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Iwata Y. Developing a Novel Pediatric Eye Chart Assessing Visual Acuity by Minimum Separable Threshold. CHILDREN (BASEL, SWITZERLAND) 2024; 11:397. [PMID: 38671614 PMCID: PMC11048868 DOI: 10.3390/children11040397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
The purpose of this study was to develop a new pediatric acuity chart that can assess the minimum separation threshold by incorporating the minimum separation threshold into the picture. To overcome the design limitations of the Landolt ring, two designs of highly versatile minimum separable thresholds that can be easily incorporated into a picture were created: a black, filled circle (the "Circle") and a segment (the "Square"), both with the same break as in the Landolt ring. The three designs-the Landolt ring, Circle, and Square-were used to evaluate and compare the differences in the visual acuity of 21 healthy adults. No significant differences were observed between the results of the visual acuity tested with the Landolt ring, Circle, and Square (Landolt ring vs. Circle: p = 0.92, Landolt ring vs. Square: p = 0.31, Circle vs. Square: p = 0.40). The Bland-Altman analysis revealed no fixed errors between the Landolt ring and Circle and between the Landolt ring and Square (95% CI: -0.09-0.08, -0.09-0.12). Proportional errors were also not observed (p = 0.68, p = 0.41). The Landolt ring, Circle, and Square designs obtained equal results in visual acuity, thus achieving the successful development of a novel pediatric visual acuity chart using these designs.
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Affiliation(s)
- Yo Iwata
- Department of Rehabilitation, Orthoptics and Visual Science Course, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara 252-0373, Japan
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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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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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Le T, Örge F. Treatment compliance in amblyopia: A mini-review and description of a novel online platform for compliance tracking. Surv Ophthalmol 2022; 67:1685-1697. [PMID: 35970235 DOI: 10.1016/j.survophthal.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
Patient compliance with amblyopia therapies, including eye patching and atropine drops, is crucial for optimal visual acuity outcomes. Studies utilizing objective measures of compliance measurement have consistently shown that a majority of patients receive significantly less treatment than prescribed. We review the subjective and objective compliance rates reported in the literature, assess possible explanations for poor compliance and describe studies of interventions to improve compliance. Additionally, we report our experience implementing Inside Out Care, a novel online platform designed to improve monitoring of amblyopia patient compliance, in our clinics. We have found that this platform, which is accessible via both computer and smartphone, has improved monitoring of amblyopia patient patching compliance, as well as allowed for enhanced doctor-patient communication.
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Affiliation(s)
- Tinh Le
- Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital and University Hospitals Eye Institute
| | - Faruk Örge
- Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital and University Hospitals Eye Institute.
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Abstract
Occlusion therapy has a long history as the gold standard treatment for amblyopia. Over the past two decades, large multicenter randomized controlled trials and objective dose-monitoring studies have characterized the effects of refractive correction, patching, and atropine penalization, providing insights into the impact of factors such as age and treatment dose. More recent approaches, whose development has been accelerated by advances in technology, are designed to provide different stimulation to the amblyopic eye and the fellow eye. This review explores a variety of such dichoptic approaches, categorized according to whether they primarily feature requisite use of the amblyopic eye in the face of fellow-eye masking, integration of visual information from both eyes, or reduction of stimulus salience in the fellow eye. It is still unclear whether dichoptic treatments are superior to traditional, low-cost treatment methods or whether their therapeutic mechanisms are fundamentally different from those of established treatments. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kimberly Meier
- Department of Psychology, University of Washington, Seattle, Washington, USA;
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Sen S, Singh P, Saxena R. Management of amblyopia in pediatric patients: Current insights. Eye (Lond) 2022; 36:44-56. [PMID: 34234293 PMCID: PMC8727565 DOI: 10.1038/s41433-021-01669-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Amblyopia is a cause of significant ocular morbidity in pediatric population and may lead to visual impairment in future life. It is caused due to formed visual deprivation or abnormal binocular interactions. Several risk factors in pediatric age group may lead to this disease. Author groups have tried managing different types of amblyopia, like anisometropic amblyopia, strabismic amblyopia and combined mechanism amblyopia, with optical correction, occlusion therapy, penalization, binocular therapy and surgery. We review historical and current management strategies of different types of amblyopia affecting children and outcomes in terms of visual acuity, binocularity and ocular deviation, highlighting evidence from recent studies. Literature searches were performed through Pubmed. Risk factors for amblyopia need to be identified in pediatric population as early in life as possible and managed accordingly, as visual outcomes in amblyopia are best if treated at the earliest. Although, monocular therapies like occlusion or penalization have been shown to be quite beneficial over the years, newer concepts related to binocular vision therapy are still evolving.
