1
|
Rakshit A, Schmid KL, Webber AL. Fine visuomotor skills in amblyopia: a systematic review and meta-analysis. Br J Ophthalmol 2024; 108:633-645. [PMID: 37669851 DOI: 10.1136/bjo-2022-322624] [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: 09/21/2022] [Accepted: 06/25/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Amblyopia is characterised by reduced visual acuity, poor binocular sensory fusion, and impaired or absent stereoacuity. Understanding the extent to which amblyopia affects everyday task performance is important to quantifying the disease burden of amblyopia and can assist clinicians to understand patients' likely functional capability. METHODS A systematic literature search identified published studies comparing fine visuomotor performance in either children or adults with amblyopia and those with normal binocular vision. The included studies (22 studies involving 835 amblyopes and 561 controls) reported results of self-perception patient reported outcome measures, tests of motor proficiency and video recorded reaching and grasping. The outcomes of 17 studies were grouped into four meta-analyses, with pooled results reported as standardised mean difference (SMD) with corresponding 95% CI. RESULTS Regardless of the cause of amblyopia (anisometropia, strabismus, mixed, deprivation), significant reduction in self-perception of physical competence and athletic competence (SMD=-0.74, 95% CI -1.23 to -0.25, p=0.003); fine motor skills scores (SMD=-0.86, 95% CI -1.27 to -0.45, p<0.0001); speed of visually guided reaching and grasping movements (SMD=0.86, 95% CI 0.65 to 1.08, p<0.00001); and precision of temporal eye-hand coordination (SMD=0.75, 95% CI 0.26 to 1.25, p=0.003) occurred in amblyopes compared with those with normal visual development. CONCLUSION Reports of the impact of amblyopia on fine motor skills performance find poorer outcomes in participants with amblyopia compared with those with normal vision development. Consistency in the outcome measure used to assess the functional impact of amblyopia would be valuable for future studies.
Collapse
Affiliation(s)
- Archayeeta Rakshit
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, Queensland, Australia
| | - Ann L Webber
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
Hernández-Rodríguez CJ, Ferrer-Soldevila P, Artola-Roig A, Piñero DP. Rehabilitation of amblyopia using a digital platform for visual training combined with patching in children: a prospective study. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06475-0. [PMID: 38578335 DOI: 10.1007/s00417-024-06475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To assess the possible benefits of the use of perceptual learning and dichoptic therapy combined with patching in children with amblyopia over the use of only patching. METHODS Quasi-experimental multicentric study including 52 amblyopic children. Patients who improved their visual acuity (VA) by combining spectacles and patching were included in patching group (PG: 20 subjects), whereas those that did not improved with patching performed visual training (perceptual learning + dichoptic therapy) combined with patching, being assigned to the visual treatment group (VT: 32 subjects). Changes in VA, contrast sensitivity (CS), and stereopsis were monitored during a 6-month follow-up in each group. RESULTS Significant improvements in VA were found in both groups at 1 month (p < 0.01). The total improvement of VA was 0.18 ± 0.16 and 0.31 ± 0.35 logMAR in PG and VT groups, respectively (p = 0.317). The Wilcoxon effect size was slightly higher in VT (0.48 vs. 0.54) at 6 months. An enhancement in CS was observed in the amblyopic eye of the VT group for all spatial frequencies at 1 month (p < 0.001). Likewise, the binocular function score also increased significantly in VT group (p = 0.002). A prediction equation of VA improvement at 1 month in VT group was obtained by multiple linear regression analysis (p < 0.001, R2 = 0.747). CONCLUSIONS A combined treatment of visual training and patching is effective for obtaining a predictable improvement of VA, CS, and binocularity in patching-resistant amblyopic children.
Collapse
Affiliation(s)
- Carlos J Hernández-Rodríguez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/N 03016, San Vicente del Raspeig, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Ribera Virgen de La Caridad Hospital, Cartagena, Spain
| | | | - Alberto Artola-Roig
- Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - David P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/N 03016, San Vicente del Raspeig, Alicante, Spain.
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain.
