1
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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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2
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Jia Y, Ye Q, Liu J, Feng L, Xu Z, He Y, Zhou Y, Chen X, Yao Y, Thompson B, Li J. Associations between the cause of amblyopia and pre-treatment contrast sensitivity, stereoacuity, fixation, and nystagmus. Heliyon 2024; 10:e28857. [PMID: 38596124 PMCID: PMC11002286 DOI: 10.1016/j.heliyon.2024.e28857] [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: 10/25/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024] Open
Abstract
Purpose To explore the association between the cause of amblyopia and pre-treatment contrast sensitivity, stereoacuity, fixation and nystagmus. Design Retrospective cohort study. Methods A retrospective review was conducted for 3408 patients with amblyopia who had not yet started amblyopia treatment utilizing a large amblyopia patient database maintained at Zhongshan Ophthalmic Centre. Six amblyogenic factor subtypes were identified: anisometropia, isoametropia, strabismus, anisometropia and strabismus, monocular visual deprivation, and binocular visual deprivation amblyopia. Monocular best corrected visual acuity (BCVA), the contrast sensitivity function (CSF), fixation, and stereopsis were compared between the subtypes before and after propensity score matching (PSM) for age and sex. Results The two deprivation groups had poorer BCVA and CSF than the other groups. There were no systematic differences in CSF between the non-deprivation groups. Nystagmus was more common in the bilateral amblyopia groups compared to the monocular amblyopia groups. Eccentric fixation was uncommon with the exception of the anisometropia and strabismus group which had an eccentric fixation rate of 20%. Distance stereoacuity measured without monocular cues was absent for almost all patients. The results were consistent when analyzed using PSM. Conclusion Visual deprivation causes more severe amblyopia than other amblyogenic factors. For non-deprivation amblyopia subtypes, individual differences such as variation in the severity of the amblyogenic factor might be more important in determining pre-treatment vision than whether amblyopia was caused by refractive error, strabismus or both.
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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
| | - Jing Liu
- 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
| | - 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
| | - 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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3
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Kaur S, Sharda S, Aggarwal H, Dadeya S. Comprehensive review of amblyopia: Types and management. Indian J Ophthalmol 2023; 71:2677-2686. [PMID: 37417105 PMCID: PMC10491072 DOI: 10.4103/ijo.ijo_338_23] [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: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
The optimal method of treatment for a child depends on the patient's age at the time of diagnosis, the onset and type of amblyopia, and the degree of compliance attainable. In deprivation amblyopia, the cause of visual impairment (e.g., cataract, ptosis) needs to be treated first, and then the disorder can be treated such as other types of amblyopia. Anisometropic amblyopia needs glasses first. In strabismic amblyopia, conventionally amblyopia should be treated first, and then strabismus corrected. Correction of strabismus will have little if any effect on the amblyopia, although the timing of surgery is controversial. Best outcomes are achieved if amblyopia is treated before the age of 7 years. The earlier the treatment, the more efficacious it is. In selected cases of bilateral amblyopia, the more defective eye must be given a competitive advantage over the comparatively good eye. Glasses alone can work when a refractive component is present, but occlusion might make the glasses work faster. The gold standard therapy for amblyopia remains occlusion of the better eye although penalization is also evidenced to achieve equal results. Pharmacotherapy has been shown to achieve suboptimal outcomes. Newer monocular and binocular therapies based on neural tasks and games are adjuncts to patching and can also be used in adults.
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Affiliation(s)
- Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shipra Sharda
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | | | - Subhash Dadeya
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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4
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Wu C, Gaier ED, Nihalani BR, Whitecross S, Hensch TK, Hunter DG. Durable recovery from amblyopia with donepezil. Sci Rep 2023; 13:10161. [PMID: 37349338 PMCID: PMC10287641 DOI: 10.1038/s41598-023-34891-5] [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: 05/24/2022] [Accepted: 05/09/2023] [Indexed: 06/24/2023] Open
Abstract
An elevated threshold for neuroplasticity limits visual gains with treatment of residual amblyopia in older children and adults. Acetylcholinesterase inhibitors (AChEI) can enable visual neuroplasticity and promote recovery from amblyopia in adult mice. Motivated by these promising findings, we sought to determine whether donepezil, a commercially available AChEI, can enable recovery in older children and adults with residual amblyopia. In this open-label pilot efficacy study, 16 participants (mean age 16 years; range 9-37 years) with residual anisometropic and/or strabismic amblyopia were treated with daily oral donepezil for 12 weeks. Donepezil dosage was started at 2.5 or 5.0 mg based on age and increased by 2.5 mg if the amblyopic eye visual acuity did not improve by 1 line from the visit 4 weeks prior for a maximum dosage of 7.5 or 10 mg. Participants < 18 years of age further patched the dominant eye. The primary outcome was visual acuity in the amblyopic eye at 22 weeks, 10 weeks after treatment was discontinued. Mean amblyopic eye visual acuity improved 1.2 lines (range 0.0-3.0), and 4/16 (25%) improved by ≥ 2 lines after 12 weeks of treatment. Gains were maintained 10 weeks after cessation of donepezil and were similar for children and adults. Adverse events were mild and self-limited. Residual amblyopia improves in older children and adults treated with donepezil, supporting the concept that the critical window of visual cortical plasticity can be pharmacologically manipulated to treat amblyopia. Placebo-controlled studies are needed.
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Affiliation(s)
- Carolyn Wu
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Bharti R Nihalani
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sarah Whitecross
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Takao K Hensch
- Center for Brain Science, Department of Molecular Cellular Biology, Harvard University, Cambridge, MA, USA
- International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, Tokyo, Japan
- FM Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- International Research Center for Neurointelligence, University of Tokyo Institutes for Advanced Study, Tokyo, Japan
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5
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Yoneda T, Miki A, Wakayama A, Nishina S. National survey of amblyopia treatment in Japan: comparison with amblyopia treatment study results of the pediatric eye disease investigator group. Jpn J Ophthalmol 2023; 67:97-108. [PMID: 36508061 DOI: 10.1007/s10384-022-00968-3] [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: 05/11/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the treatment policy for amblyopia in Japan as of 2017 through a survey of multiple facilities and to compare the findings with those obtained by the Amblyopia Treatment Study (ATS) of the Pediatric Eye Disease Investigator Group. STUDY DESIGN Questionnaire survey study. SUBJECTS AND METHODS A questionnaire was sent to 181 facilities where patients with amblyopia are being treated. The outcomes of the present survey were compared with the results of the ATS study, and the coincidence rates were evaluated. RESULTS The questionnaire response rate was 68.0%. The treatment plan that showed the highest agreement between the outcomes of the ATS study and the present study was whether or not treatment was to be given to patients aged 10-15 years who had received no previous treatment; 90% of the facilities answered that they would provide treatment to such patients as well. The next highest agreement was the future treatment of amblyopia with stable visual acuity in the affected eye; 82.6% of the facilities responded that they would reduce the occlusion time. On the other hand, the lowest agreement rate was the follow-up period of the refractive correction for moderate anisometropic amblyopia. The ATS showed "4 months," whereas most of the facilities in the present survey replied "3 months." The agreement rate was 10.8%. CONCLUSION The amblyopia treatment in Japan survey did not always agree with the research results of the ATS. Japanese ophthalmologists tend to make treatment plans for amblyopia according to their clinical experience.
