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Asensio-Jurado L, Argilés M, Quevedo-Junyent L, Mestre C, Levi DM. Can viewing a 3D movie improve visual function in children with a history of amblyopia and neurotypical children?: A pilot study. PLoS One 2024; 19:e0305401. [PMID: 38917142 PMCID: PMC11198783 DOI: 10.1371/journal.pone.0305401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
PURPOSE The aim of this pilot study was to determine whether viewing an immersive 3D movie with large disparities in a cinema resulted in improved visual acuity (VA), stereoscopic depth perception (ST), and improved eye alignment in residual amblyopic children and children without amblyopia. METHODS A total of 24 children aged between 5 and 12 years with a history of anisometropic and/or strabismic amblyopia, that had been previously treated and who currently have residual amblyopia (N = 14), and in children with typical development without amblyopia (N = 10) viewed the movie in 3D Sing 2 in a cinema for 110 minutes. Visual acuity, stereoacuity and ocular deviation were assessed before viewing the movie, and three months later. Stereoacuity and ocular deviation were also measured immediately after viewing the movie. RESULTS We observed an improvement in visual acuity in the non-dominant (amblyopic) eye 3 months after viewing the movie in the amblyopic group (P<0.001). Stereopsis improved immediately after viewing the movie (P = 0.02), and after 3 months by ≈ 40% (P = 0.01). Moreover, improvements in stereopsis were also observed in children without amblyopia (P = 0.04). No significant changes in ocular deviation were observed in either group. CONCLUSIONS These pilot results suggest that brief exposure to large disparities by viewing a 3D movie in a cinema can help to improve stereopsis and visual acuity in children aged 5‒12 years with previously treated amblyopia, and provide a rationale for a randomized clinical trial.
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Affiliation(s)
- Laura Asensio-Jurado
- Centre for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya, Terrassa, Spain
- Departament d’Òptica i Optometria, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Terrassa, Spain
- Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Marc Argilés
- Centre for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya, Terrassa, Spain
- Departament d’Òptica i Optometria, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Terrassa, Spain
| | - Lluïsa Quevedo-Junyent
- Departament d’Òptica i Optometria, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Terrassa, Spain
| | - Clara Mestre
- Centre for Sensors, Instruments and Systems Development (CD6), Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Dennis M. Levi
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, Berkeley, CA, United States of America
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Hwang J, Jo KS, Kim MS, Choi S, Lee J, Kim A, Yoo YJ. Internet of Things-Enabled Patch With Built-in Microsensors and Wireless Chip: Real-Time Remote Monitoring of Patch Treatment. Transl Vis Sci Technol 2024; 13:18. [PMID: 38776108 PMCID: PMC11127496 DOI: 10.1167/tvst.13.5.18] [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: 08/23/2023] [Accepted: 03/03/2024] [Indexed: 05/27/2024] Open
Abstract
Purpose We aimed to design, develop, and evaluate an internet of things-enabled patch (IoT patch) for real-time remote monitoring of adherence (or patch wear time) during patch treatment in child participants in clinical trials. This study provides healthcare providers with a tool for objective, real-time, and remote assessment of adherence and for making required adjustments to treatment plans. Methods The IoT patch had two temperature microsensors and a wireless chip. One sensor was placed closer to the skin than the other, resulting in a temperature difference depending on whether the patch was worn. When the patch was worn, it measured temperatures every 30 seconds and transmitted temperature data to a cloud server via a mobile application every 15 seconds. The patch was evaluated via 2 experiments with 30 healthy adults and 40 children with amblyopia. Results Excellent monitoring accuracy was observed in both adults (mean delay of recorded time data, 0.4 minutes) and children (mean, 0.5 minutes). The difference between manually recorded and objectively recorded patch wear times showed good agreement in both groups. Experiment 1 showed accurate monitoring over a wide range of temperatures (from 0 to 30°C). Experiment 2 showed no significant differences in wearability (ease-of-use and comfort scores) between the IoT and conventional patches. Conclusions The IoT patch offers an accurate, real-time, and remote system to monitor adherence to patch treatment. The patch is comfortable and easy to use. The utilization of an IoT patch may increase adherence to patch treatment based on accurate monitoring. Translational Relevance Results show that the IoT patch can enable real-time adherence monitoring in clinical trials, improving treatment precision, and patient compliance to enhance outcomes.
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Affiliation(s)
- Jiwoo Hwang
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, South Korea
| | - Kyu-Seong Jo
- Department of Ophthalmology, Kangwon National University Hospital, Chuncheon, South Korea
| | - Min-Seo Kim
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, South Korea
| | | | - Jungmin Lee
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, South Korea
| | - Auk Kim
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon, South Korea
| | - Yung-Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Chuncheon, South Korea
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Aljohani S, Wang J, Scheiman M, Tan QQ, Xu H, Almutairi N, Alshammeri S. The Feasibility of an Educational Cartoon Video for Improving Adherence with Amblyopia Treatment in Children. Clin Ophthalmol 2023; 17:1639-1646. [PMID: 37309368 PMCID: PMC10257930 DOI: 10.2147/opth.s415892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] Open
Abstract
Background Previous studies have shown that it is necessary to evaluate adherence during the treatment process, using educational intervention methods which have been shown to improve adherence with patching treatment. A previous study reported that an educational cartoon had significantly improved adherence with patching. However, this black-white cartoon is not commercially available. Objective This study investigates the feasibility of a 4-minute educational cartoon video in improving adherence with patching therapy for amblyopic children. Methods Children (3 to 10 years old) with unilateral amblyopia who were prescribed 2 hours or 6 hours of patching per day were enrolled. Objective adherence to the treatment was tracked using a microsensor. Children returned after 4 weeks ± 2 days to measure adherence. Participants with adherence ≤50% were eligible to watch the educational cartoon video. They continued with the previously prescribed treatment (2 hours or 6 hours patching) for an additional week to evaluate the follow-up adherence. Results A total of 27 participants were enrolled. The mean age (SD) was 6.6 (1.5) years. Twenty-two participants (12 in the 2 hours patching group and 10 in the 6 hours patching group) had adherence ≤50% and watched our cartoon video. The cartoon video improved mean adherence (SD) from 29.6% (11.9%) to 56.8% (12.1%) in all 22 participants from both regimens (paired 2-tailed t-test, t= -11, P < 0.000). Conclusion The Educational cartoon video is feasible for use in a clinical setting. These data showed a trend of improvement in adherence with both patching regimens in children after watching the educational cartoon video.
