1
|
Sharma P, Tibrewal S, Singh PK, Ganesh S. Efficacy of anti-suppression therapy in improving binocular vision in children with small-angle Esotropia. JOURNAL OF OPTOMETRY 2024; 17:100490. [PMID: 38061140 PMCID: PMC10750105 DOI: 10.1016/j.optom.2023.100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision. METHODS A retrospective review of patients aged 3-8 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test. RESULTS Eighteen patients with a mean age of 5.4 ± 1.38 years (range 3-8 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), post-operative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 3-8). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.03-93.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %). Near stereopsis improved to 200 s of arc or more in 60% of the patients. The mean esotropia reduced from 5.7 ± 4.0 PD for distance and 6.2 ± 4.66 PD for near to 2.7 ± 2.4 PD and 3.38 ± 4.7 PD respectively, at the last follow-up (p-value 0.004 and 0.006). Failure of therapy was noticed after six months of follow-up in the child with infantile esotropia. CONCLUSION Anti-suppression exercises may be beneficial to improve binocular vision functions in children with small-angle esotropias of variable etiologies. Recurrence of suppression after cessation of therapy is possible, warranting regular follow up.
Collapse
Affiliation(s)
- Preeti Sharma
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi 110002, India.
| | - Shailja Tibrewal
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi 110002, India
| | - Prem Kumar Singh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi 110002, India
| | - Suma Ganesh
- Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr. Shroff's Charity Eye Hospital, Daryaganj, New Delhi 110002, India
| |
Collapse
|
2
|
Hong JD, Choi EH, Suh S, Bui JH, Storch AM, Walker KR, Shahraki K, Yanez C, Torres D, Espinoza J, Molina I, Suh DW. UCI EyeMobile Exam Findings from School Children Following on-Site Screening. Clin Ophthalmol 2024; 18:1667-1678. [PMID: 38860118 PMCID: PMC11164085 DOI: 10.2147/opth.s460879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/30/2024] [Indexed: 06/12/2024] Open
Abstract
Purpose Uncorrected refractive errors (REs) and amblyopia can lead to visual impairment with deleterious effects on quality of life and academic performance. Early detection and treatment by community vision care programs, such as the UCI EyeMobile for Children, can aid in addressing preventable vision loss. Methods A total of 5074 children between the ages of 3 and 10 years were screened at 153 locations, including preschools, head start programs, and elementary schools within Orange County (OC), California (CA). Subsequently, 1024 children presented for comprehensive eye examinations. A retrospective analysis of all examined children was conducted, determining the frequency and severity of REs and amblyopia and the spectacle prescription rate by age. Propensity score matching analysis evaluated the effect of median household income on RE and amblyopia frequency. Results Among those who failed initial screening and were subsequently examined, significant rates of REs and amblyopia were detected: myopia (24.4%), hyperopia (35.4%), astigmatism (71.8%), anisometropia (8.9%), amblyopia (7.0%), and amblyopia risk (14.4%). A majority (65.0%) of those examined received prescription spectacles from UCI EyeMobile, with around a third requiring a new or updated prescription. The frequency of REs and amblyopia and the spectacle prescription rate were uniform across OC congressional districts. Myopia and amblyopia risk was positively and negatively associated with household income, respectively. Conclusion The UCI EyeMobile for Children serves as a vital vision care program, providing free vision screening, comprehensive eye examinations, and spectacles. A significant number of children required examination, and a high frequency of REs and amblyopia were detected in examined children, with subsequent provision of prescription spectacles to most children.
Collapse
Affiliation(s)
- John D Hong
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Elliot H Choi
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Susie Suh
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Joseph H Bui
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Annabelle M Storch
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Kimberly R Walker
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Kourosh Shahraki
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Carolina Yanez
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Diana Torres
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Jennifer Espinoza
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| | - Iliana Molina
- Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, CA, USA
| | - Donny W Suh
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California, Irvine, CA, USA
| |
Collapse
|
3
|
Şengör T, Gençağa Atakan T. Management of Contact Lenses and Visual Development in Pediatric Aphakia. Turk J Ophthalmol 2024; 54:90-102. [PMID: 38645732 PMCID: PMC11034540 DOI: 10.4274/tjo.galenos.2023.56252] [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: 03/30/2023] [Accepted: 11/28/2023] [Indexed: 04/23/2024] Open
Abstract
Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.