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Affiliation(s)
- Sagnik Sen
- Department of Neuroophthalmology and Strabismus, Dr R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pallavi Singh
- Department of Neuroophthalmology and Strabismus, Dr R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Department of Neuroophthalmology and Strabismus, Dr R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Birch EE, Kelly KR, Wang J. Recent Advances in Screening and Treatment for Amblyopia. Ophthalmol Ther 2021; 10:815-830. [PMID: 34499336 PMCID: PMC8589941 DOI: 10.1007/s40123-021-00394-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment in children, with a prevalence of 2-3%. Not only is visual acuity reduced in one eye but binocular vision is affected, fellow eye deficits may be present, eye-hand coordination and reading can be affected, and self-perception may be diminished. New technologies for preschool vision screening hold promise for accessible, early, and accurate detection of amblyopia. Together with recent advances in our theoretical understanding of amblyopia and technological advances in amblyopia treatment, we anticipate improved visual outcomes for children affected by this very common eye condition. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA.
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Krista R Kelly
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingyun Wang
- SUNY College of Optometry, State University of New York, New York, NY, USA
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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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Hamm LM, Chen Z, Li J, Dai S, Black J, Yuan J, Yu M, Thompson B. Contrast‐balanced binocular treatment in children with deprivation amblyopia. Clin Exp Optom 2021; 101:541-552. [DOI: 10.1111/cxo.12630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/25/2017] [Accepted: 09/07/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Zidong Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Shuan Dai
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand,
| | - Joanna Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Junpeng Yuan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Benjamin Thompson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada,
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Sehgal S, Satgunam P. Quantifying Suppression in Anisometropic Amblyopia With VTS4 (Vision Therapy System 4). Transl Vis Sci Technol 2020; 9:24. [PMID: 33244444 PMCID: PMC7683859 DOI: 10.1167/tvst.9.12.24] [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: 06/11/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Visual acuity (VA) of the amblyopic eye is usually considered for monitoring improvement with therapy. However, participation of the amblyopic eye under binocular viewing conditions is also important. This study investigated the use of a clinically available tool VTS4 (Vision Therapy System 4) to quantify the participation or suppression of the amblyopic eye under binocular viewing conditions. Methods A cross-sectional study on patients with anisometropic amblyopia was undertaken. Monocular VA was thresholded. Stereo acuity was measured with Randot stereo test. Simultaneous macular perception (SMP) targets in VTS4 were dichoptically presented. SMP target size was reduced till the amblyopic eye's target disappeared (suppression scotoma size). An average of three measurements was taken for the suppression scotoma size. Results Twenty-eight patients participated (aged 6 to 21 years). The mean interocular VA difference was 0.50 ± 0.27 logMAR. The mean scotoma size was 8.2° ± 5.4°. Mean stereo acuity was 2.06 ± 0.34 log arc seconds from 21 patients on whom stereopsis could be measured. Suppression scotoma size showed a significant (P < 0.001) positive correlation with both interocular VA difference (r = 0.59) and stereoacuity (r = 0.72). Conclusions Participation of the amblyopic eye under binocular viewing condition can be assessed by measuring the suppression scotoma size in VTS4, even when stereoacuity is poor or not measurable. Smaller the suppression scotoma, better is the amblyopic eye's participation. Translational Relevance VTS4 can be used in monitoring amblyopia therapy by quantifying suppression of the amblyopic eye.
