhode Island
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Abstract
Amblyopia is the most common cause of monocular visual impairment. Patching, which is modestly effective, is the current treatment of amblyopia in children. There is no clinically approved treatment for adults. The present study is a clinical trial (non-sham controlled and non-randomized) that assessed the efficacy of binocular training for improvement of the visual acuity in children and adults with amblyopia. Twenty-two amblyopic subjects ranging in age from 5 to 73 (mean: 36.2) years for whom patching and/or surgical treatments did not correct their visual impairment completed an average of 14.5 sessions of binocular training over a period of 4 to 6 weeks. Random dot kinematograms were presented dichoptically to the two eyes and the participants' task was to identify the direction of motion of the targets. Mean visual acuity improvement was 0.34 LogMAR (range: 0.1-0.58 LogMAR) and was shown to persist 6 months following the cessation of binocular training. Our study provides results in a large number of patients that confirm the clinical effectiveness of binocular training as a treatment for amblyopia in improving visual acuity in both children and adults. Moreover, this study is the first to demonstrate that the improvements in visual function were maintained for 6 months in the absence of any additional treatment.
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Affiliation(s)
- B Mansouri
- Section of Neurology, Department of Internal Medicine, University of Manitoba , Winnipeg, Manitoba , Canada and
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Abstract
PURPOSE It has been suggested that children perceptually adapt to changes in retinal image size in the presence of anisometropia and therefore do not display clinically significant aniseikonia. However, given that early methods of eikonometry were not child-friendly, the prevalence of this condition in children is poorly understood. Retinal image size differences may be relevant in the discussion of amblyogenesis. The computer-based Aniseikonia Inspector Version 3 (AI3) uses a simple, forced-choice method and includes calibration for heterophoria. The present study is designed to evaluate AI3 by measuring background and induced aniseikonia in children aged 5 to 13 years. METHODS All subjects were present for a standard-of-care eye examination and had at least 20/40 best-corrected visual acuity and no history of strabismus or amblyopia. Trials of AI3 were performed in the vertical direction only, using the 12-point test, and two trials were recorded. Each subject was randomized to have a 4% size lens added to either the right eye or the left eye. Two trials were performed in this manner, followed by two more trials with the size lens over the alternate eye. RESULTS Eighteen children were enrolled; three subjects were not able to complete testing because of lack of attention or understanding. Results from each condition (background aniseikonia, induced aniseikonia OD, and induced aniseikonia OS) were averaged for each patient. With the 4% size lens over the OD, mean aniseikonia measured -3.83%. With the 4% size lens over the OS, mean aniseikonia measured 4.29%. CONCLUSIONS Most children were able to complete aniseikonia testing with AI3. Background aniseikonia was clinically insignificant (0.59%), and induced aniseikonia measurements were close to expected values using a 4% size lens. Aniseikonia Inspector Version 3 appears to be a useful means for measuring aniseikonia in a normal pediatric population. Further study in children with anisometropia is needed.
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Abstract
PURPOSE Patient-reported outcome (PRO) instruments are increasingly common in both clinical practice and research. The data obtained from these instruments can be used to help inform decision making and policy-making decisions. The methodological approaches undertaken in developing PROs is not frequently reported. Literature on the development of the descriptive systems for PROs is sparse in comparison with that on the assessment of the psychometric properties of such instruments. The purpose of this study is to describe the results of qualitative interviews conducted to identify potential themes for the Child Amblyopia Treatment Questionnaire (CAT-QoL), a pediatric disease-specific health-related quality of life instrument for amblyopia designed for children aged 4 to 7 years. METHODS Semistructured interviews were undertaken with 59 children (aged 3 years 9 months to 9 years 11 months; average, 6 years 3 months) with amblyopia. The interviews were transcribed verbatim and imported into QSR NVivo 8. Interview transcripts were analyzed to identify potential items to be included in the descriptive system. Thematic content analysis was undertaken using Framework. RESULTS Eleven potential themes were identified for inclusion in the CAT-QoL instrument, namely, physical sensation of the treatment, pain, being able to play with other children, how other children have treated them, ability to undertake schoolwork, ability to undertake other tasks, sad or unhappy, cross, worried, frustrated, and feelings toward family members. CONCLUSIONS Children are able to identify their thoughts and opinions of their own health and to describe what impact their amblyopia treatment has had on their daily lives. Themes for the draft descriptive system for a pediatric self-reported amblyopia QoL instrument have been identified. A draft version of the CAT-QoL instrument has been developed. Further research is required to refine and assess the psychometric properties of the instrument.
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