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Ophthalmic Research 2021Amblyopia is an important public health problem and standard screening is quite necessary for early diagnosis and treatment especially for the remote areas. As the place...
INTRODUCTION
Amblyopia is an important public health problem and standard screening is quite necessary for early diagnosis and treatment especially for the remote areas. As the place of the largest Tibetan population, the Tibetan Plateau has special geographical characteristics such as high altitude, time zone, and ethnic composition, where very little information is available about the prevalence of amblyopia and other ocular diseases. The article aims to determine the prevalence of amblyopia and associated factors in grade 1 Tibetan children, living in Lhasa, Tibet Autonomous Region.
METHODS
A cross-sectional study was conducted. All the participants were scheduled for comprehensive eye examinations including visual acuity testing, ocular deviation and movement evaluation, cycloplegic refraction and examinations of the external eye, anterior segment, media, and fundus. Amblyopia was assessed in the children according to the standard definition.
RESULTS
A total of 1,856 students participated in the examinations (97.58% response rate). 1,852 students completed all the related examinations, and 34 of them were diagnosed as amblyopia with the prevalence of 1.84% (95% confidence interval [CI]: 1.22-2.45%). Unilateral amblyopia was diagnosed in 23 students (1.24%, 95% CI: 0.74-1.75%), including 16 anisometropic, 4 strabismic, 1 visual deprivational, and 2 mixed. Other 11 students were diagnosed as bilateral amblyopia (0.59%, 95% CI: 0.24-0.94%), including 9 ametropic, 1 deprivational, and 1 with nystagmus. The mean cylinder refraction and absolute value of the spherical equivalent refraction of amblyopic eyes was respectively -2.15 ± 1.52 D and 2.70 ± 2.33 D. Amblyopia was significantly associated with hyperopia (≥+2.00 D, odds ratio [OR] 8.22, 95% CI 3.42-19.72), astigmatism (≤-2.00 D, OR 6.76, 95% CI 2.56-17.85), and anisometropia (≥+0.50 to <+1.00 D, OR 3.95, 95% CI 1.44-10.79; ≥+1.00 D, OR 21.90, 95% CI 8.24-58.18).
CONCLUSIONS
The prevalence of amblyopia in grade 1 students of Lhasa is relatively higher than that of many other ethnic populations in China previously reported. Refractive errors including anisometropia, hyperopia, and astigmatism are the major risk factors of amblyopia.
Topics: Amblyopia; Child; Child, Preschool; China; Cross-Sectional Studies; Ethnicity; Female; Humans; Male; Prevalence; Refraction, Ocular; Retrospective Studies; Risk Factors; Schools; Tibet; Visual Acuity
PubMed: 33279900
DOI: 10.1159/000511264 -
Indian Journal of Ophthalmology Sep 2019Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual... (Review)
Review
Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.
Topics: Amblyopia; Atropine; Eyeglasses; Humans; Mydriatics; Ophthalmic Solutions; Sensory Deprivation; Visual Acuity
PubMed: 31436180
DOI: 10.4103/ijo.IJO_11_19 -
Indian Journal of Ophthalmology Oct 2023To describe the presence of ocular abnormalities in children with developmental delay (DD) and compare with normal children; to analyze associated risk factors, systemic... (Observational Study)
Observational Study
PURPOSE
To describe the presence of ocular abnormalities in children with developmental delay (DD) and compare with normal children; to analyze associated risk factors, systemic problems, and the possible treatment that can be delivered.
METHODS
This was a cross sectional, observational study. We included children between one and 18 years, diagnosed as developmental delay in DD group, and next immediate age- and sex-matched children without developmental delay on the same day or during the same period in the control group. Detailed history and neuroimaging findings were noted. Uncorrected visual acuity, best-corrected visual acuity for distance and near, cycloplegic refraction, anterior, and posterior segment examination was carried out. Various ocular problems, delayed visual maturation (DVM), and cortical visual impairment (CVI) were diagnosed based on examination. Data were analyzed statistically, and P value <0.05 was considered as statistically significant.
RESULTS
Ninety-four children were included in each group. Mean age was 4.97 ± 3.84 years, and 64.89% were males. In DD group: Most common abnormal neuroimaging finding was gliotic changes; systemic associations: 39 children; 83 children had ocular problems: refractive error-70, strabismus-39, cataract-five, amblyopia-16; DVM-13; CVI-13 children; glasses and vision stimulation were advised in 39 and 65 children, respectively; whereas, in control group: refractive error-36, strabismus-15, cataract-two; amblyopia-20 children.
CONCLUSION
88.29% of developmental delay children had ocular abnormalities, commonest was refractive error (74.47%); these values were higher than in control group; common risk factors were low birthweight and consanguineous marriage; epilepsy was the most common systemic association.
Topics: Male; Humans; Child; Infant; Child, Preschool; Female; Amblyopia; Cross-Sectional Studies; Prevalence; Refractive Errors; Vision Disorders; Strabismus; Cataract; Refraction, Ocular
PubMed: 37787230
DOI: 10.4103/IJO.IJO_3358_22 -
Facial Plastic Surgery & Aesthetic... 2023Periorbital infantile hemangiomas (POIHs) are associated with a high incidence of visual complications. To analyze the sites of predilection of POIHs and to determine...
