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Beyoglu Eye Journal 2023This study aimed to evaluate the macular pigment optical density (MPOD) scores in eyes with hyperopic anisometropic amblyopia and compare those with their fellow and...
OBJECTIVES
This study aimed to evaluate the macular pigment optical density (MPOD) scores in eyes with hyperopic anisometropic amblyopia and compare those with their fellow and control eyes using one-wavelength fundus reflectometry.
METHODS
This cross-sectional study enrolled 33 patients diagnosed with hyperopic anisometropic amblyopia aged 12-40 years. The control group consisted of 36 hyperopic and 42 emmetropic children, age-matched to the patients. Central macular thickness (CMT), MPOD, axial length (AL), best-corrected visual acuity, and refraction errors were measured between the study group and the control group.
RESULTS
Eyes with the diagnosis of hyperopic anisometropic amblyopia had significantly higher mean and maximum (max) MPOD scores compared with their fellow eyes as well as hyperopic and emmetropic eyes (p<0.001 for all). The mean AL in eyes with hyperopic anisometropic amblyopia was statistically shorter than that in hyperopic and emmetropic controls (p=0.027, p<0.001, respectively). The mean CMT was found to be thicker in eyes with hyperopic anisometropic amblyopia when compared to their fellow eyes, as well as hyperopic and emmetropic controls, eventhough there was no significant difference was found among the four groups (p=0.052). The mean MPOD levels were significantly correlated with the difference in CMT (r=-0.21, p=0.032), and logMAR visual acuity scores (r=-0.44, p<0.001) in the hyperopic anisometropic amblyopia group.
CONCLUSION
The present study indicates that the MPOD is reduced in eyes with hyperopic anisometropic amblyopia. This reduction may be due to less visual stimulus-induced deterioration of foveal development and microarchitecture in anisometropic amblyopic eyes.
PubMed: 37766762
DOI: 10.14744/bej.2023.98159 -
BMJ Open Jul 2023Amblyopia is the most common cause of unilateral visual impairment in children and requires long-term treatment. This study aimed to quantify the impact of pandemic...
OBJECTIVES
Amblyopia is the most common cause of unilateral visual impairment in children and requires long-term treatment. This study aimed to quantify the impact of pandemic control measures on amblyopia management.
DESIGN AND SETTING
This was a retrospective cohort study of data from a large amblyopia management database at a major tertiary eye care centre in China.
PARTICIPANTS
Outpatients with amblyopia who visited the hospital from 1 June 2019, through 28 February 2022.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was the number of first and follow-up in-person visits to the hospital for amblyopia treatment. Secondary outcomes included the time interval between consecutive visits and improvement of vision (visual acuity, contrast sensitivity and stereopsis). Patient records were grouped into prepandemic and during pandemic periods.
RESULTS
A total of 10 060 face-to-face visits for 5361 patients (median age 6.7 years, IQR 5.4, 8.9) that spanned two lockdown periods were included in the analysis, of which 28% were follow-up visits. Pandemic control measures caused a sharp decline in the number of outpatient visits (3% and 30% of prepandemic levels in the months directly after the start of the first (2020) and second (2021) periods of pandemic control measures, respectively). However, these drops were followed by pronounced rebounds in visits that exceeded prepandemic levels by 51.1% and 108.5%, respectively. The interval between consecutive visits increased significantly during the pandemic from a median (IQR) of 120 (112, 127) days in 2019 to 197 (179, 224) in 2020 (p<0.001) and 189 (182, 221) in 2021 (p<0.001). There were no significant differences in the improvement of visual function or treatment compliance between the prepandemic and postpandemic groups.
CONCLUSIONS
The number of amblyopia patient hospital visits spiked well above prepandemic levels following lockdown periods. This pattern of patient behaviour can inform planning for amblyopia treatment services during and after public health-related disruptions.
Topics: Child; Humans; Amblyopia; Retrospective Studies; Pandemics; Treatment Outcome; COVID-19; Communicable Disease Control; Tertiary Care Centers; China
PubMed: 37407054
DOI: 10.1136/bmjopen-2023-071839 -
Deutsches Arzteblatt International Nov 2023In this systematic review, we address the question whether children and adolescents with developmental visual disorders benefit from computer-assisted visual training.