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Affiliation(s)
- Tsuyoshi Yoneda
- Department of Orthoptics, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama, 701-0193, Japan
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Atsushi Miki
- Department of Orthoptics, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama, 701-0193, Japan.
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Akemi Wakayama
- Department of Ophthalmology, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Sachiko Nishina
- Department of Ophthalmology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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6
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Xiao S, Angjeli E, Gaier ED, Binenbaum G, Hunter DG. Reply. Ophthalmology 2022; 129:e152-e153. [PMID: 35868879 DOI: 10.1016/j.ophtha.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Scott Xiao
- 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
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7
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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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8
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Randomized clinical trial of streaming dichoptic movies versus patching for treatment of amblyopia in children aged 3 to 7 years. Sci Rep 2022; 12:4157. [PMID: 35264692 PMCID: PMC8905014 DOI: 10.1038/s41598-022-08010-9] [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] [Received: 10/12/2021] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Contrast-rebalanced dichoptic movies have been shown to be an effective binocular treatment for amblyopia in the laboratory. Yet, at-home therapy is a more practical approach. In a randomized clinical trial, we compared dichoptic movies, streamed at-home on a handheld 3D-enabled game console, versus patching as amblyopia treatment. Sixty-five amblyopic children (3–7 years; 20/32–125) were randomly assigned to one of two parallel arms, binocular treatment (3 movies/week) or patching (14 h/week). The primary outcome, change in best corrected visual acuity (BCVA) at the 2-week visit was completed by 28 and 30, respectively. After the primary outcome, both groups of children had the option to complete up to 6 weeks of binocular treatment. At the 2-week primary outcome visit, BCVA had improved in the movie (0.07 ± 0.02 logMAR; p < .001) and patching (0.06 ± 0.01 logMAR; p < 0.001) groups. There was no significant difference between groups (CI95%: − 0.02 to 0.04; p = .48). Visual acuity improved in both groups with binocular treatment up to 6 weeks (0.15 and 0.18 logMAR improvement, respectively). This novel, at-home, binocular movie treatment improved amblyopic eye BCVA after 2 weeks (similar to patching), with additional improvement up to 6 weeks. Repeated binocular visual experience with contrast-rebalanced binocular movies provides an additional treatment option for amblyopia. Clincaltrials.gov identifier: NCT03825107 (31/01/2019).
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9
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White E, Walsh L. The impact of occlusion therapy and predictors on amblyopia dose-response relationship. Strabismus 2022; 30:78-89. [PMID: 35259060 DOI: 10.1080/09273972.2022.2046114] [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] [Indexed: 10/18/2022]
Abstract
This study aimed to calculate the dose-response relationship and predictors of visual acuity (VA) improvement following occlusion therapy at the IWK Health Center Eye Clinic and to add to amblyopia therapy dose-response relationship literature. A retrospective chart review was performed, considering patients who reached an occlusion therapy outcome at the IWK Eye Clinic between 2012 and 2019. The treatment outcome was defined as equal VA or stable VA for three consecutive clinical visits despite reported compliance. Subjective patching hours from parental reports, not prescribed hours, were used for statistical analyses. One hundred and thirty-four patients (66 females and 68 males) ages 2-11 years were included. Results showed a dose-response relationship of 224 hours/0.1logMAR increase in VA and total dose of 1344 hours for full-time occlusion and 504 hours for part-time occlusion was required to reach outcome VA. The fastest VA improvement occurred with younger age at treatment initiation, during the first 4 weeks of treatment, and in patients with strabismic and/or severe amblyopia. Classification of amblyopia, age, VA chart, initial distance VA (amblyopic eye), and treatment dose predicted the hour dose-response relationship. Dose-response relationship was faster in younger participants, in participants with strabismic and severe amblyopia, and during the first month of occlusion. Additionally, by creating a GLM model of dose-response relationship, relationship calculations can be performed. Therefore, an estimated timeline can be developed to allow allocation of clinical resources and to prepare patients for the treatment duration required and possibly increase treatment compliance.
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Affiliation(s)
- Emily White
- IWK Eye Clinic, IWK Health Centre, Halifax, Nova Scotia, Canada.,Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Faculty of Health, Clinical Vision Science Program, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Walsh
- IWK Eye Clinic, IWK Health Centre, Halifax, Nova Scotia, Canada.,Faculty of Health, Clinical Vision Science Program, Dalhousie University, Halifax, Nova Scotia, Canada
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Huang X, Xia H, Zhang Q, Blakemore C, Nan Y, Wang W, Gao J, Ng SS, Wen J, Huang T, Li X, Pu M. New treatment for amblyopia based on rules of synaptic plasticity: a randomized clinical trial. SCIENCE CHINA. LIFE SCIENCES 2022; 65:451-465. [PMID: 35015247 DOI: 10.1007/s11427-021-2030-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
Amblyopia resulting from early deprivation of vision or defocus in one eye reflects an imbalance of input from the eyes to the visual cortex. We tested the hypothesis that asynchronous stimulation of the two eyes might induce synaptic plasticity and rebalance input. Experiments on normal adults showed that repetitive brief exposure of grating stimuli, with the onset of each stimulus delayed by 8.3 ms in one eye, results in a shift in perceptual eye dominance. Clinical studies (Clinical trial registration number: ChiCTR2100049130), using popular 3D movies with similar asynchrony between the two eyes (amblyopic eye stimulated first) to treat anisometropic amblyopia, established that just 10.5 h of conditioning over <3 weeks produced improvement that met criteria for successful treatment. The benefits of asynchronous conditioning accumulate over 20-30 45 min sessions, and are maintained for at least 2 years. Finally, we demonstrate that asynchronous binocular treatment alone is more effective than patching only. This novel treatment is popular with children and is some 50 times more efficient than patching alone.