| |
Collapse
|
3
|
Giaschi DE, Asare AK, Jost RM, Kelly KR, Birch EE. Motion-Defined Form Perception in Deprivation Amblyopia. Invest Ophthalmol Vis Sci 2024; 65:13. [PMID: 38573617 PMCID: PMC10996940 DOI: 10.1167/iovs.65.4.13] [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: 10/11/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Purpose The purpose of this study was to assess motion-defined form perception, including the association with clinical and sensory factors that may drive performance, in each eye of children with deprivation amblyopia due to unilateral cataract. Methods Coherence thresholds for orientation discrimination of motion-defined form were measured using a staircase procedure in 30 children with deprivation amblyopia and 59 age-matched controls. Visual acuity, stereoacuity, fusion, and interocular suppression were also measured. Fixation stability and fellow-eye global motion thresholds were measured in a subset of children. Results Motion-defined form coherence thresholds were elevated in 90% of children with deprivation amblyopia when viewing with the amblyopic eye and in 40% when viewing with the fellow eye. The deficit was similar in children with a cataract that had been visually significant at birth (congenital) and in children for whom the cataract appeared later in infancy or childhood (developmental). Poorer motion-defined form perception in amblyopic eyes was associated with poorer visual acuity, poorer binocular function, greater interocular suppression, and the presence of nystagmus. Fellow-eye deficits were not associated with any of these factors, but a temporo-nasal asymmetry for global motion perception in favor of nasalward motion suggested a general disruption in motion perception. Conclusions Deficits in motion-defined form perception are common in children with deprivation amblyopia and may reflect a problem in motion processing that relies on binocular mechanisms.
Collapse
Affiliation(s)
- Deborah E Giaschi
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Akosua K Asare
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Reed M Jost
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Krista R Kelly
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, Dallas, Texas, United States
| |
Collapse
|
4
|
Wang Y, Wu Y, Luo L, Li F. Structural and functional alterations in the brains of patients with anisometropic and strabismic amblyopia: a systematic review of magnetic resonance imaging studies. Neural Regen Res 2023; 18:2348-2356. [PMID: 37282452 PMCID: PMC10360096 DOI: 10.4103/1673-5374.371349] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different. Therefore, we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia; this study is registered with PROSPERO (registration ID: CRD42022349191). We searched three online databases (PubMed, EMBASE, and Web of Science) from inception to April 1, 2022; 39 studies with 633 patients (324 patients with anisometropic amblyopia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria (e.g., case-control designed, peer-reviewed articles) and were included in this review. These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate cortices during task-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations, respectively; these may have arisen from abnormal visual experiences. Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state, as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometropic amblyopia and strabismic amblyopia patients. The shared dysfunction of anisometropic amblyopia and strabismic amblyopia patients, relative to controls, is also characterized by reduced spontaneous brain activity in the oculomotor cortex, mainly involving the frontal and parietal eye fields and the cerebellum; this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia. With regards to specific alterations of the two forms of amblyopia, anisometropic amblyopia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients, as reflected by diffusion tensor imaging, and more significant dysfunction and structural loss in the ventral pathway. Strabismic amblyopia patients experience more attenuation of activation in the extrastriate cortex than in the striate cortex when compared to anisometropic amblyopia patients. Finally, brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients, and the patterns of brain alterations are more limited in amblyopic adults than in children. In conclusion, magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alterations in anisometropic amblyopia and strabismic amblyopia patients; these alterations may improve our understanding of the neural mechanisms underlying amblyopia.
Collapse
Affiliation(s)
- Yuxia Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Ye Wu
- Department of Ophthalmology, Laboratory of Optometry and Vision Sciences, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan Province, China
| | - Lekai Luo
- Department of Radiology, West China Second Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| |
Collapse
|
5
|
Duffy KR, Bear MF, Patel NB, Das VE, Tychsen L. Human deprivation amblyopia: treatment insights from animal models. Front Neurosci 2023; 17:1249466. [PMID: 37795183 PMCID: PMC10545969 DOI: 10.3389/fnins.2023.1249466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Amblyopia is a common visual impairment that develops during the early years of postnatal life. It emerges as a sequela to eye misalignment, an imbalanced refractive state, or obstruction to form vision. All of these conditions prevent normal vision and derail the typical development of neural connections within the visual system. Among the subtypes of amblyopia, the most debilitating and recalcitrant to treatment is deprivation amblyopia. Nevertheless, human studies focused on advancing the standard of care for amblyopia have largely avoided recruitment of patients with this rare but severe impairment subtype. In this review, we delineate characteristics of deprivation amblyopia and underscore the critical need for new and more effective therapy. Animal models offer a unique opportunity to address this unmet need by enabling the development of unconventional and potent amblyopia therapies that cannot be pioneered in humans. Insights derived from studies using animal models are discussed as potential therapeutic innovations for the remediation of deprivation amblyopia. Retinal inactivation is highlighted as an emerging therapy that exhibits efficacy against the effects of monocular deprivation at ages when conventional therapy is ineffective, and recovery occurs without apparent detriment to the treated eye.
