-
Journal of AAPOS : the Official... Apr 2023Economic evaluations in health care quantitatively compare interventions using cost and outcomes data. These evaluations can aid in the adoption of new surgical or... (Review)
Review
BACKGROUND
Economic evaluations in health care quantitatively compare interventions using cost and outcomes data. These evaluations can aid in the adoption of new surgical or medical treatments and inform policy decisions regarding healthcare spending. Several common types of economic analysis exist (cost-benefit, cost-analysis, cost-effectiveness, and cost-utility). We review all English-language economic evaluations in strabismus surgery and pediatric ophthalmology.
METHODS
An electronic literature search of the PubMed and Health Economic Evaluations databases was conducted. Two reviewers independently reviewed the search string yield and assessed articles against inclusion and exclusion criteria. Outcome measures included journal of publication, year of publication, domain of ophthalmology, region/country of study, and type of economic evaluation.
RESULTS
We identified 62 articles. Cost-utility studies comprised 30% of evaluations. The most studied domain was retinopathy of prematurity (33%), followed by amblyopia and vision screening (24%) and cataracts (14%). The Journal of the American Association for Pediatric Ophthalmology and Strabismus published the most economic evaluations (15%) followed by Ophthalmology and Pediatrics. The number of published economic evaluations did not increase over time.
CONCLUSIONS
Economic evaluations in pediatric ophthalmology and strabismus have not increased over time. A minority (30%) of studies used cost utility-analysis, limiting comparisons to other domains of medicine. This suggests the need to alert pediatric ophthalmologists to the benefits of economic analysis, and cost-utility methodology specifically, to better inform and influence policy decisions regarding healthcare spending.
Topics: Child; Humans; Infant, Newborn; Amblyopia; Cost-Benefit Analysis; Delivery of Health Care; Ophthalmology; Strabismus
PubMed: 36940859
DOI: 10.1016/j.jaapos.2022.12.005 -
The Cochrane Database of Systematic... Mar 2020Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation...
BACKGROUND
Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation of a clear image on the retina. SDA can be resistant to treatment, leading to poor visual prognosis. SDA probably constitutes less than 3% of all amblyopia cases, although precise estimates of prevalence are unknown. In high-income countries, most people present under the age of one year; in low- to middle-income countries, people are likely to be older at the time of presentation. The mainstay of treatment is correction of the obstruction (e.g., removal of the cataract) and then occlusion of the better-seeing eye, but regimens vary, can be difficult to execute, and traditionally are believed to lead to disappointing results.
OBJECTIVES
To evaluate the effectiveness of occlusion therapy for SDA in an attempt to establish realistic treatment outcomes and to examine evidence of any dose-response effect and assess the effect of the duration, severity, and causative factor on the size and direction of the treatment effect.
SEARCH METHODS
We searched CENTRAL (2018, Issue 12), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; and five other databases. We used no date or language restrictions in the electronic searches. We last searched the databases on 12 December 2018.
SELECTION CRITERIA
We planned to include randomized controlled trials (RCTs) and controlled clinical trials of participants with unilateral SDA with visual acuity worse than 0.2 LogMAR or equivalent. We specified no restrictions for inclusion based upon age, gender, ethnicity, comorbidities, medication use, or the number of participants.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodology.
MAIN RESULTS
We identified no trials that met the inclusion criteria specified in the protocol for this review.
AUTHORS' CONCLUSIONS
We found no evidence from RCTs or quasi-randomized trials on the effectiveness of any treatment for SDA. RCTs are needed in order to evaluate the safety and effectiveness of occlusion, duration of treatment, level of vision that can be realistically achieved, effects of age at onset and magnitude of visual defect, optimum occlusion regimen, and factors associated with satisfactory and unsatisfactory outcomes with the use of various interventions for SDA.
Topics: Amblyopia; Blepharoptosis; Cataract; Child, Preschool; Humans; Infant; Occlusive Dressings; Treatment Outcome
PubMed: 32203629
DOI: 10.1002/14651858.CD005136.pub4 -
Journal of Binocular Vision and Ocular... 2022The World Health Organization's Package of Eye Care Interventions (PECI) aims to support incorporation of amblyopia detection and treatment into health service...