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Affiliation(s)
- Xin Huang
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China.,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China
| | - Huika Xia
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China.,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China.,Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Qi Zhang
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China.,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China
| | - Colin Blakemore
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China.
| | - Yan Nan
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China.,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China
| | - Wenyao Wang
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China.,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China.,Department of Computer Science, School of Electrical Engineering and Computer Sciences, Peking University, Beijing, 100191, China
| | - Jie Gao
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China.,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China
| | - Spencer S Ng
- Department of Biology, University of California, Los Angeles, 90095-7246, USA
| | - Jing Wen
- Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, 100034, China.,National Amblyopia and Strabismus Prevention and Treatment Center, Beijing, 100034, China
| | - Tiejun Huang
- Department of Computer Science, School of Electrical Engineering and Computer Sciences, Peking University, Beijing, 100191, China. .,National Engineering Laboratory for Video Technology, Peking University, Beijing, 100871, China.
| | - Xiaoqing Li
- Department of Pediatric Ophthalmology, Peking University First Hospital, Beijing, 100034, China. .,National Amblyopia and Strabismus Prevention and Treatment Center, Beijing, 100034, China.
| | - Mingliang Pu
- Department of Anatomy, School of Basic Medical Sciences, Peking University, Beijing, 100083, China. .,Key Laboratory on Machine Perception (Ministry of Education), Peking University, Beijing, 100083, China.
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11
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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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12
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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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13
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Roda M, Pellegrini M, Di Geronimo N, Vagge A, Fresina M, Schiavi C. Binocular treatment for amblyopia: A meta-analysis of randomized clinical trials. PLoS One 2021; 16:e0257999. [PMID: 34624028 PMCID: PMC8500435 DOI: 10.1371/journal.pone.0257999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To date, there is still no consensus regarding the effect of binocular treatment for amblyopia. The purpose of this systematic review and meta-analysis was to summarize the available evidence to determine whether binocular treatment is more effective than patching in children with amblyopia. METHODS Four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) were searched for studies that compared binocular treatment and patching in children with amblyopia. The outcome measures were visual acuity and stereopsis. Pooled effects sizes were calculated with a random-effect model. The standardized difference in means (SDM) with 95% confidence intervals (CI) was calculated. Sensitivity analysis and assessment of publication bias were performed. RESULTS Five randomized clinical trials were included. No significant difference in visual acuity between patients treated with binocular treatment and patching was observed (SDM = -0.12; 95% CI: -0.45-0.20; P = 0.464). No significant difference in stereopsis between patients treated with binocular treatment and patching was observed (SDM = -0.07; 95% CI: -0.61-0.48; P = 0.809). For both variables, the between-study heterogeneity was high (respectively, I2 = 61% and I2 = 57%). CONCLUSIONS This meta-analysis found no convincing evidence supporting the efficacy of binocular treatment as an alternative to conventional patching. Therefore, the binocular treatment cannot fully replace traditional treatment but, to date, it can be considered a valid complementary therapy in peculiar cases. Further studies are required to determine whether more engaging therapies and new treatment protocols are more effective.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Marco Pellegrini
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Natalie Di Geronimo
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, Genoa, Italy
| | - Michela Fresina
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
| | - Costantino Schiavi
- Ophthalmology Unit, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Italy
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Shoshany TN, Chinn RN, Staffa SJ, Bishop K, Michalak S, Hunter DG. Identifying Characteristics Predictive of Lost-to-Follow-Up Status in Amblyopia. Am J Ophthalmol 2021; 230:200-206. [PMID: 33992614 DOI: 10.1016/j.ajo.2021.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/29/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify demographic and disease-related characteristics predictive of Lost-to-Follow-Up (LTFU) status in amblyopia treatment and create a risk model for predicting LTFU status. DESIGN Retrospective cohort study METHODS: Setting: Single-center, ophthalmology department at Boston Children's Hospital (BCH). PATIENTS 2037 patients treated for amblyopia at BCH between 2010 and 2014. OBSERVATION PROCEDURE LTFU was defined as patients who did not return after initial visit, excluding those who came for second opinion. Multiple variables were tested for association with LTFU status. OUTCOME MEASURE Odds ratio of LTFU risk associated with each variable. Multivariate logistic regression was used to create a risk score for predicting LTFU status. RESULTS A large proportion of patients (23%) were LTFU after first visit. Older age, nonwhite race, lack of insurance, previous glasses or atropine treatment, and longer requested follow-up intervals were independent predictors of LTFU status. A multivariable risk score was created to predict probability of LTFU (area under the curve 0.68). CONCLUSIONS Our comprehensive amblyopia database allows us to predict which patients are more likely to be LTFU after baseline visit and develop strategies to mitigate these effects. These findings may help with practice efficiency and improve patient outcomes in the future by transitioning these analyses to an electronic medical record that could be programmed to provide continually updated decision support for individual patients based on large data sets.
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Affiliation(s)
| | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kaila Bishop
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Suzanne Michalak
- From the Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, USA
| | - David G Hunter
- From the Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
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15
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Boniquet-Sanchez S, Sabater-Cruz N. Current Management of Amblyopia with New Technologies for Binocular Treatment. Vision (Basel) 2021; 5:31. [PMID: 34200969 PMCID: PMC8293449 DOI: 10.3390/vision5020031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 12/19/2022] Open
Abstract
Amblyopia is the most common cause of monocular poor vision affecting up to 3.7% of the global population. Classically, the first step in treatment has been optical correction, followed by patching and/or pharmacological treatment. However, this is an evolving scenario, since researchers and clinicians are interested in new binocular treatments due to the increasing development of new technologies. In this article main, current binocular treatments as Dig Rush, falling blocks, I-BiT, Occlu-tab, Vivid Vision, and movies are reviewed for binocular amblyopia management.
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Affiliation(s)
- Sandra Boniquet-Sanchez
- Anterior Segment Department, Institut Clinic d’Oftalmologia, Hospital Clinic of Barcelona, 08036 Barcelona, Spain;
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16
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Portable rotating grating stimulation for anisometropic amblyopia with 6 months training. Sci Rep 2021; 11:11430. [PMID: 34075118 PMCID: PMC8169940 DOI: 10.1038/s41598-021-90936-7] [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: 12/17/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Treatment of grating stimulation has been used in amblyopia for decades, but high dropout rate and inconvenience for daily practice occur in previous studies. We developed a home-based portable system with rotating grating stimulation on a tablet. Thirty anisometropic amblyopic children were randomly allocated into the control or Grating group. They drew contour of the picture under patch of a better eye for 6 months. Best-corrected visual acuity (BCVA), grating acuity (GA), and contrast sensitivity (CS) were assessed at the baseline, 1st, 2nd, 3rd, and 6th months of training. All participants completed the 6-month training. Patched eyes of both groups exhibited no difference. Trained eyes of the control group had significantly slight improvement in BCVA and GA. In particular, the Grating group exhibited significantly higher BCVA, GA, and CS compared with those of the control group at the 3rd and 6th months of training. Moreover, percentage of the Grating group with great improvement (BCVA ≥ 0.3 or CS ≥ 0.3) was significantly larger than those of the control group at the 3rd or 6th months of training. The portable grating stimulation system demonstrates its trainability by no dropout and effectiveness by significant improvements in all assessments through a well experimental design. Trial Registration: ClinicalTrials.gov NCT04213066, registered 30/12/2019, https://clinicaltrials.gov/ct2/show/NCT04213066.