Collapse
Affiliation(s)
- Kevin R. Duffy
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Mark F. Bear
- Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Nimesh B. Patel
- College of Optometry, University of Houston, Houston, TX, United States
| | - Vallabh E. Das
- College of Optometry, University of Houston, Houston, TX, United States
| | - Lawrence Tychsen
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States
| |
Collapse
|
6
|
Horwood A, Heijnsdijk E, Kik J, Sloot F, Carlton J, Griffiths HJ, Simonsz HJ. A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven. Strabismus 2023; 31:220-235. [PMID: 37870065 DOI: 10.1080/09273972.2023.2268128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE/BACKGROUND Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4 years and 4-5 years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. CONCLUSIONS All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
Collapse
Affiliation(s)
- Anna Horwood
- Department of Psychology, University of Reading, Reading, UK
| | - Eveline Heijnsdijk
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Kik
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Jiang SQ, Chen YR, Liu XY, Zhang JY. Contour integration deficits at high spatial frequencies in children treated for anisometropic amblyopia. Front Neurosci 2023; 17:1160853. [PMID: 37564367 PMCID: PMC10411894 DOI: 10.3389/fnins.2023.1160853] [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: 02/07/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study was conducted to reexamine the question of whether children treated for anisometropic amblyopia have contour integration deficits. To do so, we used psychophysical methods that require global contour processing while minimizing the influence of low-level deficits: visibility, shape perception, and positional uncertainty. Methods Thirteen children with anisometropic amblyopia (age: 10.1 ± 1.8 years) and thirteen visually normal children (age: 10.8 ± 2.0 years) participated in this study. The stimuli were closed figures made up of Gabor patches either in noise or on a blank field. The contrast thresholds to detect a circular contour on a blank field, as well as the thresholds of aspect ratio and contour element number to discriminate a circular or elliptical contour in noise, were measured at Gabor spatial frequencies of 1.5, 3, and 6 cpd for amblyopic eyes (AEs), fellow eyes (FEs), and normal control eyes. Visual acuities and contrast sensitivity functions for AEs and FEs and the Randot stereoacuity were measured before testing. Results The AEs showed contrast deficits and degraded shape perception compared to the FEs at higher spatial frequencies (6 cpd). When the influence of abnormal contrast sensitivity and shape perception were minimized, the AEs showed contour integration deficits at spatial frequencies 3 and 6 cpd. These deficits were not related to basic losses in contrast sensitivity and acuity, stereoacuity, and visual crowding. Besides, no significant difference was found between the fellow eyes of the amblyopic children and the normal control eyes in the performance of contour integration. Conclusion After eliminating or compensating for the low-level deficits, children treated for anisometropic amblyopia still show contour integration deficits, primarily at higher spatial frequencies, which might reflect the deficits in global processing caused by amblyopia. Contour integration deficits are likely independent of spatial vision deficits. Refractive correction and/or occlusion therapies may not be sufficient to fully restore contour integration deficits, which indicates the need for the development of clinical treatments to recover these deficits.
Collapse
Affiliation(s)
- Shu-Qi Jiang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Yan-Ru Chen
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Xiang-Yun Liu
- The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong, China
| | - Jun-Yun Zhang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| |
Collapse
|
8
|
Dulaney CS, Murray J, Ghasia F. Contrast sensitivity, optotype acuity and fixation eye movement abnormalities in amblyopia under binocular viewing. J Neurol Sci 2023; 451:120721. [PMID: 37433244 DOI: 10.1016/j.jns.2023.120721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Visual function deficits are seen in amblyopic subjects during fellow and binocular viewing. The purpose of the study was to examine the relationship between Fixation Eye Movement (FEM) abnormalities and binocular contrast sensitivity and optotype acuity deficits in amblyopia. METHODS We recruited 10 controls and 25 amblyopic subjects [Anisometropic = 6, Strabismic = 10, Mixed = 9]. We measured binocular contrast sensitivity at spatial frequencies 1,2, 4, 8, 12 and 16 and binocular and monocular optotype acuity using a staircase procedure. We recorded FEMs using high-resolution video-oculography and classified subjects as having no nystagmus(None = 9) or nystagmus without FMN(n = 7) and with Fusion Maldevelopment Nystagmus (FMN)(n = 9). We computed the fixation instability, amplitude and velocity of the fast and slow FEMs. RESULTS Amblyopic subjects with and without nystagmus had worse binocular contrast sensitivity at spatial frequencies 12 and 16 and binocular optotype acuity than controls. The abnormalities were most pronounced in amblyopic subjects with FMN. Fixation instability of the Fellow Eye and Amblyopic Eye and vergence instability, amplitude of fast FEMs and velocity of slow FEMs were increased with reduced binocular contrast sensitivity and reduced optotype acuity in amblyopic subjects. CONCLUSIONS Fixation instability of Fellow Eye and Amblyopic Eye, optotype acuity and contrast sensitivity deficits are seen under binocular viewing in amblyopic subjects with and without nystagmus but are most pronounced in those with FMN. FEMs abnormalities correlate with both lower order (contrast sensitivity) and higher order (optotype acuity) visual function impairment in amblyopia.