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Affiliation(s)
- Shivalika Sehgal
- Brien Holden Institute of Optometry and Vision Sciences, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
| | - PremNandhini Satgunam
- Brien Holden Institute of Optometry and Vision Sciences, Hyderabad Eye Research Foundation, L V Prasad Eye Institute, Hyderabad, India
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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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Improved monitoring of adherence with patching treatment using a microsensor and Eye Patch Assistant. J AAPOS 2020; 24:96.e1-96.e7. [PMID: 32198079 PMCID: PMC7276289 DOI: 10.1016/j.jaapos.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/08/2020] [Accepted: 01/28/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Use of a microsensor has been suggested to monitor patching adherence. Application has been limited because the microsensor's small size makes it easy to lose and a swallowing risk. We designed the Eye Patch Assistant (EPA) to hold the small microsensor in place and reduce the risk of loss or swallowing. This study reports the accuracy, precision, ease of use, and comfort for patching with EPA (patch+EPA) to monitor adherence. METHODS Adults (N = 13) wore an adhesive patch alone or a patch+EPA for 2 hours each, recorded wear time, and completed an ease of use/comfort questionnaire; 30 children wore a patch or patch+EPA and completed the questionnaire. Sensor sampling interval was every 5 minutes or every 1 minute. Sensor accuracy and precision were evaluated by Bland-Altman analysis and 95% limits of agreement, and questionnaire scores compared by Wilcoxon tests. RESULTS With 5-minute sampling, we found excellent accuracy for adults (mean actual vs recorded time difference, 1.4 minutes) and children (mean difference, -0.9 min). We found high precision for both adults and children (95% limits of agreement half widths of 6.4 minutes and 1.9 minutes, respectively). In adults, the ease of use score for the patch+EPA was lower than the patch (P < 0.01), but the comfort score for the patch+EPA was higher (P < 0.01). For children, scores did not differ significantly. The patch+EPA functioned well between 45° and 82°F. CONCLUSIONS The patch+EPA was well accepted and monitored adherence accurately and precisely.
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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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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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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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Wallace MP, Stewart CE, Moseley MJ, Stephens DA, Fielder AR. Treatment of Amblyopia Using Personalized Dosing Strategies: Statistical Modelling and Clinical Implementation. Strabismus 2017; 24:161-168. [PMID: 27929726 DOI: 10.1080/09273972.2016.1242638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To generate a statistical model for personalizing a patient's occlusion therapy regimen. METHODS Statistical modelling was undertaken on a combined data set of the Monitored Occlusion Treatment of Amblyopia Study (MOTAS) and the Randomized Occlusion Treatment of Amblyopia Study (ROTAS). This exercise permits the calculation of future patients' total effective dose (TED)-that predicted to achieve their best attainable visual acuity. Daily patching regimens (hours/day) can be calculated from the TED. RESULTS Occlusion data for 149 study participants with amblyopia (anisometropic in 50, strabismic in 43, and mixed in 56) were analyzed. Median time to best observed visual acuity was 63 days (25% and 75% quartiles; 28 and 91 days). Median visual acuity in the amblyopic eye at start of occlusion was 0.40 logMAR (quartiles 0.22 and 0.68 logMAR) and at end of occlusion was 0.12 (quartiles 0.025 and 0.32 logMAR). Median lower and upper estimates of TED were 120 hours (quartiles 34 and 242 hours), and 176 hours (quartiles 84 and 316 hours). The data suggest a piecewise linear relationship (P = 0.008) between patching dose-rate (hours/day) and TED with a single breakpoint estimated at 2.16 (standard error 0.51) hours/day, suggesting doses below 2.16 hours/day are less effective. CONCLUSION We introduce the concept of TED of occlusion. Predictors for TED are visual acuity deficit, amblyopia type, and age at start of occlusion therapy. Dose-rates prescribed within the model range from 2.5 to 12 hours/day and can be revised dynamically throughout treatment in response to recorded patient compliance: a personalized dosing strategy.