Periorbital infantile hemangiomas (POIHs) are associated with a high incidence of visual complications. To analyze the sites of predilection of POIHs and to determine whether certain sites require earlier intervention due to their higher rate of visual complications. A retrospective case series study was conducted on patients from two tertiary care centers for 25 years. The location of POIHs was determined from clinical photographs, medical records, and radiological studies. The presence or absence of anisometropic astigmatism (anisoastigmatism) and amblyopia was recorded. Data were analyzed using a chi-square test. There were 486 patients, of which 302 patients had ophthalmology evaluations and 245 patients had refractive error data. At presentation, 10% of patients already had amblyopia and 44% had anisoastigmatism. Medial eyelid lesions had the highest risk of developing anisoastigmatism (anisoastigmatism correlates with eyelid position, = 0.0001). Segmental and upper medial lesions had the highest risk of amblyopia at initial evaluation. The site of POIH is an important indicator for developing clinically significant anisoastigmatism and amblyopia, underlining the need for early ophthalmologic assessment and management.
Topics: Humans; Amblyopia; Retrospective Studies; Astigmatism; Tertiary Care Centers; Hemangioma
PubMed: 36473202
DOI: 10.1089/fpsam.2022.0099 -
American Journal of Ophthalmology Jun 2023The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent...
PURPOSE
The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus.
DESIGN
Prospective clinical validity analysis of a screening device based on sensitivity and specificity.
METHODS
Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared.
RESULTS
In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals.
CONCLUSIONS
Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.
Topics: Child; Humans; Amblyopia; Prospective Studies; Vision Screening; Strabismus; Refractive Errors; Sensitivity and Specificity
PubMed: 36682517
DOI: 10.1016/j.ajo.2023.01.013 -
American Journal of Ophthalmology Jan 2022Many clinicians treat unilateral amblyopia with glasses alone and initiate patching when needed; others start glasses and patching simultaneously. In this study, we... (Clinical Trial)
Clinical Trial
PURPOSE
Many clinicians treat unilateral amblyopia with glasses alone and initiate patching when needed; others start glasses and patching simultaneously. In this study, we reviewed the outcomes of the two approaches at our institution.
DESIGN
Retrospective nonrandomized clinical trial.
METHODS
Setting: Institutional practice.
PATIENT POPULATION
All patients diagnosed with amblyopia at Boston Children's Hospital between 2010 and 2014.
INCLUSION CRITERIA
Unilateral amblyopia (visual acuity (VA) 20/40 to 20/200 with interocular difference ≥3 lines,) age 3 to 12 years, with a 6-month follow-up visit.
EXCLUSION CRITERIA
Deprivation amblyopia, prior amblyopia treatment, treatment other than patching, surgery. Patients were categorized as "simultaneous treatment" (concurrent glasses and patching therapy at their first visit) or "sequential treatment" (glasses alone at first visit, followed by patching therapy at second visit.) Observation procedures: Patient demographics, VA, and stereopsis were compared.
OUTCOME MEASURES
VA and stereopsis at the last visit on treatment.
RESULTS
We identified 98 patients who met inclusion criteria: 36 received simultaneous treatment and 62 sequential treatment. Median amblyopic eye VA improved similarly between the simultaneous (∆0.40; interquartile range [IQR], 0.56-0.30 logMAR) and sequential (∆0.40; IQR, 0.52-0.27 logMAR) groups. Patients without stereopsis at first visit had better stereopsis outcomes with sequential treatment (5.12 [IQR, 4.00-7.51] log stereopsis) compared with simultaneous treatment (8.01 [IQR, 5.65-9.21]) log stereopsis, P = 0.046).
CONCLUSIONS
VA improved approximately 4 lines regardless of treatment type. For children without stereopsis at first presentation, sequential patching yielded better stereopsis outcomes. These findings require further validation and highlight the importance of evaluating stereopsis in future studies.
Topics: Amblyopia; Child; Child, Preschool; Follow-Up Studies; Humans; Retrospective Studies; Sensory Deprivation; Treatment Outcome; Vision, Binocular
PubMed: 34303687
DOI: 10.1016/j.ajo.2021.07.012 -
Der Ophthalmologe : Zeitschrift Der... May 2022Congenital corneal opacities are comparatively rare diseases with high amblyogenic potential. (Review)
Review
BACKGROUND
Congenital corneal opacities are comparatively rare diseases with high amblyogenic potential.
PURPOSE
The present work provides an overview of the diagnostics, clinical aspects and genetics of congenital corneal opacities.
METHODS
A literature search was carried out to compile an overview and illustration with own clinical case examples.
RESULTS
Differentiated diagnostics are of high importance in the treatment of patients with congenital corneal opacities. A close cooperation between the medical departments involved and also the parents is absolutely essential. The structured classification of congenital corneal opacities provides the basis for a targeted treatment.
