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International Ophthalmology Feb 2024Amblyopia is generally a unilateral disorder, defined by at least a difference of two lines of visual acuity between both eyes with the best-corrected visual acuity, a...
INTRODUCTION
Amblyopia is generally a unilateral disorder, defined by at least a difference of two lines of visual acuity between both eyes with the best-corrected visual acuity, a decrease in contrast sensitivity, and a decrease in stereopsis. Pattern electroretinogram (PERG) is a noninvasive technique that provides a retinal biopotential and is a highly sensitive indicator of changes in the macular area. Our aim was to evaluate if there are differences in the retinal response of an amblyopic eye compared with a normal eye (NE).
METHODS
We evaluated twenty-four adult volunteers, twelve amblyopes (mean 43.42 ± 12.72 years old), and twelve subjects with NE (mean 35.58 ± 12.85 years old). None of the subjects in the two groups had comorbidities. A complete optometric examination was performed including parameters such as visual acuity (VA) by far and near with ETDRS chart, eye alignment with cover test, and evaluation of retinal cells response with PERG.
RESULTS
The refractive error found in the NE group of subjects had a mean of - 0.95 ± 1.65D, while the amblyopic group showed a mean of - 2.03 ± 4.29D. The VA in amblyopic eyes had a mean of 0.38 ± 0.20 logMAR. Analyzing PERG data, we observed significant differences in the P50-N95 amplitudes of the amblyopic group compared with the NE group (p < 0.0001-amblyopic eye vs. NE; p = 0.039-fellow eye vs. NE).
DISCUSSION
These findings suggest that amblyopic patients may also present other impairments beyond the visual cortex. PERGs seem to be an important complementary examination in the diagnosis of other impairments in amblyopia.
Topics: Adult; Humans; Middle Aged; Young Adult; Amblyopia; Electroretinography; Visual Acuity; Retina; Refractive Errors
PubMed: 38363441
DOI: 10.1007/s10792-024-03042-8 -
European Journal of Medical Genetics Jun 2024ADH5/ALDH2 deficiency is a rare inherited syndrome characterized by short stature, microcephaly, delayed mental development, and hematopoietic dysfunction and has... (Review)
Review
ADH5/ALDH2 deficiency is a rare inherited syndrome characterized by short stature, microcephaly, delayed mental development, and hematopoietic dysfunction and has recently been proposed as a disease paradigm. Acute and severe presentations include aplastic anemia, myelodysplastic syndrome, or leukemia, requiring bone marrow transplantation during childhood. Conversely, non-hematological manifestations may exhibit a prolonged and nonspecific clinical trajectory, with growth failure and developmental delay, most of which are often overlooked, particularly in patients with milder symptoms. Here, we describe the clinical course of a girl with a wide spectrum of clinical presentations, including nonspecific hematopoietic disorders, growth retardation, mild developmental delay, amblyopia, hemophagocytic lymphohistiocytosis, and verruca vulgaris, culminating in a genetic diagnosis of AMeD syndrome at 12 years of age. We also summarized the clinical manifestations of previously reported cases of AMeD syndrome. Cumulatively, 13 females and 5 males have been documented, with a cardinal triad of symptoms, aplastic anemia, short stature, and intellectual disability. Additional characteristic observations included pigmentary deposition in approximately half of the cases and skeletal difficulties in one-quarter. We propose that early diagnosis of patients who exhibit relatively mild phenotypes of skin or skeletal lesions is important for managing and improving the quality of life of patients with AMeD syndrome.
Topics: Humans; Female; Phenotype; Child; Aldehyde Dehydrogenase, Mitochondrial; Developmental Disabilities; Male; Microcephaly; Intellectual Disability; Anemia, Aplastic
PubMed: 38614309
DOI: 10.1016/j.ejmg.2024.104939 -
Scientific Reports Nov 2023Heterophoria is a common type of binocular fusion disorder that consists of a latent eye misalignment with potential consequences on daily activities such as reading or...
Heterophoria is a common type of binocular fusion disorder that consists of a latent eye misalignment with potential consequences on daily activities such as reading or working on a computer (with CVS). Crowding, a type of contextual modulation, can also impair reading. Our recent studies found an abnormal pattern of low-level visual processing with larger perceptive fields (PF) in heterophoria. The PF is the fundamental processing unit of human vision and both masking and crowding depend on its size. We investigated how heterophoria would impact the PF's size via a lateral masking experiment and consequently affect the foveal crowding at different letter-spacings (the crowding zone). More specifically, we explored the relationship between crowding, lateral masking, the PF's size, and the amount of heterophoria. The binocular horizontal PF's size was larger with heterophoric subjects, in agreement with our previous study. We found a stronger crowding and an extended crowding zone associated with slower response times; this shows that the processing of letter identification under both crowded and uncrowded conditions requires more processing effort in heterophoric individuals. In agreement with previous studies, we found a correlation between the crowding zone and the PF's size; each was strongly correlated with the amount of phoria. These findings resemble those involving the PF size and the extended crowding found at the fovea in amblyopia and young children. We suggest that these findings could help explain the inter-observers' variability found in the masking literature, and the reading difficulties often encountered in subjects with high heterophoria.
