-
Journal of Binocular Vision and Ocular... 2019The use of inverse occlusion and pleoptics came into favor in Europe and then in North America in the late 1940's, and fell out of favor less than 25 years later....
The use of inverse occlusion and pleoptics came into favor in Europe and then in North America in the late 1940's, and fell out of favor less than 25 years later. Introduced as a method of promoting foveal fixation, and improving binocularity and vision in cases of eccentric fixation, it did not outperform conventional occlusion prescribed at an earlier age.In this issue, Godts and Mathysen provide a case series of 11 contemporary patients treated with inverse occlusion after patching failure. In response, this article reviews the procedures and goals of inverse occlusion and pleoptics using the historic information available, in attempt to ascertain whether there is an indication for renewing their use.
Topics: Amblyopia; Europe; Fixation, Ocular; Humans; North America; Orthoptics
PubMed: 31697193
DOI: 10.1080/2576117X.2019.1662250 -
Journal of Motor Behavior 2021Amblyopia influences psychomotor and psychosocial skills, although not all studies are unanimous. Different treatments coexist, but the effect on those variables is not...
Amblyopia influences psychomotor and psychosocial skills, although not all studies are unanimous. Different treatments coexist, but the effect on those variables is not clear. This study aims to probe whether children with amblyopia have impairments in these areas and if different optometric treatments reduce them effectively. 50 children, diagnosed with amblyopia, and 33 without amblyopia participated in this study. Eye-hand coordination, psychosocial skills and reading abilities, were measured before and after three months of different treatments (patch, patch and near vision activities and perceptual learning). Results revealed lower scores in eye-hand coordination and some reading issues in children with amblyopia, without differences in psychosocial skills in regard to the control group. Moreover, optometric treatments improved eye-hand coordination.
Topics: Amblyopia; Child; Child, Preschool; Female; Humans; Male; Psychomotor Performance; Reading; Social Skills; Vision, Binocular
PubMed: 32281918
DOI: 10.1080/00222895.2020.1747384 -
Der Ophthalmologe : Zeitschrift Der... Oct 2020The 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: Aftercare; Amblyopia; Cataract; Cataract Extraction; Child, Preschool; Glaucoma; Humans; Infant
PubMed: 33001262
DOI: 10.1007/s00347-020-01232-0 -
Ophthalmology Feb 2020To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments. (Review)
Review
PURPOSE
To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.
METHODS
Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.
RESULTS
Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.
CONCLUSIONS
There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.
Topics: Academies and Institutes; Amblyopia; Databases, Factual; Humans; Ophthalmology; Technology Assessment, Biomedical; United States; Vision, Binocular; Visual Acuity
PubMed: 31619356
DOI: 10.1016/j.ophtha.2019.08.024 -
Eye (London, England) Sep 2023Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic... (Review)
Review
Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic review. A systematic review was performed using Ovid MEDLINE, PubMed, The Cochrane Library, Embase, Web of Science Core Collection, and Clinicaltrials.gov. All studies reporting the diagnostic accuracy of home-based screening tools for amblyopia among children were included. Studies involving orthoptist or ophthalmologist-led screening and adult subjects were excluded. The main outcome measure was the diagnostic accuracy expressed as sensitivity and specificity. Among 3670 studies identified, 28 were eligible for inclusion in our systematic review. The age range of patients were less than 1 month to 16 years old. 7 studies used internet-based tools, 16 used smartphone/tablet applications, 3 used digital cameras, and 3 used home-based questionnaires and visual acuity tools. All studies included a reference standard except one, which was a longitudinal study. 21 studies had full ophthalmological examination whilst 6 studies had validated visual acuity measurement tools as gold standards. Of the 27 studies which compared against a reference test, only 25 studies reported sensitivity and specificity values. Using the QUADAS-2 tool, 50% of studies were deemed to have applicability concern due to patient selection from tertiary centres and unclear methods for recruitment. There is a need to improve the quality of diagnostic accuracy studies, standardise thresholds for detecting amblyopia, and ensure consistent reporting of results. Further research is needed to evaluate the suitability of these tools for amblyopia screening.
Topics: Adult; Child; Humans; Infant; Amblyopia; Longitudinal Studies; Sensitivity and Specificity; Physical Examination
PubMed: 36828959
DOI: 10.1038/s41433-023-02412-3 -
Turkish Journal of Ophthalmology Jun 2022To compare subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) in patients with hyperopic refractive and strabismic amblyopia and healthy subjects.
OBJECTIVES
To compare subfoveal choroidal thickness (SFCT) and choroidal vascular index (CVI) in patients with hyperopic refractive and strabismic amblyopia and healthy subjects.
MATERIALS AND METHODS
The study included 17 patients with strabismic amblyopia (Group 1), 29 patients with hyperopic refractive amblyopia (Group 2), and 16 eyes of 16 healthy volunteers (Group 3). Best corrected visual acuity was noted in all patients and volunteers. In addition to detailed anterior and posterior segment examinations, macular images were obtained by enhanced-depth imaging mode of optical coherence tomography (OCT). SFCT measurements were made from these images and CVI was calculated using the Image J program.