Collapse
Affiliation(s)
- Cody S Dulaney
- Cleveland Clinic Cole Eye Institute, Visual Neurosciences and Ocular Motility Laboratory, Cleveland, OH, USA
| | - Jordan Murray
- Cleveland Clinic Cole Eye Institute, Visual Neurosciences and Ocular Motility Laboratory, Cleveland, OH, USA
| | - Fatema Ghasia
- Cleveland Clinic Cole Eye Institute, Visual Neurosciences and Ocular Motility Laboratory, Cleveland, OH, USA.
| |
Collapse
|
9
|
Kelly KR, Jost RM, Hudgins LA, Stager DR, Hunter JS, Beauchamp CL, Dao LM, Birch EE. Slow Binocular Reading in Amblyopic Children Is a Fellow Eye Deficit. Optom Vis Sci 2023; 100:194-200. [PMID: 36715973 PMCID: PMC10245300 DOI: 10.1097/opx.0000000000001995] [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] [Indexed: 01/31/2023] Open
Abstract
SIGNIFICANCE Amblyopic children read 25% slower than their peers during binocular silent reading. PURPOSE We compared binocular reading to fellow eye reading to determine whether slow reading in amblyopic children is due to binocular inhibition; that is, the amblyopic eye is interfering during binocular reading. METHODS In a cross-sectional study, 38 children with amblyopia and 36 age-similar control children who completed grades 1 to 6 were enrolled. Children silently read grade-appropriate paragraphs during binocular reading and fellow eye reading while wearing ReadAlyzer eye-tracking goggles (Compevo AB, Stockholm, Sweden). Reading rate, number of forward saccades, number of regressive saccades, and fixation duration were analyzed between groups and between viewing conditions. We also examined whether sensory factors (amblyopia severity, stereoacuity, suppression) were related to slow reading. RESULTS For amblyopic children, binocular reading versus fellow eye reading did not differ for reading rate (176 ± 60 vs. 173 ± 53 words per minute, P = .69), number of forward saccades (104 ± 35 vs. 97 ± 33 saccades/100 words, P = .18), number of regressive saccades (21 ± 15 vs. 22 ± 13 saccades/100 words, P = .75), or fixation duration (0.31 ± 0.06 vs. 0.32 ± 0.07 seconds, P = .44). As expected, amblyopic children had a slower reading rate and more forward saccades than control children during binocular reading and fellow eye reading. Slow reading was not related to any sensory factors. CONCLUSIONS Binocular reading did not differ from fellow eye reading in amblyopic children. Thus, binocular inhibition is unlikely to play a role in slow binocular reading and is instead a fellow eye deficit that emerges from a disruption in binocular visual experience during development.
Collapse
Affiliation(s)
| | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | - David R Stager
- Pediatric Ophthalmology and Adult Strabismus, PA, Plano, Texas
| | | | | | - Lori M Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, Texas
| | | |
Collapse
|
10
|
Birch EE, Kelly KR. Amblyopia and the whole child. Prog Retin Eye Res 2023; 93:101168. [PMID: 36736071 PMCID: PMC9998377 DOI: 10.1016/j.preteyeres.2023.101168] [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: 09/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
Amblyopia is a disorder of neurodevelopment that occurs when there is discordant binocular visual experience during the first years of life. While treatments are effective in improving visual acuity, there are significant individual differences in response to treatment that cannot be attributed solely to difference in adherence. In this considerable variability in response to treatment, we argue that treatment outcomes might be optimized by utilizing deep phenotyping of amblyopic deficits to guide alternative treatment choices. In addition, an understanding of the broader knock-on effects of amblyopia on developing visually-guided skills, self-perception, and quality of life will facilitate a whole person healthcare approach to amblyopia.
Collapse
Affiliation(s)
- Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Krista R Kelly
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA; Vision and Neurodevelopment Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA.
| |
Collapse
|
11
|
Niechwiej-Szwedo E, Colpa L, Wong A. The role of binocular vision in the control and development of visually guided upper limb movements. Philos Trans R Soc Lond B Biol Sci 2023; 378:20210461. [PMID: 36511416 PMCID: PMC9745875 DOI: 10.1098/rstb.2021.0461] [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: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Vision provides a key sensory input for the performance of fine motor skills, which are fundamentally important to daily life activities, as well as skilled occupational and recreational performance. Binocular visual function is a crucial aspect of vision that requires the ability to combine inputs from both eyes into a unified percept. Summation and fusion are two aspects of binocular processing associated with performance advantages, including more efficient visuomotor control of upper limb movements. This paper uses the multiple processes model of limb control to explore how binocular viewing could facilitate the planning and execution of prehension movements in adults and typically developing children. Insight into the contribution of binocularity to visuomotor control also comes from examining motor performance in individuals with amblyopia, a condition characterized by reduced visual acuity and poor binocular function. Overall, research in this field has advanced our understanding of the role of binocular vision in the development and performance of visuomotor skills, the first step towards developing assessment tools and targeted rehabilitation for children with neurodevelopment disorders at risk of poor visuomotor outcomes. This article is part of a discussion meeting issue 'New approaches to 3D vision'.