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Murray J, Garg K, Ghasia F. Monocular and Binocular Visual Function Deficits in Amblyopic Patients with and without Fusion Maldevelopment Nystagmus. Eye Brain 2021; 13:99-109. [PMID: 33953627 PMCID: PMC8089081 DOI: 10.2147/eb.s300454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study is to examine the association between amblyopia type and the presence of nystagmus on binocular and monocular functions of the fellow (FE) and amblyopic eye (AE). Methods We recruited 19 controls and 44 amblyopes (anisometropes=13, strabismic=10, mixed=21). We measured visual, grating, and vernier acuities and high/low spatial frequency (SF) contrast sensitivities in each eye using a staircase method. Stereoacuity was measured with the Titmus fly test. We recorded fixation eye movements (FEM) using high-resolution video-oculography. Subjects were classified as having either no nystagmus (n=18), fusion maldevelopment nystagmus syndrome (FMNS) (n=12), or nystagmus without any structural anomalies that does not meet the criteria for FMNS or infantile nystagmus (n=14). Results Analysis of visual function by clinical amblyopia type showed that patients with strabismus/mixed amblyopia (F (2,54)=9.5, p<0.001) were more likely to have poor stereopsis while controlling for AE grating acuity deficit. The FE of patients with anisometropia had greater contrast sensitivity deficits at low (F (2,43)=4.4, p=0.018) and high SF (F (2,42)=10.1, p<0.001). Analysis of visual function by FEM characteristics (low SF: (F (3,43)=4.3, p=0.010) and high SF: (F (3,42)=7.1, p=0.001) showed that the FE of patients with FMNS had worse low and high SF contrast sensitivities, whereas those without FMNS had greater contrast sensitivity deficits only at high SF compared to controls. Patients with FMNS (F (3,54) = 12.9, p<0.001) were more likely to have poor stereopsis while controlling for AE grating acuity deficit compared to patients without FMNS. All amblyopic patients had worse high SF contrast sensitivity of the AE irrespective of type or FEM characteristics (Type = F (2,43)=8.8, p=0.001; FEM characteristics= F (3,43)=5.1, p=0.004). Conclusion The presence of FMNS in patients with strabismic/mixed amblyopia is associated with poor/absent stereopsis. FE deficits vary across amblyopia type. Like FEM abnormalities, visual function deficits are seen in the FE of patients with and without nystagmus.
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Affiliation(s)
- Jordan Murray
- Cleveland Clinic Cole Eye Institute, Ophthalmological Research, Cleveland, OH, USA
| | - Kiran Garg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fatema Ghasia
- Cleveland Clinic Cole Eye Institute, Department of Ophthalmology, Cleveland, OH, 44195-0001, USA
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19
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Suttle CM. Active treatments for amblyopia: a review of the methods and evidence base. Clin Exp Optom 2021; 93:287-99. [DOI: 10.1111/j.1444-0938.2010.00486.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Catherine M Suttle
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
E‐mail
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20
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Milla M, Piñero DP. Characterization, passive and active treatment in strabismic amblyopia: a narrative review. Int J Ophthalmol 2020; 13:1132-1147. [PMID: 32685403 PMCID: PMC7321947 DOI: 10.18240/ijo.2020.07.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/15/2020] [Indexed: 12/22/2022] Open
Abstract
Strabismic amblyopia is characterized by a distorted spatial perception. In this condition, the neurofunctional disorder occurring during first years of life provoke several monocular and binocular anomalies such as crowding, deficits in the accommodative response, contrast sensitivity, and ocular motility abilities. The inhibition of the binocular function of the brain by the misaligned amblyopic eye induces a binocular imbalance leading to interocular suppression and the reduction or lack of stereoacuity. Passive treatments such as occlusion, optical and/or pharmacological penalization, and Bangerter foils has been demonstrated to be potentially useful treatments for strabismic amblyopia. Recent researches have proved new pharmacological options to improve and maintain visual acuity after occlusion treatment in strabismic amblyopia. Likewise, the active vision therapy, in the last years, is becoming a very relevant therapeutic option in combination with passive treatments, especially during and after monocular therapy, in the attempt of recovering the imbalanced binocular vision.
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Affiliation(s)
- Myriam Milla
- Department of Optometry, OFTALVIST Alicante, Alicante 03016, Spain
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, Alicante 03690, Spain
| | - David P. Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, Alicante 03690, Spain
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21
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Park SH. Current Management of Childhood Amblyopia. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 33:557-568. [PMID: 31833253 PMCID: PMC6911788 DOI: 10.3341/kjo.2019.0061] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/08/2019] [Accepted: 09/02/2019] [Indexed: 11/23/2022] Open
Abstract
Amblyopia is defined as the reduction of best-corrected visual acuity of one or both eyes caused by conditions that affect normal visual development. The basic strategy to treat amblyopia is to obtain a clear retinal image in each eye and correct ocular dominance through forced use of the amblyopic eye. Treatment modalities include correcting any underlying organic disease, prescribing appropriate optical correction, and providing occlusion/penalization therapy for the non-amblyopic eye. Given the success of amblyopia treatment declines with increasing age, the detection and management of amblyopia should begin as early as possible during the sensitive period for visual development. Proper management of amblyopia during childhood can reduce the overall prevalence and severity of visual loss. This study aims to provide an update for the management of childhood amblyopia to provide better visual outcomes.
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Affiliation(s)
- Shin Hae Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.
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22
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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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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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Pineles SL, Aakalu VK, Hutchinson AK, Galvin JA, Heidary G, Binenbaum G, VanderVeen DK, Lambert SR. Binocular Treatment of Amblyopia: A Report by the American Academy of Ophthalmology. Ophthalmology 2019; 127:261-272. [PMID: 31619356 DOI: 10.1016/j.ophtha.2019.08.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments. METHODS Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology. RESULTS Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance. CONCLUSIONS There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.