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Affiliation(s)
- Saeed Aljohani
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia
| | | | | | - Qing-Qing Tan
- Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People’s Republic of China
| | | | - Nawaf Almutairi
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia
| | - Saleh Alshammeri
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Qassim, Saudi Arabia
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Bhattacharya S, Subhedar K, Bhadauria M, Shukla R, Manaktala R, Kumar A, Wilson A. Comparison of novel clinic-based approach (amblyopia school) Vs. home-based occlusion for amblyopia therapy - A retrospective study. Indian J Ophthalmol 2023; 71:2094-2099. [PMID: 37203088 PMCID: PMC10391462 DOI: 10.4103/ijo.ijo_1097_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To compare visual outcomes of standard occlusion therapy at home versus clinic in amblyopic children. Methods A retrospective study of case records of children aged <15 years with diagnosis of strabismic or anisometropic amblyopia or both was conducted at a tertiary eye hospital located in rural North India between Jan 2017-Jan 2020. Those with at least 1 follow-up visit were included. Children with ocular co-morbidities were excluded. Treatment in clinic by admission or at home was based on the parents' discretion. Children in clinic group underwent part time occlusion & near work exercises for minimum 1 month, in classroom format which we called amblyopia school. Those in home group underwent part time occlusion as per PEDIG recommendations. Primary outcome measure was improvement in number of Snellen's lines at the end of 1 month & at final follow-up. Results We included 219 children with mean age of 8.8±3.23 years, out of which clinic group had 122 (56%) children. At one-month, visual improvement in clinic group (2.1±1.1 lines) was significantly greater than home group (mean=1.1±0.8 lines) (P < 0.001). Both groups continued to improve vision on follow-up, however the vision in the clinic group (2.9±1.2 lines improvement at mean follow-up of 4.1±1.6 months), continued to be better than home group (2.3±1.1 lines improvement at mean follow-up 5.1±0.9 months) (P = 0.05). Conclusion Clinic based amblyopia therapy in the form of an amblyopia school can help expedite visual rehabilitation. Thus, it may be a better option for rural settings where patients in general tend to be poorly compliant.
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Affiliation(s)
- Subhajit Bhattacharya
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ketaki Subhedar
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Madhu Bhadauria
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ranjana Shukla
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ruchita Manaktala
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Abhinav Kumar
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
| | - Ayush Wilson
- Department of Paediatric Ophthalmology, Sitapur Eye Hospital and Regional Institute of Ophthalmology, Sitapur, Uttar Pradesh, India
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Martinez JD, Donnelly MJ, Popke DS, Torres D, Wilson LG, Brancaleone WP, Sheskey S, Lin CM, Clawson BC, Jiang S, Aton SJ. Enriched binocular experience followed by sleep optimally restores binocular visual cortical responses in a mouse model of amblyopia. Commun Biol 2023; 6:408. [PMID: 37055505 PMCID: PMC10102075 DOI: 10.1038/s42003-023-04798-y] [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: 10/10/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
Studies of primary visual cortex have furthered our understanding of amblyopia, long-lasting visual impairment caused by imbalanced input from the two eyes during childhood, which is commonly treated by patching the dominant eye. However, the relative impacts of monocular vs. binocular visual experiences on recovery from amblyopia are unclear. Moreover, while sleep promotes visual cortex plasticity following loss of input from one eye, its role in recovering binocular visual function is unknown. Using monocular deprivation in juvenile male mice to model amblyopia, we compared recovery of cortical neurons' visual responses after identical-duration, identical-quality binocular or monocular visual experiences. We demonstrate that binocular experience is quantitatively superior in restoring binocular responses in visual cortex neurons. However, this recovery was seen only in freely-sleeping mice; post-experience sleep deprivation prevented functional recovery. Thus, both binocular visual experience and subsequent sleep help to optimally renormalize bV1 responses in a mouse model of amblyopia.
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Affiliation(s)
- Jessy D Martinez
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Marcus J Donnelly
- Undergraduate Program in Neuroscience, University of Michigan, Ann Arbor, MI, USA
| | - Donald S Popke
- Undergraduate Program in Neuroscience, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Torres
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Lydia G Wilson
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah Sheskey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Cheng-Mao Lin
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brittany C Clawson
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Sha Jiang
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Sara J Aton
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA.
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Asare AO, Maurer D, Wong AMF, Saunders N, Ungar WJ. Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada. JAMA Netw Open 2023; 6:e2249384. [PMID: 36598785 PMCID: PMC9857467 DOI: 10.1001/jamanetworkopen.2022.49384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. OBJECTIVE To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. MAIN OUTCOMES AND MEASURES For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. RESULTS School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. CONCLUSIONS AND RELEVANCE In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.
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Affiliation(s)
- Afua Oteng Asare
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- John Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Daphne Maurer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Agnes M. F. Wong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Program of Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Saunders
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Wendy J. Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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A Social Media Listening Study to Understand the Unmet Needs and Quality of Life in Adult and Pediatric Amblyopia Patients. Ophthalmol Ther 2022; 11:2183-2196. [PMID: 36175822 DOI: 10.1007/s40123-022-00571-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Amblyopia is an important cause of monocular vision impairment worldwide, and it negatively impacts patients' quality of life (QoL). Understanding patients' perspectives may help to optimize treatment outcomes and improve treatment adherence. METHODS This was a non-interventional, retrospective analysis of social media data available in the public domain posted by patients and caregivers on selected social media channels (Twitter®, forums, blogs, and news) from 12 countries between July 2018 and June 2020. RESULTS Approximately 2662 conversations relevant to the research objective were analyzed. The patient journey for adults and children was constructed based on the conversations. Eyeglasses, eye patches, contact lenses, and vision exercises were the common treatment options for amblyopia. Patients also reported vision improvement with emerging technologies such as digital therapeutics. Amblyopia and its treatment had a negative impact on QoL, and increased caregiver burden. Insurance coverage, long appointment waiting times, and recurring expenses of treatment options were reported as barriers to treatment. Non-compliance, switching between treatment options or technology, or discontinuation of treatment options was found to emanate from various issues including no improvement of the condition, discomfort with the treatment option, bullying, dissatisfaction with healthcare professional (HCP) recommendation, cost of treatment/issues with insurance coverage, side effects, and/or other unspecified reasons. The need for regular eye examinations, better diagnostic tests, awareness of the disease, awareness amongst HCPs about treatment options, and the need for better health insurance coverage policies emerged as unmet needs. CONCLUSION This social media listening study generated insights on patients with amblyopia and their caregivers regarding the patient journey, treatment options, reasons for non-compliance, reasons for switching HCPs, barriers to treatment, and unmet needs. Further qualitative research is required to validate the findings.
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Le T, Örge F. Treatment compliance in amblyopia: A mini-review and description of a novel online platform for compliance tracking. Surv Ophthalmol 2022; 67:1685-1697. [PMID: 35970235 DOI: 10.1016/j.survophthal.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022]
Abstract
Patient compliance with amblyopia therapies, including eye patching and atropine drops, is crucial for optimal visual acuity outcomes. Studies utilizing objective measures of compliance measurement have consistently shown that a majority of patients receive significantly less treatment than prescribed. We review the subjective and objective compliance rates reported in the literature, assess possible explanations for poor compliance and describe studies of interventions to improve compliance. Additionally, we report our experience implementing Inside Out Care, a novel online platform designed to improve monitoring of amblyopia patient compliance, in our clinics. We have found that this platform, which is accessible via both computer and smartphone, has improved monitoring of amblyopia patient patching compliance, as well as allowed for enhanced doctor-patient communication.