Collapse
Affiliation(s)
- Ewa Niechwiej-Szwedo
- Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue, Waterloo, ON, Canada N2L 3G1
| | - Linda Colpa
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8
- University of Toronto, 27 King's College Circle, Toronto, ON, Canada M5S 1A4
| |
Collapse
|
12
|
Magli A, Esposito Veneruso P, Rinaldi M, Caputo R, Tranfa F, Costagliola C. Long-term effects of early/late-onset visual deprivation on macular and retinal nerve fibers layer structure: A pilot study. PLoS One 2023; 18:e0283423. [PMID: 36952524 PMCID: PMC10035877 DOI: 10.1371/journal.pone.0283423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND/AIMS Tomographic analysis of macular and peripapillary retinal nerve fibers layer (RNFL) thickness in patients with history of congenital (CC) and developmental cataract (DC). METHODS Analysis of macular and RNFL thickness using a spectral-domain optical coherence tomography was performed. Retinal layers thickness was measured using the internal segmentation software. Measurements of affected (unilateral and bilateral), contralateral eyes and control eyes were compared. RESULTS Patients with history of CC or DC (n = 13 and 11 respectively) and 35 healthy control subjects were enrolled. Thicker inner and outer nuclear layers (INL, ONL) and thicker ONL were found when CC and DC group when compared to controls respectively. Bilateral CC showed the most relevant differences. Slight thickening of CC inner retinal layers were found when compared to DC. Increased superonasal RNFL thickness was found in CC group when compared to DC and controls. Thickening of RNFL of contralateral unaffected eyes of unilateral CC were found when compared to controls. CONCLUSION Significant macular and RNFL thickness changes between CC, DC patients and controls that partially involve also contralateral unaffected eyes of unilateral congenital cataract were found. CC and DC groups show significant differences only in inner retinal layers thickness. Our data suggest that early visual deprivation may influence retinal arrangements occurring during development involving predominantly the outer nuclear layer and para/perifoveal inner retinal layers, and confirm that early treatment of CC allow to achieve better long-term visual outcome. Moreover functional and structural data support the hypothesis that unilateral amblyopia is not exclusively an unilateral issue.
Collapse
Affiliation(s)
- Adriano Magli
- Department of Ophthalmology, Orthoptic and Pediatric Ophthalmology, University of Salerno, Salerno, Italy
| | | | - Michele Rinaldi
- Pediatric Ophthalmology Unit, A. Meyer Children's Hospital, Florence, Italy
| | - Roberto Caputo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fausto Tranfa
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| |
Collapse
|
13
|
Xiang A, Du K, Fu Q, Zhang Y, Zhao L, Yan L, Wen D. Do monocular myopia children need to wear glasses? Effects of monocular myopia on visual function and binocular balance. Front Neurosci 2023; 17:1135991. [PMID: 37034177 PMCID: PMC10073496 DOI: 10.3389/fnins.2023.1135991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective This study aims to compare the binocular visual functions and balance among monocular myopic adolescents and adults and binocular low myopic adolescents and explore whether monocular myopia requires glasses. Methods A total of 106 patients participated in this study. All patients were divided into three groups: the monocular myopia children group (Group 1 = 41 patients), the monocular myopia adult group (Group 2 = 26 patients) and the binocular low myopia children group (Group 3 = 39 patients). The refractive parameters, accommodation, stereopsis, and binocular balance were compared. Results The binocular refractive difference in Group 1, Group 2, and Group 3 was -1.37 ± 0.93, -1.94 ± 0.91, and -0.32 ± 0.27 D, respectively. Moreover, uncorrected visual acuity (UCVA), spherical equivalent (SE) and monocular accommodative amplitude (AA) between myopic and emmetropic eyes in Group 1 and Group 2 were significantly different (all P < 0.05). There was a significant difference in the accommodative facility (AF) between myopic and emmetropic eyes in Group 2 (t = 2.131, P = 0.043). Furthermore, significant differences were found in monocular AA (t = 6.879, P < 0.001), binocular AA (t = 5.043, P < 0.001) and binocular AF (t = -3.074, P = 0.003) between Group 1 and Group 2. The normal ratio of stereopsis according to the random dots test in Group 1 was higher than in Group 2 (χ2 = 14.596, P < 0.001). The normal ratio of dynamic stereopsis in Group 1 was lower than in Group 3 (χ2 = 13.281, P < 0.001). The normal signal-to-noise ratio of the binocular balance point in Group 1 was lower than Group 3 (χ2 = 4.755, P = 0.029). Conclusion First, monocular myopia could lead to accommodative dysfunction and unbalanced input of binocular visual signals, resulting in myopia progression. Second, monocular myopia may also be accompanied by stereopsis dysfunction, and long-term uncorrected monocular myopia may worsen stereopsis acuity in adulthood. In addition, patients with monocular myopia could exhibit stereopsis dysfunction at an early stage. Therefore, children with monocular myopia must wear glasses to restore binocular balance and visual functions, thereby delaying myopia progression.
