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Yeritsyan A, Surve AV, Ayinde B, Chokshi P, Adhikari S, Jaimalani A, Hamid P. Efficacy of Amblyopia Treatments in Children Up to Seven Years Old: A Systematic Review. Cureus 2024; 16:e56705. [PMID: 38650802 PMCID: PMC11034898 DOI: 10.7759/cureus.56705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Amblyopia is a neurodevelopmental disorder of the visual system that impairs the vision of millions of children worldwide. Amblyopia is best treated within the sensitive period of visual development when a child is up to seven years of age. Currently, the gold standard for early treatment of childhood amblyopia is patching, with new treatments emerging in recent years. We aim to evaluate the effectiveness of these newly developed treatments for amblyopia in children aged seven years and younger while comparing them to the current industry standard of patching. We searched online databases including PubMed, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and narrative reviews relating to amblyopia treatment in children aged seven and younger. We only included articles and studies completed within the last five years and those written in the English language. After compiling a list of 297 articles, we removed duplicates, articles without an available full text, and those not relevant to our topic. Of the remaining 51 articles, we were left with 22 after reading abstracts and removing further irrelevant articles. We did a quality assessment on the remaining 22 articles and were left with 14 articles for our systematic review after removing eight low-quality articles. Of the 14 articles, we had eight RCTs, two systematic reviews, one comparative interventional study, and three narrative reviews. Seven of the articles contained data reinforcing the effectiveness of patching while comparing it to other treatment modalities. Three of the articles had data supporting spectacle correction, including a novel form called alternative flicker glass which delivers occlusion therapy via a spectacle frame with unique lenses, and ultimately deemed it at least as effective or more than patching. Data from three articles supported the use of surgery to successfully correct the angle of strabismus. Findings from five articles backed the use of pharmacologic therapy, specifically atropine when used alongside patching as a more effective alternative to patching solely. However, levodopa plus patching had no advantage over patching alone. Additionally, seven articles addressed the use of virtual reality (VR) and dichoptic therapy as prospective treatments for childhood amblyopia. VR therapy proved beneficial when used within one week after strabismus surgery. Dichoptic training was also effective in improving amblyopic-eye visual acuity when used on its own or in conjunction with spectacles. Furthermore, dichoptic movie therapy was found to be more effective than patching. Thus, we found multiple highly effective treatments for childhood amblyopia that are as effective or more than patching. Future studies should consider prescribing these treatments to larger cohorts while also performing a cost-benefit analysis for each treatment. In addition, more needs to be learned about the potential adverse side effects of these treatments, especially for pharmaceutical therapy.
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Affiliation(s)
- Artashes Yeritsyan
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ashka V Surve
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Bolaji Ayinde
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Priyank Chokshi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Sanjeev Adhikari
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aniket Jaimalani
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Rao T, Zou W, Hu X, He H, Luo W, You Z. Evaluation of retinal microcirculation alterations using OCTA in hyperopic ametropic amblyopia patients before and after treatment. Int Ophthalmol 2023; 43:3075-3085. [PMID: 37081133 PMCID: PMC10400672 DOI: 10.1007/s10792-023-02707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE We aimed to compare retinal microcirculation in hyperopic ametropic amblyopia patients before and after treatment and in healthy children using optical coherence tomography angiography (OCTA), and to explore the pathogenesis of hyperopic ametropic amblyopia. METHODS Eighteen patients with hyperopic ametropic amblyopia aged 4-8 years were selected as the patient group, and 18 age-matched healthy children were randomly selected as controls. The foveal avascular zone (FAZ) area, perimeter and circularity, vessel density (VD) and perfusion density (PD) of macular superficial retinal capillary plexus, macular thickness, peripapillary retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness were compared between both groups. After 6 months of amblyopia treatment, the same parameters were measured again. RESULTS The VD and PD in the central, inner, inner nasal, and inner inferior regions in hyperopic ametropic amblyopia were lower than in the control group after adjustment for axial length. After 6 months of treatment, the VD increased significantly, except in the outer nasal and outer inferior regions. The PD in the central (p < 0.001), inner superior (p = 0.001), inner inferior (p = 0.011) and inner temporal (p = 0.026) regions increased. The FAZ perimeter and circularity significantly differed between the groups. After 6 months of treatment, the FAZ area and perimeter decreased, but circularity increased. CONCLUSION Hyperopic ametropic amblyopia eyes showed a significant decrease in vessel and perfusion densities. After amblyopia treatment, the vessel and perfusion densities of patients with hyperopic ametropic amblyopia increased, suggesting that abnormalities in the microvascular system are a pathogenic factor of amblyopia.