Topics: Child; Humans; Child, Preschool; Visual Acuity; Perceptual Masking; Visual Perception; Amblyopia; Strabismus; Malocclusion; Pattern Recognition, Visual
PubMed: 37935803
DOI: 10.1038/s41598-023-46291-w -
Frontiers in Medicine 2024Amblyopia, or lazy eye, is a type of visual impairment in which the eyesight is not complete, even with the use of glasses. For the treatment of this disease, accurate...
INTRODUCTION
Amblyopia, or lazy eye, is a type of visual impairment in which the eyesight is not complete, even with the use of glasses. For the treatment of this disease, accurate and continuous examinations are needed. Nowadays, patient-centered care, by relying on web-based electronic records for amblyopia, has the potential to reduce treatment costs, increase the quality of care, and improve the safety and effectiveness of treatment. Therefore, the purpose of this study is to design and evaluate an Electronic Health Record (EHR) for patients with amblyopia.
METHODS
The present study is applied developmental research. Using a Morgan table as a sampling tool, a straightforward random sampling technique selected 150 records from 1,500 records that were free of flaws. The design of the electronic version proceeded in a cascading manner so that after the design of each part, it was presented to the amblyopia experts, and if approved, the next part was designed. To design this EHR, the C# programming language and MySQL database were used. A system evaluation was performed by entering and recording patient information. For this purpose, the standard Questionnaire of User Interaction Satisfaction (QUIS), consisting of 18 questions, was used.
RESULTS
According to the amblyopia EHR data elements, the data of physician and patient, examinations, website members, and members' roles were determined. After defining the fields and classes that explain the tables, the EHR was designed. The usability evaluation of the system showed that the mean selection of very good and good options by the users of EHRs was over 90%, indicating the patients' acceptance of web-based EHRs.
CONCLUSION
The design of an EHR for amblyopia is an effective step toward integrating and improving the information management of these patients. It will also enable the storage and retrieval of patients' information to reduce and facilitate the control of amblyopia complications.
PubMed: 38638930
DOI: 10.3389/fmed.2024.1322821 -
Strabismus Sep 2023Visual 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...
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.
Topics: Child; Humans; Child, Preschool; Amblyopia; Vision Screening; State Medicine; Refractive Errors; Health Care Costs
PubMed: 37870065
DOI: 10.1080/09273972.2023.2268128 -
BMC Ophthalmology Nov 2023Myopia has recently emerged as a significant threat to global public health. The high and pathological myopia in children and adolescents could result in irreversible...
BACKGROUND
Myopia has recently emerged as a significant threat to global public health. The high and pathological myopia in children and adolescents could result in irreversible damage to eye tissues and severe impairment of visual function without timely control. Posterior scleral reinforcement (PSR) can effectively control the progression of high myopia by limiting posterior scleral expansion, improving retrobulbar vascular perfusion, thereby stabilizing the axial length and refraction of the eye. Moreover, orthokeratology and low concentrations of atropine are also effective in slowing myopia progression.
CASE PRESENTATION
A female child was diagnosed with binocular congenital myopia and amblyopia at the age of 3 and the patient's vision had never been rectified with spectacles at the first consultation. The patient's ophthalmological findings suggested, high refractive error with low best corrected visual acuity, longer axial length beyond the standard level of her age, and fundus examination suggesting posterior scleral staphyloma with weakened hemodynamics of the posterior ciliary artery. Thereby, PSR was performed to improve fundus health and the combination of orthokeratology and 0.01% atropine were performed to control the development of myopia. Following up to 8 years of clinical treatment and observations, the progression of myopia could be well controlled and fundus health was stable.
CONCLUSION
In this report, 8-year of clinical observation indicated that PSR could improve choroidal thickness and hemodynamic parameters of the retrobulbar vessels, postoperative orthokeratology combined with 0.01% atropine treatment strategy may be a good choice for myopia control effectively.
Topics: Humans; Child; Adolescent; Female; Atropine; Myopia, Degenerative; Refraction, Ocular; Ophthalmologic Surgical Procedures; Eye Abnormalities; Axial Length, Eye
PubMed: 38012561
DOI: 10.1186/s12886-023-03211-w -
Journal of Optometry 2024To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS).
PURPOSE
To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS).
METHOD
This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022.