Collapse
Affiliation(s)
- Aiqun Xiang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kaixuan Du
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiuman Fu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanni Zhang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liting Zhao
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Yan
- National Engineering Research Center for Healthcare Devices, Guangzhou, China
| | - Dan Wen
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Dan Wen,
| |
Collapse
|
14
|
Chen Y, Zuo J, Xiong Y, Yu X, Wei L, Luo Y, Bao J, Chen H, Zhou J. Refraction development in anisometropic amblyopia with patching therapy. Front Med (Lausanne) 2022; 9:959085. [PMID: 36330057 PMCID: PMC9623012 DOI: 10.3389/fmed.2022.959085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/26/2022] [Indexed: 09/29/2023] Open
Abstract
PURPOSE To investigate the development of refraction in anisometropic amblyopia who had been with patching therapy. METHODS We retrospectively reviewed 37,528 medical records of the amblyopes who had been treated with patching therapy between July 2003 and January 2020 at the School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University. We included unilateral anisometropic amblyopia with a follow-up length of not < 2 years. In total, 371 cases were enrolled and followed up for a mean of 4.76 ± 2.11 years. The subjects were then divided into different groups and periods according to their initial spherical equivalent (SE) refractive error and best-corrected visual acuity (BCVA) of the amblyopic eye. Linear mixed-effects models were fitted to calculate the annual change of SE. RESULTS The annual changes in SE were -0.32 (-0.35 to -0.30) and -0.16 (-0.19 to -0.14) D/yr for the amblyopic eye and the fellow eye, respectively. The annual changes in SE of amblyopic eyes during the treatment period and the successfully treated period were -0.36 (-0.43 to -0.29; 95% CI) and -0.27 (-0.32 to -0.23; 95% CI) D/yr, respectively; the annual SE changes of the fellow eye during the treatment period and the successfully-treated period were -0.07 (-0.14 to -0.01; 95% CI) and -0.18 (-0.22 to -0.14; 95% CI) D/yr, respectively. CONCLUSION The amblyopic eye experienced a significantly greater degree of refractive error changes than the fellow eye and underwent a continuous refractive error reduction before and after 7 years old. After the patching therapy was terminated, emmetropization in the amblyopic eye remained synchronized, whereas the refractive error change was increased in the fellow eye.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Hao Chen
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China
| | - Jiawei Zhou
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
15
|
Ghasia F, Wang J. Amblyopia and fixation eye movements. J Neurol Sci 2022; 441:120373. [DOI: 10.1016/j.jns.2022.120373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/05/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
|
16
|
Hou SW, Zhang Y, Christian L, Niechwiej‐Szwedo E, Giaschi D. Evaluating visuomotor coordination in children with amblyopia. Dev Psychobiol 2022; 64:e22270. [DOI: 10.1002/dev.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/05/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sabrina W. Hou
- Department of Ophthalmology and Visual Sciences University of British Columbia Vancouver British Columbia Canada
| | - Yan Zhang
- Department of Ophthalmology and Visual Sciences University of British Columbia Vancouver British Columbia Canada
| | - Lisa Christian
- Department of Optometry and Vision Science University of Waterloo Waterloo Ontario Canada
| | | | - Deborah Giaschi
- Department of Ophthalmology and Visual Sciences University of British Columbia Vancouver British Columbia Canada
| |
Collapse
|
17
|
Birch EE, Kelly KR, Wang J. Recent Advances in Screening and Treatment for Amblyopia. Ophthalmol Ther 2021; 10:815-830. [PMID: 34499336 PMCID: PMC8589941 DOI: 10.1007/s40123-021-00394-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment in children, with a prevalence of 2-3%. Not only is visual acuity reduced in one eye but binocular vision is affected, fellow eye deficits may be present, eye-hand coordination and reading can be affected, and self-perception may be diminished. New technologies for preschool vision screening hold promise for accessible, early, and accurate detection of amblyopia. Together with recent advances in our theoretical understanding of amblyopia and technological advances in amblyopia treatment, we anticipate improved visual outcomes for children affected by this very common eye condition. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
Collapse
Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA.