BACKGROUND
In this systematic review, we address the question whether children and adolescents with developmental visual disorders benefit from computer-assisted visual training.
METHODS
Systematic literature searches were carried out in three bibliographic databases (initial search in October 2021) and trial registries. Included were randomized controlled trials that evaluated the efficacy of computer-assisted visual training in children and adolescents with developmental visual disorders in comparison to no training, sham training, or conservative treatment.
RESULTS
The inclusion criteria were met by 17 trials (with a total of 1323 children and adolescents) focusing on binocular or monocular computer-assisted visual training for the treatment of amblyopia. In these trials, visual training was carried out for 2 to 24 weeks, either as "stand alone" therapy or in addition to occlusion therapy. Six trials showed a statistically significant difference in favor of the visual training for the outcome "best corrected visual acuity of the amblyopic eye." However, this difference was small and mostly below the threshold of clinical relevance of -0.05 logMAR (equivalent to an improvement of 0.5 lines on the eye chart, or 2.5 letters per line). Only few data were available for the outcomes "binocular vision" and "adverse events"; the differences between the groups were similarly small.
CONCLUSION
The currently available data do not permit any firm conclusions regarding the efficacy of visual training in children and adolescents with amblyopia. Moreover, treatment adherence was often insufficient and the treatment durations in the trials was relatively short. No results from randomized trials have yet been published with respect to other developmental visual disorders (refractive errors, strabismus).
Topics: Child; Humans; Adolescent; Amblyopia; Visual Acuity; Vision Disorders; Refractive Errors; Computers; Randomized Controlled Trials as Topic
PubMed: 37656479
DOI: 10.3238/arztebl.m2023.0191 -
American Journal of Ophthalmology Case... Dec 2023To report Vogt-Koyanagi-Harada (VKH) disease in a patient with extreme anisometropia.
PURPOSE
To report Vogt-Koyanagi-Harada (VKH) disease in a patient with extreme anisometropia.
OBSERVATIONS
A 56-year-old woman was referred to our hospital. Her past medical history was significant for amblyopia in the right eye. At the initial visit, decimal best-corrected visual acuity (BCVA) was 0.03 (Snellen equivalent 5/160) in the right eye and 0.03 (Snellen equivalent 5/160) in the left eye, and axial length was 28.44 mm and 22.36 mm, respectively. Anterior chamber inflammation was seen predominantly in the right eye with fibrin exudates. Swept-source optical coherence tomography demonstrated choroidal thickening and folds predominantly in the left eye. Additionally, serous retinal detachment (SRD) was much more evident in the left eye than in the right eye. Subfoveal choroidal thickness (SCT) was 417 μm in the right and over 800 μm in the left eye. Cerebrospinal fluid examination revealed lymphocyte-dominant hypercellularity. Based on these findings, we diagnosed the patient with VKH disease and treated her with a high-dose systemic corticosteroid. One month after the initiation of treatment, SRD in both eyes fully resolved, and SCT decreased to 105 μm in the right and 311 μm in the left eye.
CONCLUSIONS AND IMPORTANCE
The marked discrepancy in axial length between the right and left eyes might contribute to the different severity of inflammation in VKH disease.
PubMed: 37771387
DOI: 10.1016/j.ajoc.2023.101929 -
Medicine May 2024This study was aimed to analyze ocular biometric changes following cycloplegia in pediatric patients with strabismus and amblyopia. Cycloplegia is routinely used to... (Observational Study)
Observational Study
This study was aimed to analyze ocular biometric changes following cycloplegia in pediatric patients with strabismus and amblyopia. Cycloplegia is routinely used to measure refractive error accurately by paralyzing accommodation. However, effects on axial length (AL), anterior chamber depth (ACD), keratometry (Km), and white-to-white distance (WTW) are not well studied in this population. This retrospective study examined 797 patients (1566 eyes) undergoing cycloplegic refraction at a Samsung Kangbuk hospital pediatric ophthalmology clinic from 2010 to 2023. Ocular biometry was measured before and after instilling 1% cyclopentolate and 0.5% phenylephrine/0.5% tropicamide. Patients were categorized by strabismus diagnosis, age, refractive error and amblyopia status. Differences in AL, ACD, Km, WTW, and refractive error pre- and post-cycloplegia were analyzed using paired t tests. ACD (3.44 ± 0.33 vs 3.58 ± 0.29 mm, P < .05) and WTW (12.09 ± 0.42 vs 12.30 ± 0.60 mm, P < .05) increased significantly after cycloplegia in all groups except other strabismus subgroup (Cs) in both parameters and youngest subgroup (G1) in ACD. Refractive error demonstrated a hyperopic shift from -0.48 ± 3.00 D to -0.06 ± 3.32 D (P < .05) in overall and a myopic shift from -6.97 ± 4.27 to -8.10 ± 2.26 in high myopia (HM). Also, AL and Km did not change significantly. In conclusion, cycloplegia impacts ocular biometrics in children with strabismus and amblyopia, significantly increasing ACD and WTW. Refractive error shifts hyperopically in esotropia subgroup (ET) and myopically in high myopia subgroup (HM), eldest subgroup (G3) relating more to anterior segment changes than AL/Km. Understanding cycloplegic effects on biometry is important for optimizing refractive correction in these patients.