PURPOSE
The World Health Organization's Package of Eye Care Interventions (PECI) aims to support incorporation of amblyopia detection and treatment into health service provision. The aim of this study was to systematically review clinical practice guidelines (CPGs) for amblyopia to inform the development of this package.
METHODS
MEDLINE, Embase, CINAHL and Global Index Medicus databases, guideline databases and professional body websites were searched for CPGs published in English between 2010 and 9th March 2020. Guidelines were assessed using the AGREE II tool.
RESULTS
Five CPGs from North America published between 2017-2019 were identified. One CPG provided recommendations on amblyopia treatment and four focused on amblyopia detection and assessment. Non-specialist screening for amblyopic risk factors was recommended in children aged 3-5 years. At least one comprehensive eye examination was recommended for infants and children aged 0-5 years. Treatment recommendations consisted of refractive correction followed by occlusion or cycloplegic penalization.
CONCLUSIONS
Additional evidence is required to compare the benefits and limitations of comprehensive eye examinations for asymptomatic children to those from screening programs. Identified CPGs were produced in high-resource countries and may not be readily applied in lower resource settings where the PECI has the greatest potential to improve service provision.
Topics: Amblyopia; Child; Databases, Factual; Delivery of Health Care; Humans; Infant; Physical Examination
PubMed: 35157567
DOI: No ID Found -
Ophthalmic Research 2023Amblyopia is a common cause of visual disorder with several changes in retinal structure and vessel. To date, alterations in retinal microvasculature features in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Amblyopia is a common cause of visual disorder with several changes in retinal structure and vessel. To date, alterations in retinal microvasculature features in amblyopia have yielded inconsistent results.
OBJECTIVES
This meta-analysis aimed to evaluate retinal vessel density (VD) in amblyopic patients using optical coherence tomography angiography (OCTA).
METHODS
PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for published articles comparing retinal microvasculature characteristics in patients with amblyopia and controls. Continuous variable outcomes were assessed using the mean difference (MD) with a 95% confidence interval. Review Manager Version 5.30 was used for the analysis.
RESULTS
Thirteen qualified articles were pooled in this meta-analysis. Compared with controls, the foveal whole en face VD of superficial capillary plexus (SCP) and deep capillary plexus (DCP) of patients as measured by 3 × 3-mm scans were significantly lower in amblyopia eyes (MD: -1.37, p = 0.0003; MD: 1.70, p < 0.00001, respectively). Similarly, in the 6 × 6-mm scans, foveal whole en face VD of the SCP and DCP were remarkably lower in amblyopia eyes than in controls (MD: -2.24, p = 0.03; MD: -5.08, p = 0.04, respectively). The parafoveal VD of SCP in 3 × 3-mm scans (MD: -1.96, p < 0.00001) was also lower in amblyopic patients than in controls. Similarly, in 6 × 6-mm scans, amblyopia eyes showed a significant decrease and a trending decrease in the parafoveal VD of the SCP (MD: -3.85, p = 0.007) and DCP (MD: -3.03, p = 0.10), respectively. For whole radial peripapillary capillary (RPC), VD was significantly reduced in amblyopic patients compared to controls (MD = -0.83, p < 0.00001). In addition, the deep foveal avascular zone (FAZ) was larger in amblyopic eyes than in the controls (MD = 0.55, p = 0.007).
CONCLUSIONS
Our data suggest that whole foveal and parafoveal VD and RPC whole VD were reduced in patients with amblyopia. Moreover, our results reveal that the FAZ is larger in amblyopic patients. Consequently, OCTA may have the potential for diagnosing and monitoring patients with amblyopia.