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Krista R Kelly
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingyun Wang
- SUNY College of Optometry, State University of New York, New York, NY, USA
| |
Collapse
|
18
|
Liu XY, Zhang YW, Gao F, Chen F, Zhang JY. Dichoptic Perceptual Training in Children With Amblyopia With or Without Patching History. Invest Ophthalmol Vis Sci 2021; 62:4. [PMID: 33944893 PMCID: PMC8107508 DOI: 10.1167/iovs.62.6.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Dichoptic training is becoming a popular tool in amblyopia treatment. Here we investigated the effects of dichoptic demasking training in children with amblyopia who never received patching treatment (NPT group) or were no longer responsive to patching (PT group). Methods Fourteen NPT and thirteen PT amblyopes (6-16.5 years; 24 anisometropic, two strabismus, and one mixed) received dichoptic demasking training for 17 to 22 sessions. They used the amblyopic eye (AE) to practice contrast discrimination between a pair of Gabors that were dichoptically masked by a band-filtered noise pattern simultaneously presented in the fellow eye (FE). Dichoptic learning was quantified by the increase of maximal tolerable noise contrast (TNC) for AE contrast discrimination. Computerized visual acuities and contrast sensitivity functions for both eyes and the Randot stereoacuity were measured before and after training. Results Training improved maximal TNC by six to eight times in both groups, along with a boost of AE acuities by 0.15 logMAR (P < 0.001) in the NPT group and 0.06 logMAR (P < 0.001) in the PT group. This visual acuity improvement was significantly dependent on the pretraining acuity. Stereoacuity was significantly improved by 41.6% (P = 0.002) in the NPT group and 64.2% (P < 0.001) in the PT group. The stereoacuity gain was correlated to the pretraining interocular acuity difference (r = -0.49, P = 0.010), but not to the interocular acuity difference change (r = -0.28, P = 0.15). Training improved AE contrast sensitivity in the NPT group (P = 0.009) but not the PT group (P = 0.76). Moreover, the learning effects in 12 retested observers were retained for 10 to 24 months. Conclusions Dichoptic training can improve, and sometimes even restore, the stereoacuity of amblyopic children, especially those with mild amblyopia (amblyopic VA ≦0.28 logMAR). The dissociation of stereoacuity gain and the interocular acuity difference change suggests that the stereoacuity gain may not result from a reduced interocular suppression in most amblyopes. Rather, the amblyopes may have learned to attend to, or readout, the stimulus information to improve stereopsis.
Collapse
Affiliation(s)
- Xiang-Yun Liu
- The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Yu-Wei Zhang
- School of Psychological and Cognitive Sciences, and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Feng Gao
- The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Fei Chen
- The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong Province, China
| | - Jun-Yun Zhang
- School of Psychological and Cognitive Sciences, and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| |
Collapse
|
19
|
Murray J, Garg K, Ghasia F. Monocular and Binocular Visual Function Deficits in Amblyopic Patients with and without Fusion Maldevelopment Nystagmus. Eye Brain 2021; 13:99-109. [PMID: 33953627 PMCID: PMC8089081 DOI: 10.2147/eb.s300454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study is to examine the association between amblyopia type and the presence of nystagmus on binocular and monocular functions of the fellow (FE) and amblyopic eye (AE). Methods We recruited 19 controls and 44 amblyopes (anisometropes=13, strabismic=10, mixed=21). We measured visual, grating, and vernier acuities and high/low spatial frequency (SF) contrast sensitivities in each eye using a staircase method. Stereoacuity was measured with the Titmus fly test. We recorded fixation eye movements (FEM) using high-resolution video-oculography. Subjects were classified as having either no nystagmus (n=18), fusion maldevelopment nystagmus syndrome (FMNS) (n=12), or nystagmus without any structural anomalies that does not meet the criteria for FMNS or infantile nystagmus (n=14). Results Analysis of visual function by clinical amblyopia type showed that patients with strabismus/mixed amblyopia (F (2,54)=9.5, p<0.001) were more likely to have poor stereopsis while controlling for AE grating acuity deficit. The FE of patients with anisometropia had greater contrast sensitivity deficits at low (F (2,43)=4.4, p=0.018) and high SF (F (2,42)=10.1, p<0.001). Analysis of visual function by FEM characteristics (low SF: (F (3,43)=4.3, p=0.010) and high SF: (F (3,42)=7.1, p=0.001) showed that the FE of patients with FMNS had worse low and high SF contrast sensitivities, whereas those without FMNS had greater contrast sensitivity deficits only at high SF compared to controls. Patients with FMNS (F (3,54) = 12.9, p<0.001) were more likely to have poor stereopsis while controlling for AE grating acuity deficit compared to patients without FMNS. All amblyopic patients had worse high SF contrast sensitivity of the AE irrespective of type or FEM characteristics (Type = F (2,43)=8.8, p=0.001; FEM characteristics= F (3,43)=5.1, p=0.004). Conclusion The presence of FMNS in patients with strabismic/mixed amblyopia is associated with poor/absent stereopsis. FE deficits vary across amblyopia type. Like FEM abnormalities, visual function deficits are seen in the FE of patients with and without nystagmus.