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Affiliation(s)
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Amy K Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer A Galvin
- Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gil Binenbaum
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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25
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He W, Du Y, Yu J, Lu Y, Zhu X. Associations between Macular Sensitivity and Fixation in Pseudophakic Children after Congenital Cataract Surgery. Curr Eye Res 2019; 44:1264-1270. [PMID: 31173509 DOI: 10.1080/02713683.2019.1629593] [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: 10/26/2022]
Abstract
Purpose: To investigate the associations between macular sensitivity (MS) and fixation in pseudophakic children after congenital cataract surgery.Materials and Methods: In total 55 pseudophakic eyes and 28 healthy phakic eyes were included in this cross-sectional study. MS and fixation stability in term of 95% bivariate contour ellipse area (BCEA) were assessed with a Macular Integrity Assessment microperimeter. Central foveal thickness (CFT) and subfoveal choroidal thickness (SFCT) was measured with optical coherence tomography. MS inside and outside the 95% BCEA was compared. Influencing factors for the difference in MS between the two regions (ΔMS) were assessed.Results: The overall MS was significantly lower in pseudophakic eyes than in the controls (P < .001). In the pseudophakic group, fixation stability was stable/relatively unstable/unstable in 69.1%/16.4%/14.5% of eyes, and their MS was 27.60 ± 2.56, 25.02 ± 3.82, and 20.50 ± 7.15 dB, respectively. The unstable subgroup had significantly worse MS than the stable subgroup (P < .001). Among pseudophakic eyes, the MS inside the 95% BCEA (fixation preferred region) was significantly greater than that outside this region (P = .048), and it was more correlated with BCVA than that of the entire macula. The ΔMS became greater in those pseudophakic eyes with worse fixation stability (P < .001) and longer axial length (P = .002). Backward stepwise multiple linear regression also revealed 95%BCEA and axial length had significant influences on ΔMS (R2 = 0.289, P < .001).Conclusion: MS was lower in pseudophakic eyes with poor fixation. Macular sensitivity inside and outside the fixation preferred region was different in pseudophakic children after congenital cataract surgery, and this difference increased with longer axial length and poorer fixation.
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Affiliation(s)
- Wenwen He
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,NHC key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yu Du
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,NHC key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jifeng Yu
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yi Lu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,NHC key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiangjia Zhu
- Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University, Shanghai, China.,NHC key Laboratory of Myopia, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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The treatment of amblyopia: current practice and emerging trends. Graefes Arch Clin Exp Ophthalmol 2019; 257:1061-1078. [DOI: 10.1007/s00417-019-04254-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 02/04/2023] Open
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A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years. Ophthalmology 2018; 126:456-466. [PMID: 30352226 DOI: 10.1016/j.ophtha.2018.10.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad game plus continued spectacle correction vs. continued spectacle correction alone. DESIGN Multicenter randomized clinical trial. PARTICIPANTS One hundred thirty-eight participants aged 7 to 12 years with amblyopia (33-72 letters, i.e., approximately 20/200 to 20/40) resulting from strabismus, anisometropia, or both. Participants were required to have at least 16 weeks of optical treatment in spectacles if needed or demonstrate no improvement in amblyopic-eye visual acuity (VA) for at least 8 weeks prior to enrollment. METHODS Eligible participants (mean age 9.6 years, mean baseline VA of 59.6 letters, history of prior amblyopia treatment other than spectacles in 96%) were randomly assigned to treatment for 8 weeks with the dichoptic binocular Dig Rush iPad game (prescribed for 1 hour per day 5 days per week) plus spectacle wear if needed (n = 69) or continued spectacle correction alone if needed (n = 69). MAIN OUTCOME MEASURES Change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner. RESULTS At 4 weeks, mean amblyopic-eye VA letter score improved from baseline by 1.3 (2-sided 95% confidence interval [CI]: 0.1-2.6; 0.026 logMAR) with binocular treatment and by 1.7 (2-sided 95% CI: 0.4-3.0; 0.034 logMAR) with continued spectacle correction alone. After adjusment for baseline VA, the letter score difference between groups (binocular minus control) was -0.3 (95% CI: -2.2 to 1.5, P = 0.71, difference of -0.006 logMAR). No difference in letter scores was observed between groups when the analysis was repeated after 8 weeks of treatment (adjusted mean: -0.1, 98.3% CI: -2.4 to 2.1). For the binocular group, adherence data from the iPad indicated that slightly more than half of the participants (58% and 56%) completed >75% of prescribed treatment by the 4- and 8-week visits, respectively. CONCLUSIONS In children aged 7 to 12 years who have received previous treatment for amblyopia other than spectacles, there was no benefit to VA or stereoacuity from 4 or 8 weeks of treatment with the dichoptic binocular Dig Rush iPad game.
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Deshpande PG, Bhalchandra PC, Nalgirkar AR, Tathe SR. Improvement of visual acuity in residual meridional amblyopia by astigmatic axis video games. Indian J Ophthalmol 2018; 66:1156-1160. [PMID: 30038164 PMCID: PMC6080462 DOI: 10.4103/ijo.ijo_1096_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study was carried out to evaluate the efficacy of developed “astigmatic axis video games” in children and adolescents having meridional amblyopia, with the aim to improve the visual acuity (VA). Till date, no studies are available on the treatment of amblyopic meridian. Meridional amblyopia (MA) results when astigmatism remains untreated for a long period. The aim of the study was to assess the effectiveness of a set of novel video games, the astigmatism axis video games (AAVGs), in improving the visual acuity (VA) in MA. Methods: We included 50 eyes with residual myopic MA (cylinder ≥2.0 and ≤4.0 D) whose VA did not improve beyond 0.3 LogMAR equivalent, despite patching for 2 h/day for the preceding 3 months. Patients were subjected to AAVG in conjunction with best-corrected glasses and patching of the better eye for 2 h/day for 3 months. Results: Out of 50 eyes, 32 eyes were from children between 8 and 12 years and 18 were >12 years. Full improvement of LogMAR VA up to 0.0 was seen in 36/50 (72.0%) oblique astigmatism eyes. Partial improvement of LogMAR VA at least 0.3 LogMAR or more was observed in another 7 eyes (14%) eyes. The mean VA improved from 0.43 ± 0.1 LogMAR at baseline to 0.077 ± 0.08 at 3 months (P < 0.001). Good number of eyes (n = 16, 32%) showed speedy visual improvement between 2 and 4 weeks after initiation of AAVG. No adverse effects were observed. Conclusion: Satisfactory improvement in VA in eyes with residual MA provides preliminary data into the effectiveness of stimulation of the precise amblyopic axis by AAVG in conjunction with spectacles and “minimal patching” regimen of 2 h/day. Further comparative study is warranted.
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Affiliation(s)
- Pradeep G Deshpande
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
| | - Poonam C Bhalchandra
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
| | - Aniruddha R Nalgirkar
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
| | - Sandeep R Tathe
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
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Abstract
Although historically, treatment of amblyopia has been recommended prior to closure of a critical window in visual development, the existence and duration of that critical window is currently unclear. Moreover, there is clear evidence, both from animal and human studies of deprivation amblyopia, that there are different critical windows for different visual functions and that monocular and binocular deprivation have different neural and behavioral consequences. In view of the spectrum of critical windows for different visual functions and for different types of amblyopia, combined with individual variability in these windows, treatment of amblyopia has been increasingly offered to older children and adults. Nevertheless, treatment beyond the age of 7 years tends to be, on average, less effective than in younger children, and the high degree of variability in treatment response suggests that age is only one of many factors determining treatment response. Newly emerging treatment modalities may hold promise for more effective treatment of amblyopia at older ages. Additional studies are needed to characterize amblyopia by using new and existing clinical tests, leading to improved clinical classification and better prediction of treatment response. Attention also needs to be directed toward characterizing and measuring the impact of amblyopia on the patients' functional vision and health-related quality of life.