RESULTS
No significant difference was found between the groups in terms of age, gender, and intraocular pressure (p=0.27, 0.64, and 0.85, respectively). Mean BCVAs in Group 1 were 0.57±0.16 (0.3-0.8) in the amblyopic eyes, 0.94±0.08 (0.8-1.0) in the fellow eyes, and in Group 2 were 0.61±0.17 (0.2-0.8) in amblyopic eyes, 0.92±0.1 (0.8-1.0) in fellow eyes. BCVA in Group 3 was 1.0±0 (1.0-1.0). Mean SFCT of the amblyopic eyes in Groups 1 and 2 was 341.50±60.4 (277-481) and 370.06±65.3 (247-462), respectively, and in the healthy eyes of Groups 1 and 2 and Group 3 was 321.92±68.26 (251-440), 330.35±74.00 (194-502), and 327.62±40.79 (238-385), respectively. SFCT was significantly greater in the amblyopic eyes of Group 2 compared to Group 3 (p=0.01). Mean CVI was 0.681±0.032 (0.642-0.736) in the amblyopic eyes and 0.685±0.054 (0.587-0.788) in the fellow eyes of Group 1 patients; 0.664±0.033 (0.592-0.719) in the amblyopic eye and 0.707±0.039 (0.625-0.779) in the fellow eye in Group 2 patients; and 0.689±0.031 (0.612-0.748) in Group 3 patients. CVI was significantly lower in the amblyopic eyes of Group 2 compared with fellow eyes (p=0.02) and Group 3 (p=0.025).
CONCLUSION
Morphological changes may be seen in the choroid in amblyopic eyes. We observed that the choroidal stromal component is increased in hyperopic amblyopic patients especially.
Topics: Amblyopia; Choroid; Humans; Hyperopia; Refraction, Ocular; Tomography, Optical Coherence
PubMed: 35769903
DOI: 10.4274/tjo.galenos.2021.48275 -
Ophthalmology Jan 2022
Topics: Amblyopia; Contrast Sensitivity; Humans; Vision, Binocular
PubMed: 34930552
DOI: 10.1016/j.ophtha.2021.08.015 -
Journal of Optometry 2020To determine the national and subnational prevalence of amblyopia and the respective provincial distribution and trend during 1990-2018 in Iran.
PURPOSE
To determine the national and subnational prevalence of amblyopia and the respective provincial distribution and trend during 1990-2018 in Iran.
METHODS
Amblyopia data retrieved from 26 original studies, systematic reviews, Data has been cleaned by STATA and a linear mixed effect spatio-temporal model was used to calculate Gaussian process regression mean functions. Using a Bayesian approach, by pooling empirical data based on the assumed prior, a posterior distribution obtained for age and sex specific prevalence prediction nationally during the study time and provincially.
RESULTS
The overall age-adjusted prevalence of Amblyopia was 0.03 (95% CI, 0.022-0.035). The prevalence was comparable in boys and girls (p = 0.85), highest prevalence was in >30 years old (p = 0.038). Our extrapolation revealed a stable trend of prevalence of Amblyopia in Iran during 1990-2018 (national screening program has been active from 1990 onwards). While Amblyopia prevalence suggested a declining trend in three provinces of Hormozgan, Qom and Tehran and it went up in 13 other provinces.
CONCLUSION
Amblyopia prevalence seems unchanged despite the concurrent screening program. It is noteworthy that the coverage of the program has been improved and has reached more than 85% in 2018. Our finding mandates a formal evaluation on the program.
Topics: Adolescent; Adult; Amblyopia; Child; Child, Preschool; Female; Geography; Humans; Iran; Male; Prevalence; Visual Acuity; Young Adult
PubMed: 32321688
DOI: 10.1016/j.optom.2019.12.001 -
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 the Neurological Sciences Nov 2022Reading is a vision-reliant task, requiring sequential eye movements. Binocularly discordant input results in visual sensory and oculomotor dysfunction in amblyopia,...
INTRODUCTION
Reading is a vision-reliant task, requiring sequential eye movements. Binocularly discordant input results in visual sensory and oculomotor dysfunction in amblyopia, which may contribute to reading difficulties. This study aims to determine the contributions of fixation eye movement (FEM) abnormalities, clinical type and severity of amblyopia to reading performance under binocular and monocular viewing conditions.
METHODS
Twenty-three amblyopic patients and nine healthy controls were recruited. Eye movements elicited during fixation and reading of preselected passages were collected for each subject using infrared video-oculography. Subjects were classified as having no nystagmus (n = 9), fusion maldevelopment nystagmus (FMN, n = 5), or nystagmus without structural anomalies that does not meet criteria for FMN or infantile nystagmus (n = 9). Reading rate (words/min), the number of forward and regressive saccades (per 100 words) and fixation duration (s) were computed.
RESULTS
Amblyopic patients with and without nystagmus exhibited greater vergence and fixation instability. In patients without nystagmus, the instability arises from increased amplitude and velocity of fast and slow FEMs respectively. Amblyopic patients with and without nystagmus exhibited lower reading speeds with increased fixation duration, regressive and progressive saccades than controls in all viewing conditions. Mixed etiology, greater amblyopic eye visual acuity and stereopsis deficits were associated with greater reading difficulties under binocular viewing.
CONCLUSIONS
The presence of oculomotor dysfunction and the extent of visual acuity and stereoacuity deficits contribute to reading difficulties in patients with amblyopia, with and without nystagmus. The understanding of reading difficulties is essential to devise accommodations to limit long-term academic and vocational consequences of amblyopia.
Topics: Humans; Amblyopia; Dyslexia; Eye Movements; Nystagmus, Pathologic; Ocular Motility Disorders; Saccades
PubMed: 36242809
DOI: 10.1016/j.jns.2022.120438