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Affiliation(s)
- Tinh Le
- Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital and University Hospitals Eye Institute
| | - Faruk Örge
- Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital and University Hospitals Eye Institute.
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Long-Term Efficacy of the Combination of Active Vision Therapy and Occlusion in Children with Strabismic and Anisometropic Amblyopia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071012. [PMID: 35883996 PMCID: PMC9315543 DOI: 10.3390/children9071012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
This retrospective study was conducted to evaluate the efficacy of the combined treatment of occlusion and active vision therapy in a total of 27 amblyopic children, including 14 strabismic and 13 anisometropic cases. For such purpose, changes in distance and near visual acuity as well as in the binocular function was evaluated during a two-year follow-up. In both amblyopia groups, significant improvements were found in distance and near visual acuity in the non-dominant eye (p < 0.001). In the strabismic amblyopia group, the percentage of patients with binocular function score (BF) > 3.3 decreased significantly from a baseline value of 64.3% to a two-year follow-up value of 7.1% (p < 0.001). In the anisometropic amblyopia group, this percentage also decreased significantly from a baseline value of 15.4% to a two-year follow-up value of 0.0% (p < 0.001). No recurrences were observed in the anisometropic amblyopia group, whereas recurrence occurred in two cases of the strabismic amblyopia group after finishing the vision rehabilitation process. In conclusion, the combined approach of the treatment evaluated is efficacious for providing an improvement in visual acuity and binocular function in both anisometropic and strabismic amblyopia, which was maintained over time.
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Crippa J, Flaherty M, Silveira S. Towards a national pre-school vision screening programme. J Paediatr Child Health 2022; 58:948-952. [PMID: 35481872 PMCID: PMC9321086 DOI: 10.1111/jpc.15971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Abstract
The aim of the study is to examine common approaches to pre-school vision screening, including the current New South Wales model which is known as Statewide Eyesight Preschooler Screening (StEPS) to determine whether the criteria set by the World Health Organization are fulfilled by StEPS, and therefore, whether there is sufficient justification to deploy a similar model nationally. A literature review was conducted to answer four key questions related to vision screening. The authors sought to review (i) the justification for vision screening of a pre-school population; (ii) the principles and best approaches to vision screening such as how, where and who should conduct vision screening; (iii) the conditions that are targeted in vision screening; and (iv) the acceptable pass/fail vision screening criteria. The StEPS vision screening model is an accurate, reliable and economical way of screening for reduced vision at a time when neural plasticity allows improvement in vision following intervention. It fulfils World Health Organization criteria for a successful screening programme. StEPS has very high participation rates compared to other screening methods in Australia due to its unique model whereby screeners utilise early childhood settings to recruit and screen 4-year-old children. Due consideration should be given to deploying the StEPS vision screening model nationally.
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Affiliation(s)
- Jessica Crippa
- Children's Eye CentreSydneyNew South WalesAustralia,Discipline of Orthoptics, Graduate School of HealthUniversity of TechnologySydneyNew South WalesAustralia
| | - Maree Flaherty
- Children's Eye CentreSydneyNew South WalesAustralia,Department of OphthalmologyChildren's Hospital WestmeadSydneyNew South WalesAustralia,Discipline of Ophthalmology, School of MedicineUniversity of SydneySydneyNew South WalesAustralia
| | - Sue Silveira
- Next Sense InstituteNextSenseSydneyNew South WalesAustralia,Macquarie School of Education, Faculty of ArtsMacquarie UniversitySydneyNew South WalesAustralia
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Sesma G, AlMairi T, Khashoggi H, Aljohar F, Khandekar R, Awad A. Treatment Outcome of Occlusion for Unilateral Amblyopia in Saudi Children 6-12 Years Old. Middle East Afr J Ophthalmol 2022; 29:85-90. [PMID: 37123423 PMCID: PMC10138135 DOI: 10.4103/meajo.meajo_205_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/19/2022] [Accepted: 01/10/2023] [Indexed: 05/02/2023] Open
Abstract
PURPOSE The purpose of this study was to estimate the rate and review determinants of successful therapy for unilateral amblyopia in children. METHODS This prospective cohort consisted of Saudi children aged 6-12 who received amblyopia therapy between 2020 and 2022. Best-corrected visual acuity (BCVA) in the amblyopic eye improved to reach the BCVA of the fellow eye at follow-up visits, or BCVA in the amblyopic eye improved and remained stable over three follow-up visits. Demographic and ocular characteristics were associated with the outcome. RESULTS In 30 children, the median BCVA at presentation and the last follow-up was 0.8 logMAR (interquartile range [IQR]: 0.6; 1.0) and 0.45 logMAR (IQR: 0.3; 0.6), respectively. The success rate of amblyopia therapy was 80% (95% confidence interval: 65.7; 94.3). It was 100%, 76.5%, and 77.8% in eyes with anisometropic, strabismic, and mixed types of amblyopia, respectively. Amblyopia grade (P = 0.177), type of amblyopia (P = 0.96), and spectacles as therapy in the past (P = 0.09) were not significantly associated with the successful out. The duration of follow-up was significantly longer in those with unsuccessful outcomes (P = 0.05). Excellent compliance for occlusion was observed in 62.5% of children with successful outcomes. In 14 (46.7%) children, BCVA was ≤0.3 logMAR BCVA at the last follow-up. Two-line improvement in amblyopic eyes was in 26 (86.7%) children at the last follow-up compared to BCVA at presentation. CONCLUSION Occlusion therapy complemented using glasses in older children also significantly improved visual recovery in amblyopic eyes.