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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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Abstract
PURPOSE OF REVIEW The present review article is an update on the current evidence about compliance to the prescribed occlusion treatment for amblyopia. In particular, the authors focus on the predictors and causes of noncompliance and possible interventions to increase it. RECENT FINDINGS Compliance with prescribed occlusion treatment is often challenging. Reported rates of compliance range widely from 49% to 87%. Objective monitoring of occlusion has opened up new research opportunities and allow the design of effective therapeutic regimens. Also, predictors and causes of noncompliance have been investigated and their knowledge may help the clinician to improved compliance with prescribed occlusion treatment for amblyopia. SUMMARY Although many of the studies assessing the effectiveness of interventions to increase compliance to patching treatment for amblyopia have many limitations, evidences support that use of educational supports, parents, and patient understanding on the importance of patching and written information should be considered to increase compliance with patching.
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Singh A, Sharma P, Saxena R. Evaluation of the Role of Monocular Video Game Play as an Adjuvant to Occlusion Therapy in the Management of Anisometropic Amblyopia. J Pediatr Ophthalmol Strabismus 2017; 54:244-249. [PMID: 28510773 DOI: 10.3928/01913913-20170320-04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the role of monocular video game play as an adjuvant to occlusion therapy in the treatment of anisometropic amblyopia. METHODS In a prospective randomized study design, 68 children with ages ranging from 6 to 14 years who had anisometropic amblyopia with a best corrected visual acuity (BCVA) in the amblyopic eye of better than 6/36 and worse than 6/12 and no manifest strabismus were recruited. They were randomly allocated into two groups: 34 children received 1 hour per day of video game play for the first month plus 6 hours per day of occlusion therapy (video game and occlusion group) and 34 children received 6 hours per day of occlusion therapy alone (occlusion only group). Patients were then evaluated at baseline and 1 and 3 months after treatment for BCVA, stereoacuity, and contrast sensitivity. RESULTS In the video game and occlusion group, BCVA improved from 0.61 ± 0.12 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.51 ± 0.14 logMAR (P = .001) at 1 month and 0.40 ± 0.15 logMAR (P = .001) at 3 months. In the occlusion only group, BCVA improved from 0.65 ± 0.09 logMAR at baseline to 0.60 ± 0.10 logMAR (P = .001) at 1 month and 0.48 ± 0.10 logMAR (P = .001) at 3 months. There was significantly more improvement in the video game and occlusion group compared to the occlusion only group (P = .003 at 1 month and P = .027 at 3 months). CONCLUSIONS Video game play plus occlusion therapy enhances the visual recovery in anisometropic amblyopia. [J Pediatr Ophthalmol Strabismus. 2017;54(4):244-249.].
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Holmes JM, Manh VM, Lazar EL, Beck RW, Birch EE, Kraker RT, Crouch ER, Erzurum SA, Khuddus N, Summers AI, Wallace DK. Effect of a Binocular iPad Game vs Part-time Patching in Children Aged 5 to 12 Years With Amblyopia: A Randomized Clinical Trial. JAMA Ophthalmol 2017; 134:1391-1400. [PMID: 27812703 PMCID: PMC5145771 DOI: 10.1001/jamaophthalmol.2016.4262] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance A binocular approach to treating anisometropic and strabismic amblyopia has recently been advocated. Initial studies have yielded promising results, suggesting that a larger randomized clinical trial is warranted. Objective To compare visual acuity (VA) improvement in children with amblyopia treated with a binocular iPad game vs part-time patching. Design, Setting, and Participants A multicenter, noninferiority randomized clinical trial was conducted in community and institutional practices from September 16, 2014, to August 28, 2015. Participants included 385 children aged 5 years to younger than 13 years with amblyopia (20/40 to 20/200, mean 20/63) resulting from strabismus, anisometropia, or both. Participants were randomly assigned to either 16 weeks of a binocular iPad game prescribed for 1 hour a day (190 participants; binocular group) or patching of the fellow eye prescribed for 2 hours a day (195 participants; patching group). Study follow-up visits were scheduled at 4, 8, 12, and 16 weeks. A modified intent-to-treat analysis was performed on participants who completed the 16-week trial. Interventions Binocular iPad game or patching of the fellow eye. Main Outcomes and Measures Change in amblyopic-eye VA from baseline to 16 weeks. Results Of the 385 participants, 187 were female (48.6%); mean (SD) age was 8.5 (1.9) years. At 16 weeks, mean amblyopic-eye VA improved 1.05 lines (2-sided 95% CI, 0.85-1.24 lines) in the binocular group and 1.35 lines (2-sided 95% CI, 1.17-1.54 lines) in the patching group, with an adjusted treatment group difference of 0.31 lines favoring patching (upper limit of the 1-sided 95% CI, 0.53 lines). This upper limit exceeded the prespecified noninferiority limit of 0.5 lines. Only 39 of the 176 participants (22.2%) randomized to the binocular game and with log file data available performed more than 75% of the prescribed treatment (median, 46%; interquartile range, 20%-72%). In younger participants (aged 5 to <7 years) without prior amblyopia treatment, amblyopic-eye VA improved by a mean (SD) of 2.5 (1.5) lines in the binocular group and 2.8 (0.8) lines in the patching group. Adverse effects (including diplopia) were uncommon and of similar frequency between groups. Conclusions and Relevance In children aged 5 to younger than 13 years, amblyopic-eye VA improved with binocular game play and with patching, particularly in younger children (age 5 to <7 years) without prior amblyopia treatment. Although the primary noninferiority analysis was indeterminate, a post hoc analysis suggested that VA improvement with this particular binocular iPad treatment was not as good as with 2 hours of prescribed daily patching. Trial Registration http://www.clinicaltrials.gov Identifier: NCT02200211.
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Affiliation(s)
| | - Vivian M Manh
- Division of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida4Deputy editor, JAMA Ophthalmology
| | | | | | - Eric R Crouch
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk
| | - S Ayse Erzurum
- Department of Surgery, North East Ohio Medical University, Rootstown
| | | | - Allison I Summers
- Department of Ophthalmology, Oregon Health & Science University, Portland
| | - David K Wallace
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina
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Abstract
PURPOSE OF REVIEW To review the literature up to recent for the use of videos, videogames and dichoptic stimulation as a treatment for amblyopia. RECENT FINDINGS There have been three strategies explored. The first is to use videos and videogames monocularly with the normal eye covered. The second is dichoptic stimulation with a common background presented to both eyes and an enriched foreground to the amblyopic eye. The third are games specifically designed to generate stereopsis. Most work has focused on the second of these approaches but both of the first two approaches seem to give a similar improvement of 0.1-0.2 logMAR. One large randomized control trial (RCT) has published showing that dichoptic stimulation is not inferior to patching but no evidence that it was superior. It also showed that video games have their own compliance problems and a second smaller RCT did suggest that videogames, with a game designed by a gaming company, was superior. Most of the work done has had methodological issues and should be considered exploratory rather than definitive. SUMMARY Dichoptic stimulation is a viable treatment option for the treatment of amblyopia. The first trial results have shown results that are not superior to patching but they are not without methodological issues. There is sufficient encouragement to justify further research in this area.