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Affiliation(s)
- Michael P Wallace
- a Department of Epidemiology, Biostatistics and Occupational Health , McGill University , Montreal , Canada
| | - Catherine E Stewart
- b Division of Optometry and Visual Science , City University , London , United Kingdom
| | - Merrick J Moseley
- b Division of Optometry and Visual Science , City University , London , United Kingdom
| | - David A Stephens
- c Department of Mathematics and Statistics , McGill University , Montreal , Canada
| | - Alistair R Fielder
- b Division of Optometry and Visual Science , City University , London , United Kingdom
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Interocular suppression in children with deprivation amblyopia. Vision Res 2017; 133:112-120. [PMID: 28214552 DOI: 10.1016/j.visres.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/21/2022]
Abstract
In patients with anisometropic or strabismic amblyopia, interocular suppression can be minimized by presenting high contrast stimulus elements to the amblyopic eye and lower contrast elements to the fellow eye. This suggests a structurally intact binocular visual system that is functionally suppressed. We investigated whether suppression can also be overcome by contrast balancing in children with deprivation amblyopia due to childhood cataracts. To quantify interocular contrast balance, contrast interference thresholds were measured using an established dichoptic global motion technique for 21 children with deprivation amblyopia, 14 with anisometropic or mixed strabismic/anisometropic amblyopia and 10 visually normal children (mean age mean=9.9years, range 5-16years). We found that interocular suppression could be overcome by contrast balancing in most children with deprivation amblyopia, at least intermittently, and all children with anisometropic or mixed anisometropic/strabismic amblyopia. However, children with deprivation amblyopia due to early unilateral or bilateral cataracts could tolerate only very low contrast levels to the stronger eye indicating strong suppression. Our results suggest that treatment options reliant on contrast balanced dichoptic presentation could be attempted in a subset of children with deprivation amblyopia.
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Sachdeva V, Mittal V, Gupta V, Gunturu R, Kekunnaya R, Chandrasekharan A, Chabblani PP, Rao HL. "Combined Occlusion and Atropine Therapy" Versus "Augmented Part-Time Patching" in Children with Refractory/Residual Amblyopia: A Pilot Study. Middle East Afr J Ophthalmol 2017; 23:201-7. [PMID: 27162453 PMCID: PMC4845619 DOI: 10.4103/0974-9233.175892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To compare the efficacy of combined occlusion and atropine therapy (COAT) and augmented part-time patching for the treatment of unilateral refractory/residual amblyopia. Methodology: This retrospective study evaluated children between 4 and 11 years with refractory/residual amblyopia who were treated with either additional atropine (COAT group) or increased hours of patching (augmented group). Data were collected on improvement in best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR] units) at each follow-up visit. Results: There were 19 children in the COAT group and 17 children in the augmented group. The baseline BCVA of the amblyopic eye was 0.79 ± 0.36 logMAR in the COAT group and 0.72 ± 0.26 logMAR in augmented group. Children were statistically significantly younger in the COAT group (6.4 ± 2.2 years) compared to the augmented group (8.6 ± 3.3 years, P = 0.02). The mean duration of follow-up was statistically significantly longer in the augmented group (20.2 COAT group; 13.9 months augmented group) (P = 0.03). Compliance was similar in both groups. LogMAR BCVA (adjusted for difference in age and baseline BCVA) was statistically significantly better in the COAT group (0.56 ± 0.04) compared to the augmented group (0.80 ± 0.04) at 3 months (P = 0.000); 6 months (COAT group, 0.50 ± 0.04 vs. augmented group, 0.74 ± 0.04; P = 0.04) and at 1 year (COAT group, 0.42 ± 0.04 vs. augmented group, 0.67 ± 0.04, P = 0.000). There was statistically significantly greater improvement in logMAR BCVA at 6 months in COAT group (0.26 ± 0.15) compared to the augmented group (0.02 ± 0.14), (P = 0.0002). Age, gender, pretreatment BCVA, duration of follow-up, or compliance to patching did not affect improvement in BCVA. Conclusions: COAT may result in greater improvement in BCVA than augmented part-time patching in children with unilateral residual/refractory amblyopia.
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Affiliation(s)
- Virender Sachdeva
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Vaibhev Mittal
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Varun Gupta
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Rekha Gunturu
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Ramesh Kekunnaya
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Anjali Chandrasekharan
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Preeti Patil Chabblani
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Harsha L Rao
- Centre for Clinical Epidemiology and Biostatistics, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Abstract
AIMS The proportion of patients seen by the paediatric eye service that attend for reasons related to amblyopia has not been quantified. The purpose of this study was to quantify the proportion of patients seen in the paediatric eye service attending for reasons related to amblyopia. METHODS Records of all eye appointments of children attending the Hillingdon Hospitals NHS Foundation Trust and St Mary's Hospital Imperial College Healthcare NHS Trust over one month in 2009 were examined to determine the diagnosis and reason for attendance. RESULTS Seven hundred and four patients had appointments booked at St Mary's and Hillingdon in March 2009. The fail-to-attend rates were not significantly different at the 2 sites (19% at St Mary's and 9% at Hillingdon; P=0.75). Of the 704 patients, 533 (St Mary's, 252 [75%]; Hillingdon, 281 [76%]) were attending for amblyopia-related reasons. Of the overall 982 booked appointments, 770 (79%) were amblyopia-related. CONCLUSIONS Amblyopia diagnosis and management is clearly the most common cause of attendance to the paediatric eye service, accounting for over three-quarters of outpatient visits.