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Affiliation(s)
- Gorka Sesma
- Division of Pediatric Ophthalmology and Strabismus, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Gorka Sesma, King Khaled Eye Specialist Hospital, Al Urubah Rd, West Building 2 Floor, Riyadh 11462, Saudi Arabia. E-mail:
| | - Tasnim AlMairi
- Department of Emergency, Almoosa Specialist Hospital, Al Mubarraz, Saudi Arabia
| | - Heba Khashoggi
- Division of Pediatric Ophthalmology and Strabismus, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Fahad Aljohar
- Department of Diagnostic and Imaging, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Vision Science, University of British Columbia Vancouver, Canada
| | - Abdulaziz Awad
- Division of Pediatric Ophthalmology and Strabismus, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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12
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Placide J, Ip CS, Le BHA, Ali SF, Ghergherehchi LM. An Update on the Management of Traumatic Pediatric Open Globe Repair: Prognostication and Complication Management. Int Ophthalmol Clin 2022; 62:203-218. [PMID: 34965235 DOI: 10.1097/iio.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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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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14
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Lee HJ, Kim SJ. Management of patients with small-angle esotropia and subnormal stereopsis using Fresnel prism. Graefes Arch Clin Exp Ophthalmol 2021; 260:345-352. [PMID: 34406501 DOI: 10.1007/s00417-021-05338-2] [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: 12/10/2020] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Monofixation syndrome (MFS) is a specific subnormal binocular vision status, either with or without a small deviation. Patients with MFS have a tendency to maintain stable ocular alignment. Correction of refractive errors and occlusion are considered as treatment option for amblyopia, and the status of MFS could be changed with long-term follow-up. The purpose of this study is to evaluate whether a Fresnel prism affected the visual acuity, angle of deviation, and sensory status in small-angle esotropia with subnormal stereopsis presenting with MFS features. METHODS Patients with small-angle esotropia within 8 prism diopters (PD) on the simultaneous prism and cover test from 2010 to 2019 were reviewed. Patients with subnormal stereopsis defined as more than 100 s of arc (arcsec) and with the central suppression with peripheral fusion were only included. A Fresnel prism was applied to the dominant eye, and the minimum follow-up period after Fresnel prism treatment was 24 months. We assessed patient clinical characteristics, course and response to therapy including visual acuity, angle of deviation, and stereopsis. RESULTS Twenty patients with a mean age of 5.5 ± 1.4 years were included. The mean duration of Fresnel prism treatment was 15.3 ± 10.3 months. After 50.7 ± 17.2 months of follow-up, VA of the non-dominant eye was changed from 0.26 ± 0.20 logMAR to 0.07 ± 0.17 logMAR (P < .001). The initial stereoacuities were 3.54 ± 0.27 log arcsec, ranged from 6000 to 400 arcsec. After the treatment with Fresnel prism, the final stereoacuities were 3.09 ± 0.58 log arcsec, ranged from 6000 to 100 arcsec (P = .001); nine patients (45%) improved stereoacuity more than two octaves. No changes in the angle of deviation or a change of fixation were observed. CONCLUSIONS After use of Fresnel prism, there was some improvement in visual acuity and stereopsis in patients with MFS features. Following occlusion and refractive correction, management using Fresnel prism could be attempted in small-angle esotropic patients with amblyopia or subnormal stereopsis.
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Affiliation(s)
- Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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15
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Visual outcomes and associated factors of primary congenital glaucoma in children. Graefes Arch Clin Exp Ophthalmol 2021; 259:3445-3451. [PMID: 34076742 DOI: 10.1007/s00417-021-05232-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/01/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE We evaluated the long-term visual outcomes in children with primary congenital glaucoma and determined the factors associated with the final visual outcomes. METHODS Medical records of children with primary congenital glaucoma between 2005 and 2016, seen at Seoul National University Children's Hospital in South Korea, were reviewed. The minimum follow-up period after surgery for primary congenital glaucoma was 3 years. Visual acuity (VA) was categorized into good (≧20/70) and poor (< 20/70). Factors including age, VA, refractive errors, intraocular pressure (IOP), laterality, and cup-to-disc (C/D) ratio were compared between the groups. RESULTS A total of 71 eyes of 44 patients were included. The patients' age at the time of surgery was 14.7 ± 12.2 months. The mean IOP was 28.3 ± 7.0 mmHg. During 6.7 ± 2.7 years of mean follow-up after surgery, 39 eyes (54.9%) needed occlusion treatment. After occlusion, patients with lower IOP values, lesser additional surgeries, reversal of optic disc cupping, and better initially measured VA achieved a better visual outcome. At the final assessment, the mean age was 7.8 ± 2.6 years, and the mean VA gain was 15.0 ± 19.4 letters. There were 44 eyes (62.0%) with VA ≧20/70. CONCLUSIONS In children with primary congenital glaucoma, IOP control and the optic disc configuration over time are important factors associated with visual outcome. Regular follow-up and correction of refractive errors-along with occlusion for those with difference in VA between the two eyes-might be helpful for achieving better visual outcomes.
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16
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Lee HJ, Kim SJ. Outcomes of using Bangerter foils for the treatment of residual amblyopia following patching therapy. Graefes Arch Clin Exp Ophthalmol 2021; 259:3167-3174. [PMID: 33977316 DOI: 10.1007/s00417-021-05231-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of additional treatment using Bangerter foil (BF) for children with residual amblyopia. METHODS Patients with residual amblyopia who were treated with BF between 2015 and 2020 were reviewed. Residual amblyopia was defined as no further improvement in vision following patching therapy for at least 6 months. BF that corresponds to the VA of the amblyopic eye was applied to the spectacle lens of the fellow eye. Patients were divided into two groups: group A, which included patients treated with BF alone, and group B, which included patients treated with BF and a head-mounted display. After at least 2 months of treatment, baseline and final VA and stereoacuity were compared. RESULTS Seventy-four patients with a mean age of 8.0 ± 1.6 years at the time of BF treatment were included. The mean duration of the BF treatment was 10.4 ± 5.6 months. After a mean follow-up period of 24.9 ± 11.9 months after BF treatment, the median (IQR) VA of the amblyopic eye changed from 0.20 (0.15-0.40) LogMAR to 0.10 (0.04-0.20) LogMAR (P = 0.001). The median (IQR) stereoacuity changed from 3.19 (2.53-3.75) log arcsec to 2.60 (2.15-3.48) log arcsec (P = 0.001). The number of patients improved vision by 0.2 LogMAR or more lines was 18 patients (30%) for group A and 3 patients (23%) for group B. The VA of the amblyopic eye before BF treatment was significantly associated with vision improvement. CONCLUSION BF can be considered an alternative treatment plan to provide further benefit for children with residual amblyopia.
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Affiliation(s)
- Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju, Republic of Korea.,Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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17
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Hamm LM, Chen Z, Li J, Dai S, Black J, Yuan J, Yu M, Thompson B. Contrast‐balanced binocular treatment in children with deprivation amblyopia. Clin Exp Optom 2021; 101:541-552. [DOI: 10.1111/cxo.12630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/25/2017] [Accepted: 09/07/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Zidong Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Shuan Dai
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand,
| | - Joanna Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Junpeng Yuan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Benjamin Thompson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada,
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18
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Fernandes AG, Ferraz NN. The effects of amblyopia on children's reading performance after patching treatment. Eur J Ophthalmol 2021; 32:575-579. [PMID: 33653149 DOI: 10.1177/1120672121998248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of amblyopia on children's reading performance after the successful patching treatment with 20/20 visual acuity (VA) in the treated eye. METHODS The treated amblyopes group included 10 children with strabismic amblyopia diagnosed on the first visit presenting VA equal or better than 0.0 logMAR (20/20 Snellen) in the better vision eye and VA worse than 0.2 logMAR (20/32 Snellen) in the worse eye that underwent patching treatment of amblyopia reaching a final VA equal to 0.0 logMAR in the treated eye. The control group comprised 10 children matched by age, gender and school-grade with no visual disorders. Reading performance was evaluated according to reading acuity (RA), critical print size (CPS), reading speed (RS) at 0.7 logMAR, and maximum reading speed (MRS) using the MNREAD chart. RESULTS Binocular reading performance was compared between groups and no statistically significant differences were found on RA, CPS, RS, or MRS (p > 0.05). When analyzing monocular reading performances of treated amblyopes, a worse RA (p = 0.04) and CPS (p = 0.04) were observed on the previously amblyopic eye when compared to the fellow eye. When comparing the fellow eye from treated amblyopes and a randomly selected eye from controls, no statistically significant differences on RA, CPS, RS, or MRS were found (p > 0.05). CONCLUSIONS The results suggest that even patients who reached 20/20 VA in the treated eye after patching treatment for amblyopia may present persistent impaired reading performance. These findings reinforce the importance of reading performance testing as a tool when evaluating the visual function development in amblyopic patients.