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Abstract
PURPOSE Amblyopia is a leading cause of low vision and warrants timely management during childhood. We performed a literature review of the management of amblyopia and potential risk factors for amblyopia. METHODS Literature review of the management of amblyopia and risk factors for amblyopia. RESULTS Common amblyopia risk factors include anisometropic or high refractive error, strabismus, cataract, and ptosis. Often a conservative approach with spectacles is enough to prevent amblyopia. However, surgery may be necessary to clear the visual axis or align the eyes. CONCLUSION Amblyopia risk factors should be managed early. Though amblyopia treatment is more likely to be successful at a younger age, those who are older but treatment-naïve may still respond to treatment. Promoting binocular or dichoptic experiences may be the future direction of amblyopia management.
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Affiliation(s)
- Euna B Koo
- a Boston Children's Hospital , Boston , MA , USA.,c Stanford School of Medicine , Palo Alto , CA , USA
| | - Aubrey L Gilbert
- a Boston Children's Hospital , Boston , MA , USA.,b Massachusetts Eye and Ear Infirmary , Boston , MA , USA
| | - Deborah K VanderVeen
- a Boston Children's Hospital , Boston , MA , USA.,b Massachusetts Eye and Ear Infirmary , Boston , MA , USA.,d Harvard Medical School , Boston , MA , USA
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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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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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Tailor VK, Glaze S, Khandelwal P, Davis A, Adams GGW, Xing W, Bunce C, Dahlmann-Noor A. Prescribed computer games in addition to occlusion versus standard occlusion treatment for childhood amblyopia: a pilot randomised controlled trial. Pilot Feasibility Stud 2015; 1:23. [PMID: 27965802 PMCID: PMC5154044 DOI: 10.1186/s40814-015-0018-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/29/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amblyopia ("lazy eye") is the commonest vision deficit in children. If not fully corrected by glasses, amblyopia is treated by patching or blurring the better-seeing eye. Compliance with patching is often poor. Computer-based activities are increasingly topical, both as an adjunct to standard treatment and as a platform for novel treatments. Acceptability by families has not been explored, and feasibility of a randomised controlled trial (RCT) using computer games in terms of recruitment and treatment acceptability is uncertain. METHODS We carried out a pilot RCT to test whether computer-based activities are acceptable and accessible to families and to test trial methods such as recruitment and retention rates, randomisation, trial-specific data collection tools and analysis. The trial had three arms: standard near activity advice, Eye Five, a package developed for children with amblyopia, and an off-the-shelf handheld games console with pre-installed games. We enrolled 60 children age 3-8 years with moderate or severe amblyopia after completion of optical treatment. RESULTS This trial was registered as UKCRN-ID 11074. Pre-screening of 3600 medical notes identified 189 potentially eligible children, of whom 60 remained eligible after optical treatment, and were enrolled between April 2012 and March 2013. One participant was randomised twice and withdrawn from the study. Of the 58 remaining, 37 were boys. The mean (SD) age was 4.6 (1.7) years. Thirty-seven had moderate and 21 severe amblyopia. Three participants were withdrawn at week 6, and in total, four were lost to follow-up at week 12. Most children and parents/carers found the study procedures, i.e. occlusion treatment, usage of the allocated near activity and completion of a study diary, easy. The prescribed cumulative dose of near activity was 84 h at 12 weeks. Reported near activity usage numbers were close to prescribed numbers in moderate amblyopes (94 % of prescribed) but markedly less in severe amblyopes (64 %). Reported occlusion usage at 12 weeks was 90 % of prescribed dose for moderate and 33 % for severe amblyopes. CONCLUSIONS Computer-based games and activities appear acceptable to families as part of their child's amblyopia treatment. Trial methods were appropriate and accepted by families.
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Affiliation(s)
- Vijay K. Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
| | - Selina Glaze
- Moorfields at Bedford Hospital NHS Trust, Kempston Road, Bedford, MK42 9DJ UK
- South Essex Partnership Foundation Trust, Enhanced Services Centre, 3 Kimbolton Road, Bedford, MK40 2NT UK
| | - Payal Khandelwal
- Moorfields at Bedford Hospital NHS Trust, Kempston Road, Bedford, MK42 9DJ UK
- South Essex Partnership Foundation Trust, Enhanced Services Centre, 3 Kimbolton Road, Bedford, MK40 2NT UK
| | - Alison Davis
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
| | - Gillian G. W. Adams
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
| | - Wen Xing
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
| | - Catey Bunce
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
| | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Road, London, EC1V 2PD UK
- Moorfields at Bedford Hospital NHS Trust, Kempston Road, Bedford, MK42 9DJ UK
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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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Wallace DK, Lazar EL, Crouch ER, Hoover DL, Kraker RT, Tamkins SM. Time course and predictors of amblyopia improvement with 2 hours of daily patching. JAMA Ophthalmol 2015; 133:606-9. [PMID: 25695355 PMCID: PMC4474371 DOI: 10.1001/jamaophthalmol.2015.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | | | - Darren L. Hoover
- Everett and Hurite Ophthalmic Association, Cranberry Township, PA
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41
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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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Jin H, Chung SA. Comparison of Improvement Rates between Distance and Near Visual Acuity in Children with Unilateral Amblyopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.9.1432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hosung Jin
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Ah Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
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Fronius M, Cirina L, Ackermann H, Kohnen T, Diehl CM. Efficiency of electronically monitored amblyopia treatment between 5 and 16years of age: New insight into declining susceptibility of the visual system. Vision Res 2014; 103:11-9. [DOI: 10.1016/j.visres.2014.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Amblyopia is reduced visual acuity in one or both eyes in the absence of any demonstrable abnormality of the visual pathway. It is not immediately resolved by the correction of refractive error. Strabismus develops in approximately 5% to 8% of the general population. The aim of treatment for amblyopia is to obtain the best possible level of vision in the amblyopic eye. Different treatment options were examined within the review. OBJECTIVES By reviewing the available evidence we wanted to establish the most effective treatment for strabismic amblyopia. In particular this review aimed to examine the impact of conventional occlusion therapy for strabismic amblyopia and to analyse the role of partial occlusion and optical penalisation for strabismic amblyopia. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2014), EMBASE (January 1980 to January 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 January 2014. SELECTION CRITERIA We included randomised controlled trials (RCTs) for the treatment of strabismic amblyopia including participants of any age. DATA COLLECTION AND ANALYSIS Two authors working independently extracted and entered data into Review Manager 5 and then independently checked the data for errors. MAIN RESULTS We included three RCTs in this review. The studies reported mean logMAR visual acuity achieved. Mean difference in visual acuity was calculated. When comparing conventional part-time occlusion (with any necessary glasses), PEDIG 2006 reported that this treatment was more beneficial than glasses alone for strabismic amblyopia; the mean difference between groups was -0.18 LogMAR (statistically significant 95% confidence interval (CI) -0.32 to -0.04). Supplementing occlusion therapy with near activities may produce a better visual outcome compared to non-near activities after four weeks of treatment (PEDIG 2005). The results of the pilot study showed mean difference between groups was -0.17 LogMAR (95% CI -0.53 to 0.19). Results from a larger RCT (PEDIG 2008) are now available, showing that supplementing occlusion therapy with near activities may produce a better visual outcome after eight weeks of treatment; the mean difference between groups was -0.02 LogMAR (95% CI -0.10 to 0.06). One further article ia awaiting assessment as in its current format there is insufficient information to include (Alotaibi 2012). AUTHORS' CONCLUSIONS Occlusion, whilst wearing necessary refractive correction, appears to be more effective than refractive correction alone in the treatment of strabismic amblyopia. The benefit of combining near activities with occlusion is unproven. No RCTs were found that assessed the role of either partial occlusion or optical penalisation to refractive correction for strabismic amblyopia.