RESULTS
The mean age of patients was 19.4 ± 11.9 (range, 3-70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia.
CONCLUSION
This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.
Topics: Humans; Amblyopia; Male; Female; Retrospective Studies; Adult; Visual Acuity; Child; Child, Preschool; Middle Aged; Young Adult; Adolescent; Aged; Iran; Duane Retraction Syndrome; Prevalence; Refraction, Ocular; Refractive Errors; Anisometropia
PubMed: 38215611
DOI: 10.1016/j.optom.2023.100508 -
Cureus Jan 2024Introduction Amblyopia is an abnormal development of usually one eye, leading to permanent decreased vision in the affected eye if not treated early. The condition is...
Introduction Amblyopia is an abnormal development of usually one eye, leading to permanent decreased vision in the affected eye if not treated early. The condition is primarily caused by strabismus, cataract, anisometropic refractive error, or genetic factors and can manifest from birth to seven years of age, with a worldwide prevalence of 1.75%. This study examines parental knowledge of amblyopia in an effort to improve its early detection and intervention. Improving awareness can have a direct impact by lowering the incidence of untreated amblyopia and its related visual impairment. This study can also help healthcare professionals understand how to communicate with parents about amblyopia more effectively. Materials and methods This cross-sectional study included 417 parent participants from Riyadh, Saudi Arabia, selected through random sampling while ensuring representation from various governorates. The data was collected using an online questionnaire distributed by different social media platforms (Twitter, WhatsApp, and Telegram) to the parents of all governorates, and the sample was selected randomly. It was meticulously cleaned using Excel and analyzed with IBM Statistical Package for the Social Sciences (SPSS) version 29 (IBM Corp., Armonk, NY). Results Our results showed a predominant understanding of amblyopia as "poor vision in one or both eyes" (19.1%) as well as the role of eye movement or brain-eye coordination in the condition. Only 51.3% of parents were aware of lazy eye. Notably, the internet and doctors were the primary sources of information about amblyopia. Only 8.9% of the participants were aware that amblyopia cannot be treated after 10 years of age. Understanding the causes of amblyopia mainly included genetic factors and refractive errors. Sociodemographic factors such as gender, educational level, family history of eye disease, and having a child with a lazy eye significantly influenced the parents' awareness levels of amblyopia. Conclusion Our study underscores the need for targeted educational initiatives to improve the knowledge and awareness of amblyopia among parents in Riyadh, Saudi Arabia. By addressing misconceptions, enhancing access to accurate information, and fostering a deeper understanding of amblyopia and its management, we can work toward ensuring timely diagnosis and appropriate interventions, ultimately reducing the prevalence and impact of amblyopia in the community.
PubMed: 38435939
DOI: 10.7759/cureus.53308 -
The British and Irish Orthoptic Journal 2024It is well documented that socioeconomic disadvantage adversely affects general health and ocular health worldwide. Within orthoptics, while clinicians recognise a... (Review)
Review
INTRODUCTION
It is well documented that socioeconomic disadvantage adversely affects general health and ocular health worldwide. Within orthoptics, while clinicians recognise a relationship between socioeconomic situation and treatment outcome, no previous literature review was found to address this issue. Neither was a UK-specific literature review found to address the same issue for ophthalmology as a whole.
AIM
This literature review evaluates evidence for an association between socioeconomic situation and ophthalmic/orthoptic conditions and their treatment outcomes, specifically within the UK.
METHODS
Keyword searches were conducted on Google Scholar and the University of Liverpool library catalogue. Results for the main analyses were limited to full papers, specific to the UK, written in English. Literature was only included from pre-2000 if more recent evidence was insufficient.
RESULTS
There is evidence of socioeconomic disadvantage being associated with the following: reduced visual acuity; reduced attendance at diabetic retinopathy screening appointments; and delayed presentation of glaucoma, cataracts, and diabetic retinopathy. However, evidence linking socioeconomic disadvantage to AMD is mixed. There is limited evidence of the increased prevalence of amblyopia and subsequent barriers to its treatment for socioeconomically underserved children. There is also evidence of a reduction in quality of life for socioeconomically underserved adults with strabismus.
CONCLUSIONS
Health inequalities within ophthalmology and orthoptics are reported, but with confounding results for some conditions. Further research should explore the reasons behind the inequalities that are found and identify methods of reducing them.
PubMed: 38250169
DOI: 10.22599/bioj.338 -
Turkish Journal of Ophthalmology Apr 2024Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision.... (Review)
Review
Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.
Topics: Humans; Contact Lenses; Aphakia, Postcataract; Visual Acuity; Infant; Child, Preschool; Cataract; Cataract Extraction; Amblyopia; Aphakia; Child; Infant, Newborn
PubMed: 38645732
DOI: 10.4274/tjo.galenos.2023.56252