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Affiliation(s)
- Catherine E Stewart
- a Division of Optometry and Visual Sciences , City University London , London , United Kingdom
| | - Shaheen Shah
- b London School of Hygiene & Tropical Medicine , Department of Infectious and Tropical Diseases , London , United Kingdom
| | - Siobhan Wren
- c Department of Ophthalmology , The Hillingdon Hospitals NHS Foundation Trust , Uxbridge , United Kingdom
| | - Clare J Roberts
- d Moorfields Eye Hospital Dubai, branch of Moorfields Eye Hospital London , Dubai , United Arab Emirates
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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: 25] [Impact Index Per Article: 3.1] [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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Herbison N, MacKeith D, Vivian A, Purdy J, Fakis A, Ash IM, Cobb SV, Eastgate RM, Haworth SM, Gregson RM, Foss AJ. Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system. Br J Ophthalmol 2016; 100:1511-1516. [PMID: 26951772 PMCID: PMC5136691 DOI: 10.1136/bjophthalmol-2015-307798] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/05/2015] [Accepted: 01/25/2016] [Indexed: 11/21/2022]
Abstract
Background Traditional treatment of amblyopia involves either wearing a patch or atropine penalisation of the better eye. A new treatment is being developed on the basis of virtual reality technology allowing either DVD footage or computer games which present a common background to both eyes and the foreground, containing the imagery of interest, only to the amblyopic eye. Methods A randomised control trial was performed on patients with amblyopia aged 4–8 years with three arms. All three arms had dichoptic stimulation using shutter glass technology. One arm had DVD footage shown to the amblyopic eye and common background to both, the second used a modified shooter game, Nux, with sprite and targets presented to the amblyopic eye (and background to both) while the third arm had both background and foreground presented to both eyes (non-interactive binocular treatment (non-I-BiT) games). Results Seventy-five patients were randomised; 67 were residual amblyopes and 70 had an associated strabismus. The visual acuity improved in all three arms by approximately 0.07 logMAR in the amblyopic eye at 6 weeks. There was no difference between I-BiT DVD and non-I-BiT games compared with I-BiT games (stated primary outcome) in terms of gain in vision. Conclusions There was a modest vision improvement in all three arms. Treatment was well tolerated and safe. There was no difference between the three treatments in terms of primary stated outcomes but treatment duration was short and the high proportion of previously treated amblyopia and strabismic amblyopia disadvantaged dichoptic stimulation treatment. Trial registration number NCT01702727, results.
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Affiliation(s)
- Nicola Herbison
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Daisy MacKeith
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| | - Anthony Vivian
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| | - Jon Purdy
- Department of Computer Science, University of Hull, Hull, UK
| | - Apostolos Fakis
- Derby Clinical Trials Unit, College of Health and Social Care, University of Derby, Derby, UK
| | - Isabel M Ash
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Sue V Cobb
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham, Nottingham, UK
| | - Richard M Eastgate
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham, Nottingham, UK
| | - Stephen M Haworth
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Richard M Gregson
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Alexander Je Foss
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
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22
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Abstract
Amblyopia is a neurodevelopmental disorder that affects at least 2% of most populations and can lead to permanently reduced vision if not detected and treated within a specific period in childhood. Whole-population screening of children younger than 5 years is applied in many countries. The substantial diversity in existing programmes reflects their heterogeneous implementation in the absence of the complete evidence base that is now a pre-requisite for instituting screening. The functional importance of amblyopia at an individual level is unclear as data are scarce, but in view of the high prevalence the population-level effect might be notable. Screening of all children aged 4-5 years (eg, at school entry) confers most benefit and addresses inequity in access to timely treatment. Screening at younger ages is associated with increased risk of false-positive results, and at older ages with poor outcomes for children with moderate to severe amblyopia. We suggest that the real-life adverse effects of amblyopia should be characterised and screening and diagnosis should be standardised.