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Affiliation(s)
- Ting Rao
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Wen Zou
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China
| | - Xiaoqin Hu
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Hai He
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Wei Luo
- Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Zhipeng You
- Affiliated Eye Hospital of Nanchang University, Nanchang, China.
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Simon-Martinez C, Antoniou MP, Bouthour W, Bavelier D, Levi D, Backus BT, Dornbos B, Blaha JJ, Kropp M, Müller H, Murray M, Thumann G, Steffen H, Matusz PJ. Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): a protocol for a crossover randomized controlled trial. BMC Ophthalmol 2023; 23:220. [PMID: 37198558 DOI: 10.1186/s12886-023-02944-y] [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: 01/18/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Amblyopia is the most common developmental vision disorder in children. The initial treatment consists of refractive correction. When insufficient, occlusion therapy may further improve visual acuity. However, the challenges and compliance issues associated with occlusion therapy may result in treatment failure and residual amblyopia. Virtual reality (VR) games developed to improve visual function have shown positive preliminary results. The aim of this study is to determine the efficacy of these games to improve vision, attention, and motor skills in patients with residual amblyopia and identify brain-related changes. We hypothesize that a VR-based training with the suggested ingredients (3D cues and rich feedback), combined with increasing the difficulty level and the use of various games in a home-based environment is crucial for treatment efficacy of vision recovery, and may be particularly effective in children. METHODS The AMBER study is a randomized, cross-over, controlled trial designed to assess the effect of binocular stimulation (VR-based stereoptic serious games) in individuals with residual amblyopia (n = 30, 6-35 years of age), compared to refractive correction on vision, selective attention and motor control skills. Additionally, they will be compared to a control group of age-matched healthy individuals (n = 30) to account for the unique benefit of VR-based serious games. All participants will play serious games 30 min per day, 5 days per week, for 8 weeks. The games are delivered with the Vivid Vision Home software. The amblyopic cohort will receive both treatments in a randomized order according to the type of amblyopia, while the control group will only receive the VR-based stereoscopic serious games. The primary outcome is visual acuity in the amblyopic eye. Secondary outcomes include stereoacuity, functional vision, cortical visual responses, selective attention, and motor control. The outcomes will be measured before and after each treatment with 8-week follow-up. DISCUSSION The VR-based games used in this study have been conceived to deliver binocular visual stimulation tailored to the individual visual needs of the patient, which will potentially result in improved basic and functional vision skills as well as visual attention and motor control skills. TRIAL REGISTRATION This protocol is registered on ClinicalTrials.gov (identifier: NCT05114252) and in the Swiss National Clinical Trials Portal (identifier: SNCTP000005024).
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Affiliation(s)
- Cristina Simon-Martinez
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland.
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland.
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland.
| | - Maria-Paraskevi Antoniou
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Walid Bouthour
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Daphne Bavelier
- Faculty of Psychology and Education Sciences, University of Geneva, Geneva, Switzerland
| | - Dennis Levi
- Herbert Wertheim School of Optometry & Vision Science, Helen Wills Neuroscience Institute, University of California Berkley, Berkley, CA, USA
| | - Benjamin T Backus
- Vivid Vision, Inc, 424 Treat Ave., Ste B, San Francisco, CA, 94110, USA
| | - Brian Dornbos
- Vivid Vision, Inc, 424 Treat Ave., Ste B, San Francisco, CA, 94110, USA
| | - James J Blaha
- Vivid Vision, Inc, 424 Treat Ave., Ste B, San Francisco, CA, 94110, USA
| | - Martina Kropp
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Henning Müller
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland
| | - Micah Murray
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland
- Institute of Health Sciences, School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Laboratory for Investigative Neurophysiology, Department of Radiology, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Gabriele Thumann
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Heimo Steffen
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
| | - Pawel J Matusz
- University of Applied Sciences Western Switzerland (HES-SO) Valais-Wallis, Rue de Technopole 3, 3960, Sierre, Switzerland
- Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Sion, Switzerland
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland
- Institute of Health Sciences, School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
- Laboratory for Investigative Neurophysiology, Department of Radiology, Lausanne University Hospital, University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Cao Y, Wang Y, Li B, Zhu D, Sang T, Du X, Shi W, Yang L. Analysis of risk factors associated with the high incidence of amblyopia in preterm infants at the corrected gestational age of 12 months. BMC Pediatr 2023; 23:136. [PMID: 36966278 PMCID: PMC10039439 DOI: 10.1186/s12887-023-03937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 03/27/2023] Open
Abstract
OBJECTIVE To investigate the perinatal and in-hospital risk factors associated with the high incidence of amblyopia in preterm infants and to analyze the correlation between the amblyopia and neurodevelopment. METHODS Children discharged from the neonatal intensive care unit (NICU) at 12 months of corrected gestational age were retrospectively included in this study. Ocular screening was performed in children. At the risk of amblyopia was determined according to the American Academy of Ophthalmology Guidelines for automated preschool vision screening factors. Differences in perinatal characteristics, complications during hospitalization, and treatment modalities between the two groups of children were analyzed, and multifactorial logistic regression analysis was used to identify the independent risk factors for amblyopia. The results of developmental assessment were collected retrospectively to analyze the correlation between amblyopia and various aspects of neurological development. RESULTS A total of 128 preterm infants, 30 in the amblyopia risk group and 98 in the non-amblyopia risk group, were included in this study. Univariate analysis showed that the amblyopia risk group had lower birth weights, higher rates of asphyxia, preterm brain white matter injury, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis during hospitalization, and higher rates of treatment with pulmonary surfactant (PS), blood transfusion, invasive ventilator, and levothyroxine. Logistic regression analysis showed that BPD in the neonatal period (odds ratio [OR] 8.355, 95% confidence interval [CI] 1.492, 46.786), brain white matter injury (OR 16.742, 95% CI 0.684, 409.804), treatment with levothyroxine (OR 2.859, 95% CI 0.946, 8.639), and use of an invasive ventilator (OR 2.983, 95% CI 0.942, 9.445) were independent risk factors for amblyopia at 12 months of corrected gestational age, while the administration of glucocorticoids (OR 0.055, 95% CI 0.004, 0.737) was a protective factor. Regarding neurodevelopmental assessment, the number of infants with lagging fine motor development was greater in the amblyopia risk group. CONCLUSION The presence of BPD in the neonatal period, brain white matter damage in preterm infants, and use of levothyroxine and invasive ventilator were high risk factors for amblyopia. The use of glucocorticoids therapy was a protective factor. Children with risk of amblyopia had a higher rate of poor fine motor development.
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Affiliation(s)
- Yiwen Cao
- Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Ying Wang
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Bian Li
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Dehai Zhu
- Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, 100034, China
| | - Tian Sang
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Xueyan Du
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Wanjun Shi
- Department of Pediatric, Peking University First Hospital, Beijing, 100034, China
| | - Liu Yang
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, China.
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Skirzewski M, Molotchnikoff S, Hernandez LF, Maya-Vetencourt JF. Multisensory Integration: Is Medial Prefrontal Cortex Signaling Relevant for the Treatment of Higher-Order Visual Dysfunctions? Front Mol Neurosci 2022; 14:806376. [PMID: 35110996 PMCID: PMC8801884 DOI: 10.3389/fnmol.2021.806376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 11/29/2022] Open
Abstract
In the mammalian brain, information processing in sensory modalities and global mechanisms of multisensory integration facilitate perception. Emerging experimental evidence suggests that the contribution of multisensory integration to sensory perception is far more complex than previously expected. Here we revise how associative areas such as the prefrontal cortex, which receive and integrate inputs from diverse sensory modalities, can affect information processing in unisensory systems via processes of down-stream signaling. We focus our attention on the influence of the medial prefrontal cortex on the processing of information in the visual system and whether this phenomenon can be clinically used to treat higher-order visual dysfunctions. We propose that non-invasive and multisensory stimulation strategies such as environmental enrichment and/or attention-related tasks could be of clinical relevance to fight cerebral visual impairment.