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Affiliation(s)
- Arthur Gustavo Fernandes
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
| | - Nívea Nunes Ferraz
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil
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19
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Battaglini L, Oletto CM, Contemori G, Barollo M, Ciavarelli A, Casco C. Perceptual learning improves visual functions in patients with albinistic bilateral amblyopia: A pilot study. Restor Neurol Neurosci 2021; 39:45-59. [PMID: 33554927 DOI: 10.3233/rnn-201043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several visual functions are impaired in patients with oculocutaneous albinism (OCA) associated to albinistic bilateral amblyopia (ABA). OBJECTIVE In this study, we aimed at exploring whether perceptual learning (PL) can improve visual functions in albinism. METHOD Six patients and six normal sighted controls, were trained in a contrast detection task with lateral masking. Participants were asked to choose which of the two intervals contained a foveally presented low-contrast Gabor patch. Targets were presented between higher contrast collinear flankers with equal spatial frequency. When increasing target-to-flanker distance, lateral interactions effect normally switches from inhibition to facilitation, up to no effect. RESULTS Our findings showed that before PL, only controls showed facilitation. After PL, results suggest that facilitatory lateral interactions are found both in controls as well as in albino patients. These results suggest that PL could induce higher processing efficiency at early cortical level. Moreover, PL positive effect seems to transfer to higher-level visual functions, but results were not very consistent among tasks (visual acuity, contrast sensitivity function, hyperacuity and foveal crowding). CONCLUSIONS Although a small sample size was tested, our findings suggest a rehabilitative potential of PL in improving visual functions in albinism.
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Affiliation(s)
- Luca Battaglini
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy.,Department of Physics and Astronomy "Galileo Galilei", University of Padova, via Marzolo, Padova, Italy
| | | | - Giulio Contemori
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
| | - Michele Barollo
- Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy.,Dipartimento dei Beni Culturali, University of Padova, Padova, Italy
| | - Ambra Ciavarelli
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
| | - Clara Casco
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
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20
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Amblyopia Outcomes Through Clinical Trials and Practice Measurement: Room for Improvement: The LXXVII Edward Jackson Memorial Lecture. Am J Ophthalmol 2020; 219:A1-A26. [PMID: 32777377 DOI: 10.1016/j.ajo.2020.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe amblyopia prevalence and outcomes using results from randomized studies and a clinical registry. DESIGN Review of published studies, analysis of data in Intelligent Research in Sight (IRIS) Registry from 2013 to 2019, personal perspective. METHODS Literature review, analysis of IRIS Registry data and IRIS-50, a visual acuity quality measure. RESULTS Clinical trials have reduced the treatment burden of amblyopia by reducing hours of patching and frequency of atropine eye drops with clinical success of about 83%. There is no appreciable age effect if treatment is started before 5 years of age, outcomes are stable to at least 15 years of age, and treatment can be somewhat effective until 12 years of age. The IRIS Registry identified 1,760,066 individuals with amblyopia for a prevalence of 2.47%. Refractive error alone accounted for 68.9% of childhood cases. Mean amblyopic eye visual acuity improved 1.8 lines for children 3-6 years of age and 0.8 lines for 7-12 years, but mean residual amblyopia was more than 2 lines. Among 18,841 children aged 3-7 years eligible for IRIS-50, 77.3% were successful. The odds ratios for success were significantly lower for African-American (0.67; 95% confidence interval [CI] = 0.58 to 0.78) and Hispanic or Latino (0.84; 95% CI = 0.75 to 0.94) children compared with white children. CONCLUSIONS Clinical trials provided evidence of a beneficial effect from several treatments, with substantially reduced doses than previously recommended. Registry data from clinical practice found residual visual acuity impairment among all ages and races, especially among minorities.
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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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23
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Wang J, Malik A, Jin J, Pang Y, Yin K, Allen M, Grigorian A, Scombordi B, Bailey J, Aljohani S, Funari K, Shoge R, Meiyeppen S, Myung J, Soni A, Neely DE. Intense versus standard regimens of intermittent occlusion therapy for unilateral moderate amblyopia in children: study protocol for a randomized controlled trial. Trials 2020; 21:361. [PMID: 32345348 PMCID: PMC7189599 DOI: 10.1186/s13063-020-04284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background We reported that in our previous study that wearing intermittent occlusion therapy glasses (IO-therapy) for 4 hours (h) was non-inferior to patching for 2 h in 3 to 8-year-old children with amblyopia. We hypothesize that an intense regimen of 12-h IO-therapy per day for 4 weeks could be as effective as the standard regimen of 4-h IO-therapy per day for 12 weeks in treating moderate amblyopia in 3 to 8-year-old children. Methods/Design A total of 56 children between 3 and 8 years of age with amblyopia in association with anisometropia and/or strabismus will be enrolled. All participants will be prescribed IO-therapy glasses (Amblyz™), set at 30-s opaque/transparent intervals (i.e., occluded 50% of wear time). They will be randomized to receive the standard regimen for 12 weeks or the intense regimen for 4 weeks. Adherence to using the IO-therapy glasses will be objectively monitored in each participant by means of a microsensor dose monitor. The primary study objective is to compare the effectiveness of an intense regimen to a standard regimen of IO-therapy in 3 to 8-year-old children with moderate amblyopia. The secondary study objectives are to determine whether adherence differs between an intense regimen and a standard regimen of IO-therapy, and to determine the dose-response relationship of IO-therapy. Discussion In addition to testing the effectiveness, this study will test for the first time the association between treatment adherence and the visual outcome of IO-therapy, which will enhance our understanding of the dose-response relationship of IO-therapy. If an intense regimen is shown to be effective, it would alter amblyopia treatment strategies and improve visual outcomes. Trial registration ClinicalTrials.gov: NCT02767856. Registered on 10 May 2016.
