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Current Opinion in Ophthalmology Sep 2016This review article is an update on the current treatments for amblyopia. In particular, the authors focus on the concepts of brain plasticity and their implications for... (Review)
Review
PURPOSE OF REVIEW
This review article is an update on the current treatments for amblyopia. In particular, the authors focus on the concepts of brain plasticity and their implications for novel treatment strategies for both children and adults affected by amblyopia.
RECENT FINDINGS
A variety of strategies has been developed to treat amblyopia in children and adults. New evidence on the pathogenesis of amblyopia has been obtained both in animal models and in clinical trials. Mainly, these studies have challenged the classical concept that amblyopia becomes untreatable after the 'end' of the sensitive or critical period of visual development, because of a lack of sufficient plasticity in the adult brain.
SUMMARY
New treatments for amblyopia in children and adults are desirable and should be encouraged. However, further studies should be completed before such therapies are widely accepted into clinical practice.
Topics: Amblyopia; Animals; Brain; Humans; Neuronal Plasticity; Vision, Binocular
PubMed: 27152486
DOI: 10.1097/ICU.0000000000000293 -
Visual Neuroscience Jan 2018Amblyopia is a developmental disorder that affects the spatial vision of one or both eyes in the absence of an obvious organic cause; it is associated with a history of... (Review)
Review
Amblyopia is a developmental disorder that affects the spatial vision of one or both eyes in the absence of an obvious organic cause; it is associated with a history of abnormal visual experience during childhood. Subtypes have been defined based on the purported etiology, namely, strabismus (misaligned eyes) and/or anisometropia (unequal refractive error). Here we consider the usefulness of these subclassifications.
Topics: Adult; Amblyopia; Child; Child, Preschool; Genetic Variation; Humans; Infant; Vision Tests
PubMed: 29905124
DOI: 10.1017/S0952523817000190 -
JPMA. the Journal of the Pakistan... Mar 2023The narrative review was planned to investigate the efficiency of binocular treatment for amblyopic children, and to compare it with the standard methods. Literature... (Review)
Review
The narrative review was planned to investigate the efficiency of binocular treatment for amblyopic children, and to compare it with the standard methods. Literature search was conducted for articles in English language available on PubMed, Cochrane Library, Embase, Medline and PsycInfo databases as well as through bibliographies of peer-reviewed studies. Studies in the field of binocular treatment for amblyopia were included. Visual outcomes considered were visual acuity, types of amblyopia and stereoacuity. Studies on deprivation amblyopia, animal studies, literature review of amblyopia treatment, case reports, and trials targeting participants in whom previous amblyopia treatment had failed were excluded. Of the 40 studies found, 21(52.5%) met the inclusion criteria. Visual acuity and binocular function improved with binocular treatment for treating amblyopia in children by decreasing suppression depth extent and increasing stereopsis. Binocular treatment for amblyopic children was found to be an effective and fast process for the recovery of visual functions, especially in the critical time of visual development.
Topics: Animals; Amblyopia; Vision, Binocular; Visual Acuity; Databases, Factual
PubMed: 36932768
DOI: 10.47391/JPMA.6216 -
Vision Research Sep 2015In the past 20 years, there has been a great advancement in knowledge pertaining to compliance with amblyopia treatments. The occlusion dose monitor introduced... (Review)
Review
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.
Topics: Amblyopia; Atropine; Child; Humans; Mydriatics; Patient Compliance; Sensory Deprivation; Visual Acuity
PubMed: 25743080
DOI: 10.1016/j.visres.2015.02.012 -
Graefe's Archive For Clinical and... Mar 2020To identify whether there are functional abnormalities in the retina of amblyopic eyes using multifocal electroretinography (mfERG).
PURPOSE
To identify whether there are functional abnormalities in the retina of amblyopic eyes using multifocal electroretinography (mfERG).
METHODS
This is a prospective study of patients ≥ 7 years of age identified with unilateral amblyopia (strabismic or anisometropic). Multifocal ERG and flash ERG were performed to compare parameters between the amblyopic and non-amblyopic fellow eyes. A complete analysis of the five ring averages was done including the central ring.