DISCUSSION
The causes and the clinical symptoms of congenital corneal opacities are manifold. The correct diagnosis should be made early and in an interdisciplinary manner. Based on this, conservative and surgical treatment measures can be planned and an impending development of amblyopia can be specifically counteracted.
Topics: Amblyopia; Corneal Opacity; Eye Abnormalities; Humans
PubMed: 35244750
DOI: 10.1007/s00347-022-01587-6 -
Investigative Ophthalmology & Visual... Apr 2021The purpose of this study was to compare binocular visual attention, visual processing speeds, and visuo-cognitive search ability in children with and without amblyopia...
PURPOSE
The purpose of this study was to compare binocular visual attention, visual processing speeds, and visuo-cognitive search ability in children with and without amblyopia and investigate the association of visual acuity and binocular function with these measures.
METHODS
Participants included 20 children with amblyopia (mean age = 9.0 ± 1.2 years; 15 anisometropic and 5 strabismic) and 20 children with normal vision development (9.5 ± 1.7 years). Vision assessment included visual acuity (monocular and binocular) and binocular function (Worth 4 Dot and Randot Preschool Stereotest). Visual attention and processing speeds were assessed using the three subtests of the Useful Field of View (UFOV; central processing, divided attention, and selective attention). Visuo-cognitive search was measured using static and dynamic presentations of the Trail Making Tests (TMTs), parts A and B, with increasing levels of executive function demand. All children performed these tasks binocularly.
RESULTS
Children with amblyopia demonstrated slower visual processing times on the UFOV (P = 0.04), and slower completion times on the TMT search tests (P = 0.014), compared to controls. TMT performance for children with amblyopia was also more negatively impacted with increasing executive function demands on the TMT part B, compared to controls (P = 0.005). Binocular visual acuity was associated with TMT (P = 0.006) and UFOV (P = 0.07) performance, but none of the other visual function measures were related to performance on these tasks.
CONCLUSIONS
Children with amblyopia exhibit deficits in higher-order visual processing skills, including visual attention and visual search, particularly with increasing executive function demands. These findings have implications for understanding the impact of amblyopia on everyday function in children.
Topics: Adolescent; Amblyopia; Attention; Child; Female; Humans; Male; Video Games; Vision, Binocular; Visual Acuity; Visual Perception
PubMed: 33848323
DOI: 10.1167/iovs.62.4.15 -
Scientific Reports Apr 2021Amblyopia is a developmental disorder associated with abnormal visual experience during early childhood commonly arising from strabismus and/or anisometropia and leading...
Amblyopia is a developmental disorder associated with abnormal visual experience during early childhood commonly arising from strabismus and/or anisometropia and leading to dysfunctions in visual cortex and to various visual deficits. The different forms of neuronal activity that are attenuated in amblyopia have been only partially characterized. In electrophysiological recordings of healthy human brain, the presentation of visual stimuli is associated with event-related activity and oscillatory responses. It has remained poorly understood whether these forms of activity are reduced in amblyopia and whether possible dysfunctions would arise from lower- or higher-order visual areas. We recorded neuronal activity with magnetoencephalography (MEG) from anisometropic amblyopic patients and control participants during two visual tasks presented separately for each eye and estimated neuronal activity from source-reconstructed MEG data. We investigated whether event-related and oscillatory responses would be reduced for amblyopia and localized their cortical sources. Oscillation amplitudes and evoked responses were reduced for stimuli presented to the amblyopic eye in higher-order visual areas and in parietal and prefrontal cortices. Importantly, the reduction of oscillation amplitudes but not that of evoked responses was correlated with decreased visual acuity in amblyopia. These results show that attenuated oscillatory responses are correlated with visual deficits in anisometric amblyopia.
Topics: Adult; Amblyopia; Evoked Potentials; Female; Humans; Magnetoencephalography; Male; Middle Aged; Photic Stimulation; Visual Acuity; Visual Cortex
PubMed: 33859272
DOI: 10.1038/s41598-021-87545-9 -
The Journal of School Nursing : the... Jun 2022The goal of this study is to assess the referral rate accuracy of photoscreening versus the chart methodology in identifying preschool children at risk of amblyopia and...
The goal of this study is to assess the referral rate accuracy of photoscreening versus the chart methodology in identifying preschool children at risk of amblyopia and amblyogenic refractive error. Vision screenings using the plusoptiX S12 and the LEA chart were performed on 127 children, aged 3-5 years old. Comprehensive eye exams were performed after screenings. The sensitivity and specificity of the plusoptiX S12 were 80.3% and 92.1% and the LEA chart were 43.6% and 94.8%, respectively. The sensitivity of the plusoptiX S12 is significantly higher than the LEA ( value: <.001). After eye exams, 82.9% were correctly passed by the plusoptiX S12 and 64% were correctly passed by the LEA chart ( value: .009). Objective photoscreening is significantly more accurate in identifying preschool children at risk of developing amblyopia and should be considered best practice. The chart methodology provides an inaccurate report on a preschool child's amblyopic risk.
Topics: Amblyopia; Child, Preschool; Humans; Refractive Errors; Reproducibility of Results; Sensitivity and Specificity; Vision Screening
PubMed: 32662321
DOI: 10.1177/1059840520940370