Topics: Humans; Amblyopia; Fluorescein Angiography; Cross-Sectional Studies; Retina; Retinal Vessels; Microvessels; Tomography, Optical Coherence
PubMed: 35998587
DOI: 10.1159/000526531 -
Romanian Journal of Ophthalmology 2020to assess the prevalence of Amblyopia disease in the children of the world. In order to perform this systematic review, PICO was considered as the research question....
to assess the prevalence of Amblyopia disease in the children of the world. In order to perform this systematic review, PICO was considered as the research question. Then, the preferred keywords were searched in Medline (via PubMed), Embase, Scopus, Web of Science, and ProQuest databases. The retrieved citations were reviewed by two independent inspectors in a three-step process in terms of the title, abstract, and full-text, based on the inclusion criteria. The studies included in the review were critically evaluated and then were extracted by two dependent expert reviewers. Finally, the prevalence of Amblyopia disease in the children of the world was pooled by meta-analysis CMA v.2 software. The heterogeneity of the selected studies was evaluated using I2 and chi-square. Also, subgroup-analysis was performed using designs and continents. Out of 952 retrieved citations, 131 studies were included. The total prevalence of Amblyopia in the children of the world was calculated to be 4.3% [Pooled Prevalence: 4.3%, 95% CI: 2.6%-7.00%, P-value 0.0001]. In addition, the heterogeneity of the studies was reported to be high (Q: 48281.18, df: 56, p-value 0.001, I-square: 99.88). The subgroup analysis showed that America had the highest (5.57%, 95% CI: 2.23%-13.94%, P-value 0.0001) prevalence, and the lowest prevalence of Amblyopia in the children of the world was seen in Africa (7.1%, 95% CI: 0.003%-172.53%, P-value 0.05). It can be concluded that the total prevalence of Amblyopia is 3.4%, but this estimate varies in all continents, especially in Africa. The major reason for this variation was reported to be the heterogeneity of studies. These assessments have investigated different populations in terms of severity of illness, age, and gender. Therefore, further worldwide high-quality and valid studies should be carried out to allow the calculation of the real prevalence of Amblyopia among children of the world. VA = visual acuity, ALSPAC = Avon Longitudinal Study of Parents and Children, JBI = Joanna Briggs Institute, PRISMA = Systematic Review and Meta-analysis, CMA = Comprehensive Meta-analysis Software.
Topics: Amblyopia; Child; Global Health; Humans; Prevalence
PubMed: 33367172
DOI: 10.22336/rjo.2020.56 -
Journal of Ophthalmology 2020The aim of the study was evaluation of the scientific evidence about the efficacy of vision therapy in children and teenagers with anisometropic amblyopia by performing... (Review)
Review
PURPOSE
The aim of the study was evaluation of the scientific evidence about the efficacy of vision therapy in children and teenagers with anisometropic amblyopia by performing a systematic literature review.
METHODS
A search was performed using 3 searching strategies in 4 different databases (PubMed, Web of Science, Scopus, and PruQuest). The quality of the included articles was evaluated using two tools for the risk of bias assessment, ROBINS-I for nonrandomized studies of intervention (NRSI), and ROB 2.0 for randomized clinical trials.
RESULTS
The search showed 1274 references, but only 8 of them passed the inclusion criteria after the complete text review. The articles that were finally included comprised 2 randomized control trials and 6 nonrandomized studies of intervention. These articles provided evidence supporting the efficacy of vision therapy for the treatment of anisometropic amblyopia in children and teenagers. Assessment of the risk of bias showed an appropriate risk of bias for the randomized control trials, but a high risk of bias for nonrandomized studies of intervention (NRSI). A main source of risk of bias for NRSI was the domain related to the measurements of the outcomes, due to a lack of double-blind studies.
CONCLUSION
Vision therapy is a promising option for the treatment of anisometropic amblyopia in children and teenagers. However, the level of scientific evidence provided by the studies revised is still limited, and further randomized clinical trials are necessary to confirm the results provided to date and to optimize the vision therapy techniques by knowing the specific neural mechanisms involved.
PubMed: 32733699
DOI: 10.1155/2020/4282316 -
The British Journal of Ophthalmology Aug 2020Amblyopia is a leading cause of vision impairment among children and young adults. Individual studies showed significant variations in the prevalence of amblyopia in... (Meta-Analysis)
Meta-Analysis
PURPOSE
Amblyopia is a leading cause of vision impairment among children and young adults. Individual studies showed significant variations in the prevalence of amblyopia in different regions and age groups. This study is to estimate the global prevalence of amblyopia by pooling its prevalence from the previous studies and to project the number of people affected through 2040.