RESULTS
Thirty-eight patients were included: mean age was 14.3 ± 7.3 years; 18 patients were strabismic and 20 were anisometropic. Amblyopic eye responses across the rings in multifocal ERG were diminished compared with fellow non-amblyopic eyes with significant differences detected in the central rings (p = 0.001). On the other hand, flash ERG did not show any consistently significant differences. When divided by severity, amplitudes of central rings were significantly lower in severely amblyopic eyes compared with non-amblyopic eyes (p = 0.001), while in mild amblyopia, no significant differences were observed. No significant difference was observed between anisometropic and strabismic amblyopic eyes.
CONCLUSIONS
Using multifocal ERG, significantly decreased amplitudes were observed in amblyopic eyes compared with normal fellow eyes in the central ring. This correlated with the severity of amblyopia. No difference was observed when comparing the two groups of amblyopia (strabismic and anisometropic). Those findings may help clarify the pathophysiology of amblyopia better and open the door for new objective ways to monitor the response to amblyopia treatment but this needs to be further studied.
Topics: Adolescent; Amblyopia; Child; Electroretinography; Evoked Potentials, Visual; Female; Humans; Male; Nerve Fibers; Prospective Studies; Retina; Tomography, Optical Coherence; Visual Acuity; Visual Fields
PubMed: 31900648
DOI: 10.1007/s00417-019-04558-x -
Klinische Monatsblatter Fur... Oct 2015
Topics: Adolescent; Adult; Age Distribution; Aged; Amblyopia; Diagnosis, Differential; Female; Germany; Humans; Male; Middle Aged; Prevalence; Risk Factors; Strabismus; Young Adult
PubMed: 26824113
DOI: 10.1055/s-0035-1564768 -
The Cochrane Database of Systematic... Jul 2014Amblyopia is reduced visual acuity in one or both eyes in the absence of any demonstrable abnormality of the visual pathway. It is not immediately resolved by the... (Review)
Review
BACKGROUND
Amblyopia is reduced visual acuity in one or both eyes in the absence of any demonstrable abnormality of the visual pathway. It is not immediately resolved by the correction of refractive error. Strabismus develops in approximately 5% to 8% of the general population. The aim of treatment for amblyopia is to obtain the best possible level of vision in the amblyopic eye. Different treatment options were examined within the review.
OBJECTIVES
By reviewing the available evidence we wanted to establish the most effective treatment for strabismic amblyopia. In particular this review aimed to examine the impact of conventional occlusion therapy for strabismic amblyopia and to analyse the role of partial occlusion and optical penalisation for strabismic amblyopia.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2014), EMBASE (January 1980 to January 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 January 2014.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) for the treatment of strabismic amblyopia including participants of any age.
DATA COLLECTION AND ANALYSIS
Two authors working independently extracted and entered data into Review Manager 5 and then independently checked the data for errors.
MAIN RESULTS
We included three RCTs in this review. The studies reported mean logMAR visual acuity achieved. Mean difference in visual acuity was calculated. When comparing conventional part-time occlusion (with any necessary glasses), PEDIG 2006 reported that this treatment was more beneficial than glasses alone for strabismic amblyopia; the mean difference between groups was -0.18 LogMAR (statistically significant 95% confidence interval (CI) -0.32 to -0.04). Supplementing occlusion therapy with near activities may produce a better visual outcome compared to non-near activities after four weeks of treatment (PEDIG 2005). The results of the pilot study showed mean difference between groups was -0.17 LogMAR (95% CI -0.53 to 0.19). Results from a larger RCT (PEDIG 2008) are now available, showing that supplementing occlusion therapy with near activities may produce a better visual outcome after eight weeks of treatment; the mean difference between groups was -0.02 LogMAR (95% CI -0.10 to 0.06). One further article ia awaiting assessment as in its current format there is insufficient information to include (Alotaibi 2012).