Topics: Humans; Amblyopia; Strabismus; Retrospective Studies; Male; Female; Child; Biometry; Mydriatics; Child, Preschool; Refraction, Ocular; Cyclopentolate; Refractive Errors; Adolescent; Anterior Chamber; Axial Length, Eye
PubMed: 38758890
DOI: 10.1097/MD.0000000000038143 -
International Journal of Ophthalmology 2023With the rapid development of computer technology, the application of artificial intelligence (AI) to ophthalmology has gained prominence in modern medicine. As modern...
With the rapid development of computer technology, the application of artificial intelligence (AI) to ophthalmology has gained prominence in modern medicine. As modern optometry is closely related to ophthalmology, AI research on optometry has also increased. This review summarizes current AI research and technologies used for diagnosis in optometry, related to myopia, strabismus, amblyopia, optical glasses, contact lenses, and other aspects. The aim is to identify mature AI models that are suitable for research on optometry and potential algorithms that may be used in future clinical practice.
PubMed: 37724269
DOI: 10.18240/ijo.2023.09.06 -
International Journal of Environmental... Aug 2023Visual impairment (VI) negatively affects a child's quality of life. The prevalence of VI in the Caribbean is nearly three times higher than in the United States, but...
Visual impairment (VI) negatively affects a child's quality of life. The prevalence of VI in the Caribbean is nearly three times higher than in the United States, but the causes remain uncertain. This study leverages Barbados' unique eye care system to survey the eye diseases and VI prevalence in Barbadian children. Medical records of all patients aged <19 years who received ophthalmic care in Barbados' two public eye care centers between January and December 2019 were reviewed, capturing the entirety of public pediatric eye care within the study period. Age at the first visit to the clinic and at the final visit in 2019, sex, best-corrected visual acuity (BCVA), past medical history, and clinical diagnoses were extracted and analyzed. VI was defined as a BCVA of 6/12 or worse in the better-seeing eye. There were 3278 patient records with a mean age at the first visit of 7.8 ± 3.9 years. There were 80 (2.4%) children with VI, 62.5% of which were attributed to amblyopia. A total of 94% of VI was preventable or treatable. The most common diagnoses were refractive error (87.5%), strabismus (27.5%), and allergic eye disease (20.0%). Amblyopia is the major cause of pediatric VI in Barbados and is largely avoidable.
Topics: Humans; Child; Child, Preschool; Barbados; Amblyopia; Quality of Life; Vision, Low; Ambulatory Care Facilities; Hypersensitivity
PubMed: 37623140
DOI: 10.3390/ijerph20166554 -
Ophthalmology Jul 2024To analyze the genetic findings, clinical spectrum, and natural history of Best vitelliform macular dystrophy (BVMD) in a cohort of 222 children and adults. (Observational Study)
Observational Study
PURPOSE
To analyze the genetic findings, clinical spectrum, and natural history of Best vitelliform macular dystrophy (BVMD) in a cohort of 222 children and adults.
DESIGN
Single-center retrospective, consecutive, observational study.
PARTICIPANTS
Patients with a clinical diagnosis of BVMD from pedigrees with a likely disease-causing monoallelic sequence variant in the BEST1 gene.
METHODS
Data were extracted from electronic and physical case notes. Electrophysiologic assessment and molecular genetic testing were analyzed.