METHODS
We performed a systematic review and meta-analysis on the prevalence of amblyopia using data published before 20 October 2018. We estimated the prevalence rate of amblyopia and its 95% CI globally and by subgroups (eg, region and age). The prevalence data were applied to United Nations World Population Prospects to derive the projected number with amblyopia through 2040.
RESULTS
A meta-analysis of 60 studies (1 859 327 subjects) showed that the pooled prevalence rate of amblyopia was 1.44% (95% CI 1.17% to 1.78%). Prevalences in Europe (2.90%) and North America (2.41%) were higher than in Asia (1.09%) and Africa (0.72%). The highest prevalence was found in subjects over 20 years old (3.29%). There was no difference in the prevalence between genders. We estimated 99.2 (95% CI 71.7 to 146.1) million people with amblyopia in 2019 worldwide, increasing to 175.2 (95% CI 81.3 to 307.8) million by 2030 and 221.9 (95% CI 83.7 to 429.2) million by 2040.
CONCLUSIONS
The amblyopia is becoming a significant vision problem worldwide. It is of great importance to design and implement amblyopia screening, treatment and related public health strategies.
Topics: Adolescent; Adult; Age Distribution; Amblyopia; Child; Child, Preschool; Female; Global Health; Humans; Infant; Male; Prevalence; Sex Distribution; Young Adult
PubMed: 31704700
DOI: 10.1136/bjophthalmol-2019-314759 -
Medicine Jul 2022To assess the efficacy of binocular treatment for individual with amblyopia. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the efficacy of binocular treatment for individual with amblyopia.
METHODS
In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library and Web of Science databases up to December 21, 2020. Sensitivity analysis was performed for all outcomes. The Begg's test was used to assess the publication bias. Heterogeneity test was conducted for each effect indicator. Indicators were analyzed by random-effects model when the heterogeneity statistic I2 ≥ 50%, on the contrary, indicators were analyzed by fixed-effect model. Standard mean difference (SMD) or weighted mean difference (WMD) was adopted as effect indicators, and the effect amount was expressed as 95% confidence intervals (CIs).
RESULTS
A total of 13 literatures including 1146 participants were finally enrolled, with 595 in the intervention group and 551 in the control group. The results indicated that the improvement of amblyopic eye visual acuity [SMD: 0.882, 95%CI: (0.152, 1.613), P = 0.018] in binocular treatment group was better than that in control group. And binocular treatment could improve stereo acuity in individual with amblyopia [WMD: 0.138, 95%CI: (0.068, 0.208), P < 0.001].
CONCLUSION
Binocular treatment may be beneficial to visual acuity, stereo acuity and binocular function improvement for individual with amblyopia. In clinical practice, binocular treatment can be used as one of the treatments for individual with amblyopia.
Topics: Amblyopia; Control Groups; Humans; Publication Bias; Vision, Binocular; Visual Acuity
PubMed: 35801758
DOI: 10.1097/MD.0000000000028975 -
Journal of Current Ophthalmology 2022To determine the global prevalence and common causes of visual impairment (VI) and blindness in children. (Review)
Review
PURPOSE
To determine the global prevalence and common causes of visual impairment (VI) and blindness in children.
METHODS
In this meta-analysis, a structured search strategy was applied to search electronic databases including PubMed, Scopus, and Web of Science, as well as the list of references in the selected articles to identify all population-based cross-sectional studies that concerned the prevalence of VI and blindness in populations under 20 years of age up to January 2018, regardless of the publication date and language, gender, region of residence, or race. VI was reported based on presenting visual acuity (PVA), uncorrected visual acuity (UCVA), and best corrected visual acuity (BCVA) of equal to 20/60 or worse in the better eye. Blindness was reported as visual acuity worse than 20/400 in the better eye.