Collapse
Affiliation(s)
- Jordan Murray
- Cleveland Clinic Cole Eye Institute, Ophthalmological Research, Cleveland, OH, USA
| | - Kiran Garg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fatema Ghasia
- Cleveland Clinic Cole Eye Institute, Department of Ophthalmology, Cleveland, OH, 44195-0001, USA
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Kelly KR, Morale SE, Beauchamp CL, Dao LM, Luu BA, Birch EE. Factors Associated with Impaired Motor Skills in Strabismic and Anisometropic Children. Invest Ophthalmol Vis Sci 2021; 61:43. [PMID: 32845292 PMCID: PMC7452850 DOI: 10.1167/iovs.61.10.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We evaluated motor skills in children diagnosed with strabismus and anisometropia, with or without amblyopia, and explored factors associated with impairments. Methods A total of 143 strabismic and anisometropic children 3 to 13 years of age (96 amblyopic, 47 nonamblyopic) and a group of age-similar 35 control children completed Manual Dexterity, Aiming and Catching, and Balance tasks from the Movement Assessment Battery for Children, Second Edition. Raw scores were converted to standardized scores, and amblyopic and nonamblyopic children were compared to controls. Clinical and sensory factors associated with motor performance were also evaluated. Results Overall, amblyopic and nonamblyopic children were three to six times more likely than controls to be at risk for or to have a total motor impairment (≤15th percentile). Although amblyopic children scored lower than controls for the Manual Dexterity, Aiming and Catching, and Balance tasks, nonamblyopic children scored lower on Manual Dexterity only. Factors related to manual dexterity deficits include the presence of amblyopia and binocularity deficits typical of these eye conditions. Aiming, catching, and balance deficits were most pronounced in children with an infantile onset of the eye condition, a history of strabismus, and reduced binocularity. Conclusions Amblyopia and strabismus disrupt the development of motor ability in children. These findings highlight the widespread effects of discordant binocular input early in life and the visual acuity and binocularity deficits typical of these eye conditions.
Collapse
Affiliation(s)
- Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Sarah E Morale
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | | | - Lori M Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, Texas, United States
| | - Becky A Luu
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, Texas, United States
| | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| |
Collapse
|
22
|
Jin J, Apple A, Friess A, Lehman S, Salvin J, Hendricks D, Reid J, Wang J. Using OCT Fixation Shift to Assess Eccentric Fixation in Children With Residual Amblyopia. Transl Vis Sci Technol 2020; 9:30. [PMID: 33262904 PMCID: PMC7691785 DOI: 10.1167/tvst.9.12.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Eccentric fixation in amblyopia is often estimated grossly without precision. Although the usefulness of optical coherence tomography (OCT) fixation shift in the quantification of eccentric fixation in a small cohort of amblyopic children was recently reported, there is a lack of understanding of characteristics of OCT fixation shift. In a retrospective cohort study, we evaluated eccentric fixation with OCT in a large cohort of children with residual amblyopia. Methods Children, age 4 to 17 years, with residual amblyopia (amblyopic, n = 56) and without amblyopia (control, n = 75) were enrolled. Amblyopia was associated with anisometropia alone (anisometropia subtype, n = 28) and strabismus without or with anisometropia (strabismic subtype, n = 28). Spectral domain OCT was used to estimate fixation. The OCT fixation shift, defined as the distance between the fovea and the fixation point, was measured and adjusted with calculated axial length and converted into visual degrees. Fixation shift in amblyopic eyes, fellow nonamblyopic eyes, and right eyes of the control group were compared. Fixation shift between the anisometropic and strabismic amblyopia subtypes was also compared. Its correlation with visual acuity was estimated. Results The mean fixation shift was significantly different: 0.17° ± 0.29° for control right eyes, 0.94° ± 1.24° for amblyopic eyes, and 0.34° ± 0.57° for fellow eyes (χ2 = 23.3; P < 0.001). There was no significant difference between fellow eyes and control eyes (P = 0.11). Fixation shift in amblyopic eyes was significantly correlated with visual acuity (R = 0.44; P < 0.001), and it was significantly smaller in the anisometropic subtype than in the strabismic subtypes (0.34° ± 0.46° vs. 1.54° ± 1.48°, W = 338, P < 0.001). Conclusions OCT fixation shift can be used both in detection and quantification of eccentric fixation in children with residual amblyopia, especially in those with strabismus. Translational Relevance OCT fixation shift offers a convenient clinical approach in quantitative evaluation of eccentric fixation in children with strabismic amblyopia.
Collapse
Affiliation(s)
- Jing Jin
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Annie Apple
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amanda Friess
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Sharon Lehman
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jonathan Salvin
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | | | - Julia Reid
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jingyun Wang
- State University of New York, College of Optometry, New York, NY, USA
| |
Collapse
|