MAIN OUTCOME MEASURES
Molecular genetic test findings and clinical findings including best-corrected visual acuity (BCVA), choroidal neovascularization (CNV) rates, and electrophysiologic parameters.
RESULTS
Two hundred twenty-two patients from 141 families were identified harboring 69 BEST1 variants. Mean age at presentation was 26.8 years (range, 1.3-84.8 years) and most patients (61.5%) demonstrated deterioration of central vision. Major funduscopic findings included 128 eyes (30.6%) with yellow vitelliform lesions, 78 eyes (18.7%) with atrophic changes, 49 eyes (11.7%) with fibrotic changes, 48 eyes (11.5%) with mild pigmentary changes, and 43 eyes (10.3%) showing a vitelliruptive appearance. Mean BCVA was 0.37 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/47) for the right eye and 0.33 logMAR (Snellen equivalent, 20/43) for the left eye at presentation, with a mean annual loss rate of 0.013 logMAR and 0.009 logMAR, respectively, over a mean follow-up of 9.7 years. Thirty-seven patients (17.3%) received a diagnosis of CNV over a mean follow-up of 8.0 years. Eyes with CNV that received treatment with an anti-vascular endothelial growth factor (VEGF) agent showed better mean BCVA compared with eyes that were not treated with an anti-VEGF agent (0.28 logMAR [Snellen equivalent, 20/38] vs. 0.62 logMAR [Snellen equivalent, 20/83]). Most eyes exhibited a hyperopic refractive error (78.7%), and 13 patients (6.1%) received a diagnosis of amblyopia. Among the 3 most common variants, p.(Ala243Val) was associated with a later age of onset, better age-adjusted BCVA, and less advanced Gass stages compared with p.(Arg218Cys) and p.(Arg218His).
CONCLUSIONS
BVMD shows a wide spectrum of phenotypic variability. The disease is very slowly progressive, and the observed phenotype-genotype correlations allow for more accurate prognostication and counselling.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Vitelliform Macular Dystrophy; Male; Female; Retrospective Studies; Child; Visual Acuity; Adult; Bestrophins; Middle Aged; Child, Preschool; Adolescent; Aged; Young Adult; Aged, 80 and over; Electroretinography; Infant; Tomography, Optical Coherence; Pedigree; Fluorescein Angiography; Choroidal Neovascularization; Mutation; Electrooculography
PubMed: 38278445
DOI: 10.1016/j.ophtha.2024.01.027 -
Investigative Ophthalmology & Visual... Apr 2024The purpose of this study was to understand how monocular luminance reduction affects binocular balance and examine whether it differentially influences fusion and mixed...
PURPOSE
The purpose of this study was to understand how monocular luminance reduction affects binocular balance and examine whether it differentially influences fusion and mixed perception in amblyopia.
METHODS
Twenty-three normally sighted observers and 12 adults with amblyopia participated in this study. A novel binocular rivalry task was used to measure the phase duration of four perceptual responses (right- and left-tilts, fusion, and mixed perception) before and after a neutral density (ND) filter was applied at various levels to the dominant eye (DE) of controls and the fellow eye (FE) of patients with amblyopia. Phase durations were analyzed to assess whether the duration of fusion or mixed perception shifted after monocular luminance reduction. Moreover, we quantified ocular dominance and adjusted monocular contrast and luminance separately to investigate the relationship between changes in ocular dominance induced by the two manipulations.
RESULTS
In line with previous studies, binocular balance shifted in favor of the brighter eye in both normal adults and patients with amblyopia. As a function of the ND filter's density, the duration of fusion and mixed perception decreased in normal controls, whereas that of fusion but not mixed perception increased significantly in patients with amblyopia. In addition, changes in binocular balance from luminance reduction were more significant in more balanced amblyopes or normal observers. Furthermore, shifts in binocular balance after contrast and luminance modulation were correlated in both normal and amblyopic observers.
CONCLUSIONS
The duration of fusion but not mixed perception increased in amblyopia after monocular luminance reduction in the FE. Moreover, our findings demonstrate that changes in ocular dominance from contrast-modulation and luminance-modulation are correlated in both normal and amblyopic observers.
Topics: Adult; Humans; Amblyopia; Dominance, Ocular; Perception
PubMed: 38587443
DOI: 10.1167/iovs.65.4.15