RESULTS
In the present study, 5711 articles were identified, and the final analyses were done on 80 articles including 769,720 people from twenty-eight different countries. The prevalence of VI based on UCVA was 7.26% (95% confidence interval [CI]: 4.34%-10.19%), PVA was 3.82% (95% CI: 2.06%-5.57%), BCVA was 1.67% (95% CI 0.97%-2.37%), and blindness was 0.17% (95% CI: 0.13%-0.21%). Refractive errors were the most common cause of VI in the subjects of selected articles (77.20% [95% CI: 73.40%-81.00%]). The prevalence of amblyopia was 7.60% (95% CI: 05.60%-09.10%) and congenital cataract was 0.60% (95% CI: 0.3%-0.9%).
CONCLUSION
Despite differences in the definition of VI and blindness, based on PVA, 3.82%, and based on BCVA, 1.67% of the examined samples suffer from VI.
PubMed: 35620376
DOI: 10.4103/joco.joco_135_21 -
Documenta Ophthalmologica. Advances in... Feb 2021Visual evoked potentials (VEPs) can be used to measure visual resolution via a spatial frequency (SF) limit as an objective estimate of visual acuity. The aim of this... (Review)
Review
PURPOSE
Visual evoked potentials (VEPs) can be used to measure visual resolution via a spatial frequency (SF) limit as an objective estimate of visual acuity. The aim of this systematic review is to collate descriptions of the VEP SF limit in humans, healthy and disordered, and to assess how accurately and precisely VEP SF limits reflect visual acuity.
METHODS
The protocol methodology followed the PRISMA statement. Multiple databases were searched using "VEP" and "acuity" and associated terms, plus hand search: titles, abstracts or full text were reviewed for eligibility. Data extracted included VEP SF limits, stimulus protocols, VEP recording and analysis techniques and correspondence with behavioural acuity for normally sighted healthy adults, typically developing infants and children, healthy adults with artificially degraded vision and patients with ophthalmic or neurological conditions.
RESULTS
A total of 155 studies are included. Commonly used stimulus, recording and analysis techniques are summarised. Average healthy adult VEP SF limits vary from 15 to 40 cpd, depend on stimulus, recording and analysis techniques and are often, but not always, poorer than behavioural acuity measured either psychophysically with an identical stimulus or with a clinical acuity test. The difference between VEP SF limit and behavioural acuity is variable and strongly dependent on the VEP stimulus and choice of acuity test. VEP SF limits mature rapidly, from 1.5 to 9 cpd by the end of the first month of life to 12-20 cpd by 8-12 months, with slower improvement to 20-40 cpd by 3-5 years. VEP SF limits are much better than behavioural thresholds in the youngest, typically developing infants. This difference lessens with age and reaches equivalence between 1 and 2 years; from around 3-5 years, behavioural acuity is better than the VEP SF limit, as for adults. Healthy, artificially blurred adults had slightly better behavioural acuity than VEP SF limits across a wide range of acuities, while adults with heterogeneous ophthalmic or neurological pathologies causing reduced acuity showed a much wider and less consistent relationship. For refractive error, ocular media opacity or pathology primarily affecting the retina, VEP SF limits and behavioural acuity had a fairly consistent relationship across a wide range of acuity. This relationship was much less consistent or close for primarily macular, optic nerve or neurological conditions such as amblyopia. VEP SF limits were almost always normal in patients with non-organic visual acuity loss.
CONCLUSIONS
The VEP SF limit has great utility as an objective acuity estimator, especially in pre-verbal children or patients of any age with motor or learning impairments which prevent reliable measurement of behavioural acuity. Its diagnostic power depends heavily on adequate, age-stratified, reference data, age-stratified empirical calibration with behavioural acuity, and interpretation in the light of other electrophysiological and clinical findings. Future developments could encompass faster, more objective and robust techniques such as real-time, adaptive control.
REGISTRATION
International prospective register of systematic reviews PROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ), registration number CRD42018085666.
Topics: Adult; Amblyopia; Child; Child, Preschool; Electroretinography; Evoked Potentials, Visual; Humans; Infant; Vision, Ocular; Visual Acuity
PubMed: 32488810
DOI: 10.1007/s10633-020-09770-3