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Affiliation(s)
- Miguel Skirzewski
- Rodent Cognition Research and Innovation Core, University of Western Ontario, London, ON, Canada
| | - Stéphane Molotchnikoff
- Département de Sciences Biologiques, Université de Montréal, Montreal, QC, Canada
- Département de Génie Electrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Luis F. Hernandez
- Knoebel Institute for Healthy Aging, University of Denver, Denver, CO, United States
| | - José Fernando Maya-Vetencourt
- Department of Biology, University of Pisa, Pisa, Italy
- Centre for Synaptic Neuroscience, Istituto Italiano di Tecnologia (IIT), Genova, Italy
- *Correspondence: José Fernando Maya-Vetencourt
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Al-Jabri S, Rowe FJ, Kirkham JJ. Core outcome set for three ophthalmic conditions: a healthcare professional and patient consensus on core outcome sets for amblyopia, ocular motility and strabismus (COSAMS Study). BMJ Open 2021; 11:e042403. [PMID: 33980515 PMCID: PMC8118006 DOI: 10.1136/bmjopen-2020-042403] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/29/2022] Open
Abstract
OBJECTIVES Amblyopia, strabismus and ocular motility disorders are common conditions with significant impact on visual function, appearance and quality of life. We aimed to establish a core set of outcomes for each of the three conditions for use in clinical trials and routine clinical practice. DESIGN A comprehensive databank of outcomes was developed from a systematic review of the literature and a series of focus groups with healthcare professionals, researchers, patients and carers. The databank of outcomes was scored in a two-round Delphi Survey completed by two stakeholder groups: healthcare professionals/researchers and patients/carers. Results of the online Delphi were discussed at a face-to-face consensus meeting where the core outcome sets were finalised. SETTING UK-wide consultation. PARTICIPANTS Researchers, clinicians, patients and carers. OUTCOME MEASURES Core outcome sets. RESULTS For amblyopia, strabismus and ocular motility, 40/42/33 participants contributed to both rounds of the Delphi; six/nine/seven members attended consensus meetings, respectively. Consensus was reached on ten core outcomes for both amblyopia and ocular motility and nine for strabismus. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life and ocular alignment. The strabismus and ocular motility disorder core sets included, in addition, measuring the deviation, binocular vision, ocular movement, patient satisfaction and symptoms. The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, spherical and cylindrical refraction, compliance and treatment-related and functionality/long-term impacts. CONCLUSIONS The study used robust consensus methods to develop a core outcome set for three ophthalmic conditions. Implementation of these core outcome sets in clinical trials and routine clinical practice will ensure that the outcomes being measured and reported are relevant to all stakeholders. This will enhance the relevance of study findings and enable comparison of results from different studies.
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Affiliation(s)
- Samiya Al-Jabri
- Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Fiona J Rowe
- Institute of Population Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Brin TA, Chow A, Carter C, Oremus M, Bobier W, Thompson B. Efficacy of vision-based treatments for children and teens with amblyopia: a systematic review and meta-analysis of randomised controlled trials. BMJ Open Ophthalmol 2021; 6:e000657. [PMID: 33912684 PMCID: PMC8043000 DOI: 10.1136/bmjophth-2020-000657] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/18/2021] [Accepted: 03/13/2021] [Indexed: 11/03/2022] Open
Abstract
Objective To identify differences in efficacy between vision-based treatments for improving visual acuity (VA) of the amblyopic eye in persons aged 4-17 years old. Data sources Ovid Embase, PubMed (Medline), the Cochrane Library, Vision Cite and Scopus were systematically searched from 1975 to 17 June 2020. Methods Two independent reviewers screened search results for randomised controlled trials of vision-based amblyopia treatments that specified change in amblyopic eye VA (logMAR) as the primary outcome measure. Quality was assessed via risk of bias and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Results Of the 3346 studies identified, 36 were included in a narrative synthesis. A random effects meta-analysis (five studies) compared the efficacy of binocular treatments versus patching: mean difference -0.03 logMAR; 95% CI 0.01 to 0.04 (p<0.001), favouring patching. An exploratory study-level regression (18 studies) showed no statistically significant differences between vision-based treatments and a reference group of 2-5 hours of patching. Age, sample size and pre-randomisation optical treatment were not statistically significantly associated with changes in amblyopic eye acuity. A network meta-analysis (26 studies) comparing vision-based treatments to patching 2-5 hours found one statistically significant comparison, namely, the favouring of a combination of two treatment arms comparing combination and binocular treatments, against patching 2-5 hours: standard mean difference: 2.63; 95% CI 1.18 to 4.09. However, this result was an indirect comparison calculated from a single study. A linear regression analysis (17 studies) found a significant relationship between adherence and effect size, but the model did not completely fit the data: regression coefficient 0.022; 95% CI 0.004 to 0.040 (p=0.02). Conclusion We found no clinically relevant differences in treatment efficacy between the treatments included in this review. Adherence to the prescribed hours of treatment varied considerably and may have had an effect on treatment success.