Collapse
Affiliation(s)
| | - Tuğba Gençağa Atakan
- University of Health Sciences Türkiye, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Clinic of Eye Ophthalmology, İstanbul, Türkiye
| |
Collapse
|
4
|
Zhang MG, Gallo RA, Chang TC. Congenital Cataracts With Thin Lenses (Leptophakia) in Children: Morphology and Surgical Outcomes. Am J Ophthalmol 2024; 265:1-5. [PMID: 38582306 DOI: 10.1016/j.ajo.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE To determine the morphology and postoperative outcomes of pediatric cataracts with thin (leptophakic) lenses. DESIGN Retrospective comparative clinical cohort study. METHODS We identified the records of pediatric patients who had undergone cataract surgery between 2018 and 2023 and lens thickness less than 2 standard deviations of age-stratified normal eyes in the general population. Matching controls were identified based on sex, age at surgery, and intraocular lens implant status. Data abstracted include axial length, anterior chamber depth, lens thickness, visual acuity, intraocular pressure, and surgical details. RESULTS A total of 13 eyes from 7 patients were identified to be leptophakic, 8 of which had matching controls. Compared with the control eyes, leptophakic eyes had thinner lenses (2.74 ± 0.39 mm vs 4.82 ± 1.01 mm, P < .01) with comparable anterior chamber depth (3.28 ± 0.76 mm vs 2.98 ± 1.28 mm, P = .13) and axial lengths (19.17 ± 2.61 mm vs 20.76 ± 1.76 mm, P = .20). Following cataract surgery, visual acuity improved for both the leptophakic and control cohorts within 2.5 months postoperatively (-0.68 ± 0.37 logMAR vs -0.06 ± 0.42 logMAR, P = .03) and at 1-2 years postoperatively (-1.58 ± 1.03 logMAR vs -0.60 ± 0.49 logMAR, P = .22) without any glaucoma-related adverse events. Of note, 5 of 13 leptophakic eyes (38%) were found to have posterior capsular ruptures intraoperatively. CONCLUSIONS Leptophakic eyes demonstrated similar intraoperative and short-term postoperative outcomes when compared to control eyes, although vigilance for posterior capsular defects and ruptures may be necessary.
Collapse
Affiliation(s)
- Michelle G Zhang
- From the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ryan A Gallo
- From the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ta Chen Chang
- From the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
| |
Collapse
|
5
|
Pekica D, Košič Knez N, Razboršek B, Pahor D. OCT-Angiography Findings in Children with Anisometropic Amblyopia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1519. [PMID: 37761480 PMCID: PMC10528469 DOI: 10.3390/children10091519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The purpose of this prospective study is to show findings of OCT angiography in children with anisometropic amblyopia with a statistically significant difference, regardless of the type of refractive disorder, between the amblyopic and the fellow eye. This research aimed to establish whether there is a difference in vascular density [VD] and size of the foveal avascular zone [FAZ] in the superficial capillary plexus [SCP]. METHODS All children between 9 and 18 years of age who were treated at the Outpatient Clinic for Orthoptics and Pleoptics of the Department of Ophthalmology, University Medical Centre Maribor from January 2020 to December 2022 due to unilateral anisometric amblyopia were enrolled in our study. Fourteen children met the criteria. Cirrus 5000 high-resolution OCT with AngioPlex OCT angiography was used to analyze the size of the FAZ and VD in the SCP and TCS. The paired t-test or Wilcox signed-rank test [p < 0.05] was used for statistical analysis of each parameter between the amblyopic and fellow eye. RESULTS Mean child age was 13 years ± 2.9 and ranged from 9 to 18 years. Most of the children [85.7%] were boys. The VD of the SCP did not show statistically significant differences between the visually impaired and control eyes [p = 0.328]. The comparison of the FAZ area between the two eyes was also not statistically significant [p < 0.808]. There was also no statistically significant difference in central macular thickness [TCS] [p < 0.291]. CONCLUSIONS Our research results show no statistically significant differences in the VD and the FAZ of the SCP, and in the TCS between the amblyopic and fellow eye in children with unilateral anisometropic amblyopia. Our research did not confirm the results of certain previous studies in which a lower density of the capillary network was present in the visually impaired eye. Further studies with more children are necessary to confirm our results.
Collapse
Affiliation(s)
- David Pekica
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
| | - Nina Košič Knez
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
- Department of Ophthalmology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Barbara Razboršek
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
- Department of Ophthalmology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Dušica Pahor
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
- Department of Ophthalmology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| |
Collapse
|
6
|
Wang G, Liu L. Amblyopia: progress and promise of functional magnetic resonance imaging. Graefes Arch Clin Exp Ophthalmol 2022; 261:1229-1246. [PMID: 36282454 DOI: 10.1007/s00417-022-05826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Amblyopia is a neurodevelopmental disorder characterized by functional deficits in the visual cortex. Functional magnetic resonance imaging (fMRI) is the most commonly used neuroimaging technique for investigating amblyopia. Herein, we systematically searched a PubMed database from inception to December 2021 to highlight the current progress and promises about fMRI technology in amblyopia; amblyopia's neural mechanism, the comparison of different types of amblyopia, and the evaluation of the therapeutic effect were explored. Relevant articles published in English and appropriate cross-references were considered for inclusion, including basic studies, imaging techniques, clinical diagnostic and therapeutic studies, case series, and reviews.
Collapse
Affiliation(s)
- Guiqu Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Fawzy S, Hamdi M, Galal A, Ragheb T. Comparison of the outcome of partial time occlusion therapy in strabismic versus anisometropic moderate amblyopes. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.4103/ejos.ejos_64_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|