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Affiliation(s)
- Jingyun Wang
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA.
| | - Ayesha Malik
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jing Jin
- Nemours. Alfred I. duPont Hospital of Children, Wilmington, DE, USA.,Wills Eye Hospital, Philadelphia, PA, USA
| | - Yi Pang
- Illinois College of Optometry, Chicago, IL, USA
| | - Kelly Yin
- Illinois College of Optometry, Chicago, IL, USA
| | - Megan Allen
- Illinois College of Optometry, Chicago, IL, USA
| | | | - Brandy Scombordi
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Joann Bailey
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Saeed Aljohani
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Katharine Funari
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Ruth Shoge
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Siva Meiyeppen
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Jenny Myung
- Salus Univerisity Pennsylvania College of Optometry, 8360 Old York Rd, Elkins Park, PA, 19027, USA
| | - Ajay Soni
- Penn State Eye Center, Hershey, PA, USA
| | - Daniel E Neely
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
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[Treatment monitoring and innovations in amblyopia treatment]. Ophthalmologe 2019; 116:1231-1234. [PMID: 31552468 DOI: 10.1007/s00347-019-00970-0] [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
Technical innovations, such as computer games and shutter glasses open up elegant treatment options for amblyopia. The lack of monitoring of compliance means that there is no scientific basis on which a comparative study between a new therapeutic approach and occlusion therapy as the standard of care could be designed. An easy to use microsensor for measurement of compliance could have a broad spectrum of applications in scientific studies as well as in routine clinical practice. This article gives a brief overview about emerging and innovative approaches.
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Abstract
Early vision care is critical for all children. If undetected, eye disorders such as amblyopia and strabismus may result in permanent vision loss. Vision exams should include a careful history and physical including fix and follow, red reflex, and cover/uncover testing. Photo screening and visual acuity exams should be administered whenever possible.
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Affiliation(s)
- Elaine F Martin
- Elaine F. Martin is an assistant professor at Southern Connecticut State University, New Haven, Conn
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Piano MEF, Simmers AJ. 'It's too late'. Is it really? Considerations for amblyopia treatment in older children. Ther Adv Ophthalmol 2019; 11:2515841419857379. [PMID: 31259304 PMCID: PMC6585235 DOI: 10.1177/2515841419857379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/17/2019] [Indexed: 01/20/2023] Open
Abstract
In recent years, media coverage has demonstrated instances in which families of children aged 7 and older, newly diagnosed with strabismic and/or anisometropic amblyopia through community eyecare services, were told it was 'too late' for their child to effectively respond to conventional amblyopia treatment (occlusion or atropine penalisation). Formal guidance pertaining to binocular vision anomalies from eyecare professional bodies does not specifically make reference to a child's age, beyond stating the importance of early diagnosis and treatment of strabismus/amblyopia. However, there have been many changes in the way we view the recovery period for amblyopia, and it is well demonstrated both within literature and clinical practice that conventional treatment can improve amblyopic eye visual acuity in children beyond the age of 7 years. The occurrence of these media described cases within the community eyecare sphere would suggest it is worthwhile revisiting the literature on the subject of amblyopia treatment in older children (aged 7+ years), to address misconceptions and place in the spotlight current considerations facing clinicians when treating newly diagnosed amblyopia within this age group. This perspective review provides an evidence-based update covering the various considerations associated with treatment of amblyopia in older children, along with recent amblyopia treatment advances that could have an impact on treatment prospects for this patient group. Considerations include the risks, benefits and efficacy of treating newly diagnosed amblyopia in older children, monitoring density of suppression to mitigate intractable diplopia risk, and recent findings regarding binocular treatments for amblyopia.
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Affiliation(s)
| | - Anita J Simmers
- Department of Vision Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Zhou J, He Z, Wu Y, Chen Y, Chen X, Liang Y, Mao Y, Yao Z, Lu F, Qu J, Hess RF. Inverse Occlusion: A Binocularly Motivated Treatment for Amblyopia. Neural Plast 2019; 2019:5157628. [PMID: 31015829 PMCID: PMC6444262 DOI: 10.1155/2019/5157628] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/23/2018] [Accepted: 01/08/2019] [Indexed: 11/18/2022] Open
Abstract
Recent laboratory findings suggest that short-term patching of the amblyopic eye (i.e., inverse occlusion) results in a larger and more sustained improvement in the binocular balance compared with normal controls. In this study, we investigate the cumulative effects of the short-term inverse occlusion in adults and old children with amblyopia. This is a prospective cohort study of 18 amblyopes (10-35 years old; 2 with strabismus) who have been subjected to 2 hours/day of inverse occlusion for 2 months. Patients who required refractive correction or whose refractive correction needed updating were given a 2-month period of refractive adaptation. The primary outcome measure was the binocular balance which was measured using a phase combination task; the secondary outcome measures were the best-corrected visual acuity which was measured with a Tumbling E acuity chart and converted to logMAR units and the stereoacuity which was measured with the Random-dot preschool stereogram test. The average binocular gain was 0.11 in terms of the effective contrast ratio (z = -2.344, p = 0.019, 2-tailed related samples Wilcoxon Signed Rank Test). The average acuity gain was 0.13 logMAR equivalent (t(17) = 4.76, p < 0.001, 2-tailed paired samples t-test). The average stereoacuity gain was 339 arc seconds (z = -2.533, p = 0.011). Based on more recent research concerning adult ocular dominance plasticity, we conclude that inverse occlusion in adults and old children with amblyopia does produce long-term gains to binocular balance and that acuity and stereopsis can improve in some subjects.
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Affiliation(s)
- Jiawei Zhou
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Zhifen He
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Yidong Wu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Yiya Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Xiaoxin Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Yunjie Liang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Yu Mao
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Zhimo Yao
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Fan Lu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Jia Qu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325003, China
| | - Robert F. Hess
- McGill University, McGill Vision Research, Department of Ophthalmology, Quebec, Montreal, Canada H3G 1A4
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Al Jabri S, Kirkham J, Rowe FJ. Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures. BMC Ophthalmol 2019; 19:47. [PMID: 30736755 PMCID: PMC6368710 DOI: 10.1186/s12886-019-1055-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS. METHODS A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points. RESULTS A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common "visual or motility" outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements. CONCLUSION This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.