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Affiliation(s)
- Taylor Adrian Brin
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Amy Chow
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin Carter
- Library, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Oremus
- Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - William Bobier
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Benjamin Thompson
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Center for Eye and Vision Research, 17W Science Park, Hong Kong, Hong Kong.,Liggins Institute, University of Auckland, Auckland, New Zealand
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Vagge A, Ferro Desideri L, Traverso CE. An update on pharmacological treatment options for amblyopia. Int Ophthalmol 2020; 40:3591-3597. [PMID: 32770293 DOI: 10.1007/s10792-020-01535-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Amblyopia is a common cause of visual impairment in children and young adults. The cornerstone in the management of this disorder is based on increasing visual stimulation of the amblyopic eye by occlusion, by administering atropine or by causing optical penalization of the dominant eye. All these treatment options have shown some limits in terms of efficacy, due to the suboptimal treatment adherence for the patients and the lack of long-term clinical outcomes. Moreover, although it is well known that clinical efficacy decreases with age, new evidence is suggesting that cortical plasticity can be induced also in older children. For these reasons, new treatment options are being studied, in order to extend the "treatment window" beyond the critical period also in older patients. In this review, we will discuss all the most promising novel pharmacological agents in the management of amblyopia.
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Affiliation(s)
- Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Macula Onlus Foundation, Genoa, Italy
| | - Lorenzo Ferro Desideri
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy. .,Macula Onlus Foundation, Genoa, Italy.
| | - Carlo Enrico Traverso
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Macula Onlus Foundation, Genoa, Italy
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Li Y, Sun H, Zhu X, Su Y, Yu T, Wu X, Zhou X, Jing L. Efficacy of interventions for amblyopia: a systematic review and network meta-analysis. BMC Ophthalmol 2020; 20:203. [PMID: 32450849 PMCID: PMC7249307 DOI: 10.1186/s12886-020-01442-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many treatments are currently available for amblyopic patients; although, the comparative efficacy of these therapies is unclear. We conducted a systematic review and network meta-analysis (NMA) to establish the relative efficacy of these treatments for amblyopia. METHODS Electronic databases (MEDLINE, EMBASE, Cochrane Library) were systematically searched from inception to Sep. 2019. Only Randomized clinical trials comparing any two or three of the following treatments were included: refractive correction (spectacles alone), patching of 2 h per day (patch 2H), patch 6H, patch 12H, patch 2H + near activities (N), patch 2H + distant activities (D), atropine (Atr) daily, Atr weekly, Atr weekly + plano lens over the sound eye (Plano), optical penalization and binocular therapy. The reviewers independently extracted the data according to the PRISMA guidelines; assessed study quality by Cochrane risk-of-bias tool for randomized trials. The primary outcome measure was the change in best-corrected visual acuity (BCVA) expressed as log MAR lines. Direct comparisons and a Bayesian meta-analysis were performed to synthesize data. RESULTS Twenty-three studies with 3279 patients were included. In the network meta-analysis, optical penalization was the least effective of all the treatments for the change of visual acuity, spectacles (mean difference [MD], 2.9 Log MAR lines; 95% credibility interval [CrI], 1.8-4.0), patch 2H (MD, 3.3; 95% CrI, 2.3-4.3), patch 6H (MD, 3.6; 95% CrI, 2.6-4.6), patch 12H (MD, 3.4; 95% CrI, 2.3-4.5), patch 2H + N (MD, 3.7; 95% CrI, 2.5-5.0), patch 2H + D (MD, 3.5; 95% CrI, 2.1-5.0), Atr daily (MD, 3.2; 95% CrI, 2.2-4.3), Atr weekly (MD, 3.2; 95% CrI, 2.2-4.3), Atr weekly + Plano (MD, 3.7; 95% CrI, 2.7-4.7), binocular therapy (MD, 3.1; 95% CrI, 2.0-4.2). The patch 6H and patch 2H + N were better than spectacles ([MD, 0.73; 95% Crl, 0.10-1.40]; [MD, 0.84; 95% CrI, 0.19-1.50]). CONCLUSIONS The NMA indicated that the efficacy of the most of the examined treatment modalities for amblyopia were comparable, with no significant difference. Further high quality randomized controlled trials are required to determine their efficacy and acceptability. SYSTEMATIC REVIEW REGISTRATION CRD42019119843.
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Affiliation(s)
- Yonghong Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Huan Sun
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaojuan Zhu
- Department of Ophthalmology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Yana Su
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Tianqi Yu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Xinyu Wu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Xiaoqin Zhou
- Department of Clinical Research Management, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China
| | - Li Jing
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610041, China.
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