AUTHORS' CONCLUSIONS
Occlusion, whilst wearing necessary refractive correction, appears to be more effective than refractive correction alone in the treatment of strabismic amblyopia. The benefit of combining near activities with occlusion is unproven. No RCTs were found that assessed the role of either partial occlusion or optical penalisation to refractive correction for strabismic amblyopia.
Topics: Amblyopia; Child; Child, Preschool; Eyeglasses; Humans; Randomized Controlled Trials as Topic; Sensory Deprivation; Strabismus; Visual Acuity
PubMed: 25051925
DOI: 10.1002/14651858.CD006461.pub4 -
Seminars in Ophthalmology 2017Amblyopia is a leading cause of low vision and warrants timely management during childhood. We performed a literature review of the management of amblyopia and potential... (Review)
Review
PURPOSE
Amblyopia is a leading cause of low vision and warrants timely management during childhood. We performed a literature review of the management of amblyopia and potential risk factors for amblyopia.
METHODS
Literature review of the management of amblyopia and risk factors for amblyopia.
RESULTS
Common amblyopia risk factors include anisometropic or high refractive error, strabismus, cataract, and ptosis. Often a conservative approach with spectacles is enough to prevent amblyopia. However, surgery may be necessary to clear the visual axis or align the eyes.
CONCLUSION
Amblyopia risk factors should be managed early. Though amblyopia treatment is more likely to be successful at a younger age, those who are older but treatment-naïve may still respond to treatment. Promoting binocular or dichoptic experiences may be the future direction of amblyopia management.
Topics: Amblyopia; Atropine; Blepharoptosis; Cataract; Child; Child, Preschool; Evidence-Based Medicine; Humans; Mydriatics; Ophthalmologic Surgical Procedures; Refractive Errors; Risk Factors; Sensory Deprivation; Strabismus
PubMed: 27748640
DOI: 10.1080/08820538.2016.1228408 -
Visual Neuroscience Jan 2018Emerging technologies are now giving us unprecedented access to manipulate brain circuits, shedding new light on treatments for amblyopia. This research is identifying... (Review)
Review
Emerging technologies are now giving us unprecedented access to manipulate brain circuits, shedding new light on treatments for amblyopia. This research is identifying key circuit elements that control brain plasticity and highlight potential therapeutic targets to promote rewiring in the visual system during and beyond early life. Here, we explore how such recent advancements may guide future pharmacological, genetic, and behavioral approaches to treat amblyopia. We will discuss how animal research, which allows us to probe and tap into the underlying circuit and synaptic mechanisms, should best be used to guide therapeutic strategies. Uncovering cellular and molecular pathways that can be safely targeted to promote recovery may pave the way for effective new amblyopia treatments across the lifespan.
Topics: Amblyopia; Cognitive Behavioral Therapy; Gene-Environment Interaction; Humans; Molecular Targeted Therapy; Pharmaceutical Preparations
PubMed: 29905118
DOI: 10.1017/S0952523817000256 -
Der Ophthalmologe : Zeitschrift Der... Jul 2021The successful outcome of treatment for infant and childhood cataract depends on many factors. It is crucial that the treatment falls into a phase in which neither the... (Review)
Review
The successful outcome of treatment for infant and childhood cataract depends on many factors. It is crucial that the treatment falls into a phase in which neither the eye nor the visual pathway and visual cortex are fully developed. This review summarizes the current state of knowledge and provides an overview of the epidemiology, causes and clinical forms, early detection and, above all, treatment options. Special attention is paid to time-critical stages of development, according to which the therapeutic concepts are based. Complications, such as amblyopia and glaucoma are discussed in detail. In addition to surgical aspects, much emphasis is placed on orthoptic-refractive aftercare, the quality and execution of which is the essential predictor of a good functional outcome.
Topics: Amblyopia; Cataract; Cataract Extraction; Child, Preschool; Glaucoma; Humans; Infant; Lens Implantation, Intraocular
PubMed: 33783620
DOI: 10.1007/s00347-021-01370-z