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Affiliation(s)
- Samia Al Jabri
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
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Araki S, Miki A, Goto K, Yamashita T, Takizawa G, Haruishi K, Yoneda T, Ieki Y, Kiryu J, Maehara G, Yaoeda K. Effect of amblyopia treatment on choroidal thickness in hypermetropic anisometropic amblyopia using swept-source optical coherence tomography. BMC Ophthalmol 2018; 18:227. [PMID: 30170555 PMCID: PMC6119334 DOI: 10.1186/s12886-018-0894-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recent studies using optical coherence tomography (OCT) have indicated that choroidal thickness (CT) in the anisometropic amblyopic eye is thicker than that of the fellow and normal control eyes. However, it has not yet been established as to how amblyopia affects the choroid thickening. The purpose of the present study was to investigate the effect of amblyopia treatment on macular CT in eyes with anisometropic amblyopia using swept-source OCT. Methods Thirteen patients (mean age: 6.2 ± 2.4 years) with hypermetropic anisometropic amblyopia were included in this study. Visual acuity (VA), axial length (AL), and CT were measured at the enrollment visit and at the final visit, after at least 6 months of treatment. CT measurements were corrected for magnification error and were automatically analyzed using built-in software and divided into three macular regions (subfoveal choroidal thickness (SFCT), center 1 mm, and center 6 mm). A one-way analysis of covariance using AL as a covariate was performed to determine whether CT in amblyopic eyes changed after amblyopia treatment. Results The average observation period was 22.2 ± 11.0 months. After treatment, VA (logMAR) improvement in the amblyopic eyes was 0.41 ± 0.19 (p < 0.001). SFCT, center 1 mm CT, and center 6 mm CT were significantly thicker in the amblyopic eyes compared with the fellow eyes both before and after treatment (p < 0.05 for all comparisons). There were no significant changes in SFCT, center 1 mm CT, or center 6 mm CT before and after treatment in the amblyopic (p = 0.25, 0.21, and 0.84, respectively) and fellow (p = 0.75, 0.84, and 0.91, respectively) eyes. The correlation between changes in logMAR versus changes in CT after treatment was not significant. Conclusions Although VA in amblyopic eyes was significantly improved after treatment, the choroid thickening of anisometropic amblyopic eyes persisted, and there was no significant change found in the CT after the treatment. Our findings suggest that thickening of the CT in amblyopia is not directly related to visual dysfunction.
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Affiliation(s)
- Syunsuke Araki
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Atsushi Miki
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan. .,Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama, 701-0193, Japan.
| | - Katsutoshi Goto
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Tsutomu Yamashita
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.,Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama, 701-0193, Japan
| | - Go Takizawa
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Kazuko Haruishi
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Tsuyoshi Yoneda
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.,Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama, 701-0193, Japan
| | - Yoshiaki Ieki
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Junichi Kiryu
- Department of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
| | - Goro Maehara
- Department of Human Sciences, Kanagawa University, 3-27-1 Rokkakubashi, Yokohama, Kanagawa, 221-8686, Japan
| | - Kiyoshi Yaoeda
- Yaoeda Eye Clinic, 2-1649-1 Naga-Chou, Nagaoka, Niigata, 940-0053, Japan
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30
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Kraus CL, Culican SM. New advances in amblyopia therapy II: refractive therapies. Br J Ophthalmol 2018; 102:1611-1614. [PMID: 29871968 PMCID: PMC6287570 DOI: 10.1136/bjophthalmol-2018-312173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/23/2018] [Indexed: 11/11/2022]
Abstract
The treatment of anisometropic or ametropic amblyopia has traditionally enjoyed a high treatment success rate. Early initiation and consistent use of spectacle correction can completely resolve amblyopia in a majority of patients. For those with anisometropic amblyopia that fail to improve with glasses wear alone, patching or atropine penalisation can lead to equalisation of visual acuity. However, successful treatment requires full-time compliance with refractive correction and this can be a challenge for a patient population that often has one eye with good acuity without correction. Other barriers for a select population with high anisometropic or ametropic amblyopia include rejection of glasses for various reasons including discomfort, behavioural or sensory problems, postural issues and visually significant aniseikonia. When consistent wear of optical correction proves difficult and patching/atropine remains a major obstacle, surgical correction of refractive error has proven success in achieving vision improvement. Acting as a means to achieve spectacle independence or reducing the overall needed refractive correction, refractive surgery can offer a unique treatment option for this patient population. Laser surgery, phakic intraocular lenses and clear lens exchange are three approaches to altering the refractive state of the eye. Each has documented success in improving vision, particularly in populations where glasses wear has not been possible. Surgical correction of refractive error has a risk profile greater than that of more traditional therapies. However, its use in a specific population offers the opportunity for improving visual acuity in children who otherwise have poor outcomes with glasses and patching/atropine alone.
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Affiliation(s)
- Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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31
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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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32
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Interocular suppression in children with deprivation amblyopia. Vision Res 2017; 133:112-120. [PMID: 28214552 DOI: 10.1016/j.visres.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/21/2022]
Abstract
In patients with anisometropic or strabismic amblyopia, interocular suppression can be minimized by presenting high contrast stimulus elements to the amblyopic eye and lower contrast elements to the fellow eye. This suggests a structurally intact binocular visual system that is functionally suppressed. We investigated whether suppression can also be overcome by contrast balancing in children with deprivation amblyopia due to childhood cataracts. To quantify interocular contrast balance, contrast interference thresholds were measured using an established dichoptic global motion technique for 21 children with deprivation amblyopia, 14 with anisometropic or mixed strabismic/anisometropic amblyopia and 10 visually normal children (mean age mean=9.9years, range 5-16years). We found that interocular suppression could be overcome by contrast balancing in most children with deprivation amblyopia, at least intermittently, and all children with anisometropic or mixed anisometropic/strabismic amblyopia. However, children with deprivation amblyopia due to early unilateral or bilateral cataracts could tolerate only very low contrast levels to the stronger eye indicating strong suppression. Our results suggest that treatment options reliant on contrast balanced dichoptic presentation could be attempted in a subset of children with deprivation amblyopia.
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Sachdeva V, Mittal V, Gupta V, Gunturu R, Kekunnaya R, Chandrasekharan A, Chabblani PP, Rao HL. "Combined Occlusion and Atropine Therapy" Versus "Augmented Part-Time Patching" in Children with Refractory/Residual Amblyopia: A Pilot Study. Middle East Afr J Ophthalmol 2017; 23:201-7. [PMID: 27162453 PMCID: PMC4845619 DOI: 10.4103/0974-9233.175892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To compare the efficacy of combined occlusion and atropine therapy (COAT) and augmented part-time patching for the treatment of unilateral refractory/residual amblyopia. Methodology: This retrospective study evaluated children between 4 and 11 years with refractory/residual amblyopia who were treated with either additional atropine (COAT group) or increased hours of patching (augmented group). Data were collected on improvement in best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR] units) at each follow-up visit. Results: There were 19 children in the COAT group and 17 children in the augmented group. The baseline BCVA of the amblyopic eye was 0.79 ± 0.36 logMAR in the COAT group and 0.72 ± 0.26 logMAR in augmented group. Children were statistically significantly younger in the COAT group (6.4 ± 2.2 years) compared to the augmented group (8.6 ± 3.3 years, P = 0.02). The mean duration of follow-up was statistically significantly longer in the augmented group (20.2 COAT group; 13.9 months augmented group) (P = 0.03). Compliance was similar in both groups. LogMAR BCVA (adjusted for difference in age and baseline BCVA) was statistically significantly better in the COAT group (0.56 ± 0.04) compared to the augmented group (0.80 ± 0.04) at 3 months (P = 0.000); 6 months (COAT group, 0.50 ± 0.04 vs. augmented group, 0.74 ± 0.04; P = 0.04) and at 1 year (COAT group, 0.42 ± 0.04 vs. augmented group, 0.67 ± 0.04, P = 0.000). There was statistically significantly greater improvement in logMAR BCVA at 6 months in COAT group (0.26 ± 0.15) compared to the augmented group (0.02 ± 0.14), (P = 0.0002). Age, gender, pretreatment BCVA, duration of follow-up, or compliance to patching did not affect improvement in BCVA. Conclusions: COAT may result in greater improvement in BCVA than augmented part-time patching in children with unilateral residual/refractory amblyopia.
