Termination of amblyopia treatment: when to stop follow-up visits and risk factors for recurrence

Current Management of Childhood Amblyopia

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.

Ocular aberrations in amblyopic children

PURPOSE

To study the pattern of ocular aberrations in amblyopic children, and evaluate a possible relation to etiology and treatment outcomes of amblyopia.

METHODS

The WaveScan Wavefront System (AMO, Santa Ana, CA, USA) aberrometer was used to assess 75 eyes (60 children) after instillation of 1% cyclopentolate eyedrops. There were 29 males and 31 females with a mean age of 9.23 ± 2.55 years (range, 5-14 years). The study sample was subdivided into four groups; 16 emmetropic non-amblyopic eyes (control group); 24 pre-treatment newly diagnosed amblyopic eyes; 16 eyes of treated amblyopes and; 19 eyes with refractory amblyopia.

RESULTS

Amblyopes had statistically significant greater root mean square (RMS) values for whole eye aberrations, 2nd order aberrations, defocus ([Formula: see text]) and astigmatism ([Formula: see text]) compared to emmetropes (P < 0.0001). The refractory amblyopic group showed statistically significant differences in whole eye RMS, 2nd order- aberrations, defocus ([Formula: see text]) and astigmatism ([Formula: see text]) when compared to treated amblyopic groups (P < 0.0001). Apart from a statistically significant difference in 5th order RMS of pre-treated amblyopes versus the control group, no other significant differences were found in higher order aberrations (HOAs: coma, spherical, higher-order astigmatism, trefoil, or 3rd, 4th, 5th or 6th order terms) between emmetropes and any of the amblyopic groups.

CONCLUSION

Lower order aberrations remain the major factor that affect retinal image quality and hence amblyopia development especially in ametropic eyes. This can be corrected optically. Studying HOA profile in amblyopic eyes failed to explain why refractory amblyopia does not respond to orthoptic treatments. This outcome indicates that theories of central problems in image processing and binocular interaction are likely the main cause of refractory amblyopia.