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Affiliation(s)
- Kate Taylor
- Royal Victoria InfirmaryDepartment of OphthalmologyClaremont WingQueen Victoria RoadNewcastle upon TyneUKNE1 4LP
| | - Sue Elliott
- Salisbury Health Care NHS TrustOphthalmology DepartmentSalisbury District HospitalSalisburyWiltshireUKSP2 8BJ
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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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Clinical Translation of Recommendations from Randomized Clinical Trials on Patching Regimen for Amblyopia. Ophthalmology 2013; 120:657-62. [PMID: 23395531 DOI: 10.1016/j.ophtha.2012.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 09/04/2012] [Accepted: 09/11/2012] [Indexed: 11/21/2022] Open
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Abstract
Amblyopia is the most common cause of preventable visual loss in children. This article reviews treatment options, durations, and efficacy in randomized multicentered trials conducted by the Pediatric Eye Disease and Investigator Group in the last decade. Parents and patients should be counseled that many forms of treatment are efficacious, allowing the option of choice of best-tolerated treatment method. Compliance is key to successful treatment. The course of treatment is likely at least 6-12 months, with yearly follow-up suggested once amblyopia has been treated to monitor for regression.
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Affiliation(s)
- Kammi B Gunton
- Department of Pediatric Ophthalmology, Wills Eye Institute, Philadelphia, PA 19107, USA.
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49
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Abstract
BACKGROUND Refractive amblyopia is a common cause of reduced visual acuity in childhood, but optimal treatment is not well defined. This review examined the treatment effect from spectacles and conventional occlusion. OBJECTIVES Evaluation of the evidence of the effectiveness of spectacles, occlusion or both in the treatment of unilateral and bilateral refractive amblyopia. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 24 January 2012. We manually searched relevant conference proceedings. SELECTION CRITERIA Randomised controlled trials of treatment for unilateral and bilateral refractive amblyopia by spectacles, with or without occlusion, were eligible. We included studies with participants of any age. DATA COLLECTION AND ANALYSIS Two authors independently assessed abstracts identified by the searches. We obtained full-text copies and contacted study authors where necessary. Eleven trials were eligible for inclusion. We extracted data from eight. Insufficient data were present for the remaining three trials so data extraction was not possible. We identified no trials as containing participants with bilateral amblyopia. We performed no meta-analysis as there were insufficient trials for each outcome. MAIN RESULTS For all studies mean acuity (standard deviation (SD)) in the amblyopic eye post-treatment was reported. All included trials reported treatment for unilateral refractive amblyopia.One study randomised participants to spectacles only compared to no treatment, spectacles plus occlusion compared to no treatment and spectacles plus occlusion versus spectacles only. For spectacles only versus no treatment, mean (SD) visual acuity was: spectacles group 0.31 (0.17); no treatment group 0.42 (0.19) and mean difference (MD) between groups was -0.11 (borderline statistical significance: 95% confidence interval (CI) -0.22 to 0.00). For spectacles plus occlusion versus no treatment, mean (SD) visual acuity was: full treatment 0.22 (0.13); no treatment 0.42 (0.19). Mean difference (MD) between the groups -0.20 (statistically significant: 95% CI -0.30 to -0.10). For spectacles plus occlusion versus spectacles only, MD was -0.09 (borderline statistical significance 95% CI -0.18 to 0.00). For two other trials that also looked at this comparison MD was -0.15 (not statistically significant 95% CI -0.32 to 0.02) for one trial and MD 0.01 (not statistically significant 95% CI -0.08 to 0.10) for the second trial.Three trials reviewed occlusion regimes.One trial looked at two hours versus six hours for moderate amblyopia: MD 0.01 (not statistically significant: 95% CI -0.06 to 0.08); a second trial 2003b reviewed six hours versus full-time for severe amblyopia: MD 0.03 (not statistically significant: 95% CI -0.08 to 0.14) and a third trial looked at six hours versus full-time occlusion: MD -0.12 (not statistically significant: 95% CI -0.27 to 0.03). One trial looked at occlusion supplemented with near or distance activities: MD-0.03 (not statistically significant 95% CI -0.09 to 0.03). One trial looked at partial occlusion and glasses versus glasses only: MD -0.01 (not statistically significant: 95% CI -0.05 to 0.03). AUTHORS' CONCLUSIONS In some cases of unilateral refractive amblyopia it appears that there is a treatment benefit from refractive correction alone. Where amblyopia persists there is evidence that adding occlusion further improves vision. Despite advances in the understanding of the treatment of amblyopia it is currently still not possible to tailor individual treatment plans for amblyopia. The nature of any dose/response effect from occlusion still needs to be clarified. Partial occlusion appears to have the same treatment effect as glasses alone when started simultaneously for the treatment of unilateral refractive amblyopia. Treatment regimes for bilateral and unilateral refractive amblyopia need to be investigated further.
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Affiliation(s)
- Kate Taylor
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Archer SM. Are amblyopia treatments really all equal? Is that even the right question? THE AMERICAN ORTHOPTIC JOURNAL 2012; 62:1-3. [PMID: 22848111 DOI: 10.3368/aoj.62.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A series of Pediatric Eye Disease Investigator Group amblyopia treatment studies have concluded that the difference between patching and atropine penalization is inconsequential, and that there is no statistically significant difference between various amounts of prescribed patching. These results, representing mean behavior of groups of amblyopia patients, suggest that a broader range of initial treatments are appropriate than many previously believed; however, it is less clear how this informs treatment in individual cases.
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