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Affiliation(s)
- Virender Sachdeva
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Vaibhev Mittal
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Varun Gupta
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Rekha Gunturu
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Nimmagada Prasad Children's Eye Care Centre, L. V. Prasad Eye Institute, Visakhapatnam, India
| | - Ramesh Kekunnaya
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Anjali Chandrasekharan
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Preeti Patil Chabblani
- Department of Pediatric Ophthalmology, Strabismus and Neuro ophthalmology, Jasti V Ramanamma Children's Eye Care Centre, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Harsha L Rao
- Centre for Clinical Epidemiology and Biostatistics, L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Tailor V, Bossi M, Greenwood JA, Dahlmann-Noor A. Childhood amblyopia: current management and new trends. Br Med Bull 2016; 119:75-86. [PMID: 27543498 PMCID: PMC5862311 DOI: 10.1093/bmb/ldw030] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION OR BACKGROUND With a prevalence of 2-5%, amblyopia is the most common vision deficit in children in the UK and the second most common cause of functional low vision in children in low-income countries. SOURCES OF DATA Pubmed, Cochrane library and clinical trial registries (clinicaltrials.gov, ISRCTN, UKCRN portfolio database). AREAS OF AGREEMENT Screening and treatment at the age of 4-5 years are cost efficient and clinically effective. Optical treatment (glasses) alone can improve visual acuity, with residual amblyopia treated by part-time occlusion or pharmacological blurring of the better-seeing eye. Treatment after the end of the conventional 'critical period' can improve vision, but in strabismic amblyopia carries a low risk of double vision. AREAS OF CONTROVERSY It is not clear whether earlier vision screening would be cost efficient and associated with better outcomes. Optimization of treatment by individualized patching regimes or early start of occlusion, and novel binocular treatment approaches may enhance adherence to treatment, provide better outcomes and shorten treatment duration. GROWING POINTS Binocular treatments for amblyopia. AREAS TIMELY FOR DEVELOPING RESEARCH Impact of amblyopia on education and quality of life; optimal screening timing and tests; optimal administration of conventional treatments; development of child-friendly, effective and safe binocular treatments.
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Affiliation(s)
- Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK UCL Institute of Ophthalmology, London, UK
| | | | | | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, UK UCL Institute of Ophthalmology, London, UK
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35
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Chen AM, Cotter SA. The Amblyopia Treatment Studies: Implications for Clinical Practice. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2016; 1:287-305. [PMID: 28435934 PMCID: PMC5396957 DOI: 10.1016/j.yaoo.2016.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Angela M Chen
- Southern California College of Optometry at Marshall B. Ketchum University, 2575 Yorba Linda Blvd. Fullerton, CA 92831, , Phone number: (714) 449-7432
| | - Susan A Cotter
- Southern California College of Optometry at Marshall B. Ketchum University, 2575 Yorba Linda Blvd. Fullerton, CA 92831, , Phone number: (714) 449-7488
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36
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West S, Williams C. Amblyopia in children (aged 7 years or less). BMJ CLINICAL EVIDENCE 2016; 2016:0709. [PMID: 26731564 PMCID: PMC4701128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7-8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for amblyopia in children aged 7 years or less? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 14 full publications. Of the 14 full articles evaluated, two systematic reviews were updated and three RCTs and two follow-up studies were added at this update. We performed a GRADE evaluation for nine PICO combinations. CONCLUSIONS In this systematic overview we categorised the efficacy for three interventions, based on information about the effectiveness and safety of glasses, occlusion, or penalisation with atropine.
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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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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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40
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A binocular iPad treatment for amblyopic children. Eye (Lond) 2014; 28:1246-53. [PMID: 25060850 DOI: 10.1038/eye.2014.165] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/13/2014] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Monocular amblyopia treatment (patching or penalization) does not always result in 6/6 vision and amblyopia often recurs. As amblyopia arises from abnormal binocular visual experience, we evaluated the effectiveness of a novel home-based binocular amblyopia treatment. METHODS Children (4-12 y) wore anaglyphic glasses to play binocular games on an iPad platform for 4 h/w for 4 weeks. The first 25 children were assigned to sham games and then 50 children to binocular games. Children in the binocular group had the option of participating for an additional 4 weeks. Compliance was monitored with calendars and tracking fellow eye contrast settings. About half of the children in each group were also treated with patching at a different time of day. Best-corrected visual acuity, suppression, and stereoacuity were measured at baseline, at the 4- and 8-week outcome visits, and 3 months after cessation of treatment. RESULTS Mean (±SE) visual acuity improved in the binocular group from 0.47±0.03 logMAR at baseline to 0.39±0.03 logMAR at 4 weeks (P<0.001); there was no significant change for the sham group. The effect of binocular games on visual acuity did not differ for children who were patched vs those who were not. The median stereoacuity remained unchanged in both groups. An additional 4 weeks of treatment did not yield additional visual acuity improvement. Visual acuity improvements were maintained for 3 months after the cessation of treatment. CONCLUSIONS Binocular iPad treatment rapidly improved visual acuity, and visual acuity was stable for at least 3 months following the cessation of treatment.
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Abstract
Amblyopia refers to unilateral or bilateral reduction in best corrected visual acuity, not directly attributed to structural abnormality of the eye or posterior visual pathways. Early detection of amblyopia is crucial to obtaining the best response to treatment. Amblyopia responds best to treatment in the first few years of life. In the past several years a series of studies undertaken by the Pediatric Eye Disease Investigator Group (PEDIG) have been designed to evaluate traditional methods for treating amblyopia and provide evidence on which to base treatment decisions. This article summarizes and discusses the findings of the PEDIG studies to date.
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Affiliation(s)
- Diana DeSantis
- Children's Eye Physicians, 4875 Ward Road, Wheat Ridge, CO 80033, USA.
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Kassem IS, Miller MT, Archer SM. One Year of Pediatric Ophthalmology and Strabismus Research in Review. Asia Pac J Ophthalmol (Phila) 2013; 2:388-400. [PMID: 26107151 PMCID: PMC6839686 DOI: 10.1097/apo.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To highlight recent advances in amblyopia and strabismus. DESIGN Literature review. METHODS A literature search of articles published in the English language was performed in PubMed or MEDLINE between May 2012 and April 2013 using the terms amblyopia or strabismus. Articles deemed relevant were selected. RESULTS The review highlights articles that increase our understanding of strabismus and amblyopia as well as newer treatment strategies. CONCLUSIONS The review highlights some new information and possible future advances in amblyopia and strabismus.
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Affiliation(s)
- Iris S Kassem
- From the *University of Illinois at Chicago Eye and Ear Infirmary, Chicago, IL; and †Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI
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