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Affiliation(s)
- Ameenat Lola Solebo
- Life Course Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, UK; Ulverscroft Vision Research Group, UCL Institute of Child Health, London, UK; Moorfields Eye Hospital NHS Foundation Trust/NIHR Moorfields Biomedical Research Centre, London, UK; Institute of Ophthalmology, University College London, London, UK
| | - Phillippa M Cumberland
- Life Course Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, UK; Ulverscroft Vision Research Group, UCL Institute of Child Health, London, UK
| | - Jugnoo S Rahi
- Life Course Epidemiology and Biostatistics Section, UCL Institute of Child Health, London, UK; Ulverscroft Vision Research Group, UCL Institute of Child Health, London, UK; Moorfields Eye Hospital NHS Foundation Trust/NIHR Moorfields Biomedical Research Centre, London, UK; Institute of Ophthalmology, University College London, London, UK; Great Ormond Street Hospital/Institute of Child Health Biomedical Research Centre, London, UK.
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23
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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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Hamm LM, Black J, Dai S, Thompson B. Global processing in amblyopia: a review. Front Psychol 2014; 5:583. [PMID: 24987383 PMCID: PMC4060804 DOI: 10.3389/fpsyg.2014.00583] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 05/25/2014] [Indexed: 01/13/2023] Open
Abstract
Amblyopia is a neurodevelopmental disorder of the visual system that is associated with disrupted binocular vision during early childhood. There is evidence that the effects of amblyopia extend beyond the primary visual cortex to regions of the dorsal and ventral extra-striate visual cortex involved in visual integration. Here, we review the current literature on global processing deficits in observers with either strabismic, anisometropic, or deprivation amblyopia. A range of global processing tasks have been used to investigate the extent of the cortical deficit in amblyopia including: global motion perception, global form perception, face perception, and biological motion. These tasks appear to be differentially affected by amblyopia. In general, observers with unilateral amblyopia appear to show deficits for local spatial processing and global tasks that require the segregation of signal from noise. In bilateral cases, the global processing deficits are exaggerated, and appear to extend to specialized perceptual systems such as those involved in face processing.
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Affiliation(s)
- Lisa M Hamm
- Department of Optometry and Vision Science, University of Auckland Auckland, New Zealand
| | - Joanna Black
- Department of Optometry and Vision Science, University of Auckland Auckland, New Zealand
| | - Shuan Dai
- Department of Ophthalmology, Starship Children's Hospital Auckland, New Zealand ; Department of Ophthalmology, University of Auckland Auckland, New Zealand
| | - Benjamin Thompson
- Department of Optometry and Vision Science, University of Auckland Auckland, New Zealand ; Department of Optometry and Vision Science, University of Waterloo Waterloo, Canada
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25
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A randomized trial of increasing patching for amblyopia. Ophthalmology 2013; 120:2270-7. [PMID: 23755872 DOI: 10.1016/j.ophtha.2013.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. DESIGN Prospective, randomized, multicenter clinical trial. PARTICIPANTS A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. INTERVENTION Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. MAIN OUTCOME MEASURES Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. RESULTS Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50(-2)). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). CONCLUSIONS When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily.
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26
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Abstract
Amblyopia is the most common cause of monocular visual loss in children, affecting 1.3%-3.6% of children. Current treatments are effective in reducing the visual acuity deficit but many amblyopic individuals are left with residual visual acuity deficits, ocular motor abnormalities, deficient fine motor skills, and risk for recurrent amblyopia. Using a combination of psychophysical, electrophysiological, imaging, risk factor analysis, and fine motor skill assessment, the primary role of binocular dysfunction in the genesis of amblyopia and the constellation of visual and motor deficits that accompany the visual acuity deficit has been identified. These findings motivated us to evaluate a new, binocular approach to amblyopia treatment with the goals of reducing or eliminating residual and recurrent amblyopia and of improving the deficient ocular motor function and fine motor skills that accompany amblyopia.
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Affiliation(s)
- Eileen E Birch
- Pediatric Laboratory, Retina Foundation of the Southwest, Dallas, TX 75231, USA.
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