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JAMA Ophthalmology Dec 2020Although the development of self-perception and self-esteem has been investigated in children with strabismic and anisometropic amblyopia, we know little about how...
IMPORTANCE
Although the development of self-perception and self-esteem has been investigated in children with strabismic and anisometropic amblyopia, we know little about how self-perception is affected in deprivation amblyopia. Deprivation amblyopia from a dense, unilateral cataract is the least common and typically most severe form of amblyopia. After cataract extraction, optical correction, and patching treatment for amblyopia, visual acuity almost always remains abnormal, and except in rare cases, stereoacuity is nearly always nil.
OBJECTIVE
To determine whether deprivation amblyopia is associated with altered self-perception in preschool children and to determine whether any differences in self-perception are associated with vision or motor skill deficits.
DESIGN, SETTING, AND PARTICIPANTS
Cross-sectional study conducted from 2016 to 2019 at a pediatric vision research laboratory. Children aged 3 to 6 years were enrolled, including 15 children with deprivation amblyopia and 20 control children.
MAIN OUTCOMES AND MEASURES
Self-perception was assessed using the Pictorial Scale of Competence and Acceptance for Young Children, which includes 4 specific domains: cognitive competence, peer acceptance, physical competence, and maternal acceptance. Fine motor skills were evaluated with the Manual Dexterity and Aiming & Catching Scales of the Movement ABC-2 test. Visual acuity and stereoacuity also were assessed.
RESULTS
Of the 35 children included, 13 of 35 were girls (37%) and 28 of 35 were non-Hispanic White (80%). Children with deprivation amblyopia had significantly lower peer acceptance and physical competence scores compared with control children (mean [SD], 2.80 [0.44] vs 3.25 [0.33]; mean difference, 0.45; 95% CI for difference, 0.19-0.71; P = .002 and 2.94 [0.45] vs 3.41 [0.37]; mean difference, 0.47; 95% CI for difference, 0.19-0.75; P = .002, respectively). Among children with amblyopia, moderate associations were found between self-perception domain scores and motor skills, including peer acceptance and manual dexterity (r = 0.68; 95% CI, 0.26-0.89; P = .005), peer acceptance and aiming (r = 0.54; 95% CI, 0.03-0.82; P = .03), and physical competence and aiming (r = 0.55; 95% CI, 0.06-0.83; P = .03).
CONCLUSIONS AND RELEVANCE
Lower self-perception of peer acceptance and physical competence were associated with early visual deprivation in children in their everyday life.
Topics: Amblyopia; Child; Child, Preschool; Cross-Sectional Studies; Female; Humans; Male; Motor Skills; Self Concept; Sensory Deprivation; Vision, Binocular; Visual Acuity
PubMed: 33090187
DOI: 10.1001/jamaophthalmol.2020.4363 -
PloS One 2023Amblyopia is a neurodevelopmental condition resulting in reduced vision for which whole population child vision screening is undertaken. Cross-sectional studies have...
Educational attainment and trajectories at key stages of schooling for children with amblyopia compared to those without eye conditions: Findings from the Millennium Cohort Study.
BACKGROUND
Amblyopia is a neurodevelopmental condition resulting in reduced vision for which whole population child vision screening is undertaken. Cross-sectional studies have established an association between amblyopia and lower academic self-concept, slower reading speed. No difference has been found in educational performance in adolescence whilst there are mixed associations with educational attainment in adults. Educational trajectories and intentions have not been studied previously. We analyse if those treated for amblyopia have different educational performance and trajectories for core subjects during statutory schooling, or subsequent higher education (university) intentions than their peers without eye conditions.
METHODS AND FINDINGS
Data from the Millennium Cohort Study of children born in the United Kingdom in 2000-01 and followed-up to age 17 years (n = 9989). Using a validated approach drawing on parental self-report on eye conditions and treatment coded by clinical reviewers, participants were grouped into mutually exclusive categories: no eye conditions, strabismus alone, refractive amblyopia, strabismic/mixed (refractive plus strabismic) amblyopia. The outcomes were levels and trajectories of passing English, Maths, Science at ages 7-16 years, passing national exams at age 16, and intentions at ages 14-17 to pursue higher (university) education. Adjusted analyses showed that amblyopia status was not associated with performance in English, Maths, and Science at any key stage, attainment in national exams, or intending to go to university. Similarly, the age-related trajectories of performance in core subjects and higher education intentions did not differ between the groups. There were no significant differences in main reason for having or not having university intentions.
CONCLUSIONS
We found no associations between a history of amblyopia and either adverse performance or age-related attainment trajectories in core subjects during key stages of statutory schooling as well as the absence of an association with intentions for higher education. These results should be reassuring to affected children and young people, and their families, teachers and physicians.
Topics: Adult; Adolescent; Humans; Child; Amblyopia; Cohort Studies; Cross-Sectional Studies; Educational Status; Strabismus
PubMed: 36996127
DOI: 10.1371/journal.pone.0283786 -
Indian Journal of Ophthalmology Feb 2020Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the...
Childhood blindness causes significant social and economic burden. Even though pediatric eye care has gained priority under Vision 2020, it continues to come under the purview of tertiary care centers due to lack of knowhow and facilities at primary and secondary level. Currently, India does not have standard guidelines on pediatric eye examination, refraction, and amblyopia management and therefore these are being managed inadequately or inappropriately. In view of this, an expert group of pediatric ophthalmologists from across the country met under the aegis of All India Ophthalmological Society, and deliberated to reach a consensus on the correct method of pediatric eye examination, treating refractive error in children and managing amblyopia. The purpose of the consensus statement was to enable all ophthalmologists to have a broad set of guidelines, which can form the basic framework for managing common pediatric eye conditions, in most ophthalmic setups. The consensus statement is divided into three broad categories: Pediatric eye examination, pediatric refraction, and amblyopia management. The pediatric eye exam subsection discusses the recommended clinical history, which should be taken and the essential components of an ophthalmic examination including pediatric vision assessment. Additionally, it discusses the role of special tests and investigations such as imaging and electrophysiology. The section on pediatric refraction emphasizes the correct use of cycloplegia and prescribing glasses in the Indian context. The final section on amblyopia management presents the various options of treating amblyopia and provides standard guidelines for the use of occlusion therapy and its weaning over time.
Topics: Amblyopia; Child; Consensus; Disease Management; Humans; Incidence; India; Refractive Errors; Strabismus; Tertiary Care Centers; Vision Screening; Visual Acuity
PubMed: 31957721
DOI: 10.4103/ijo.IJO_471_19 -
BMC Ophthalmology Mar 2022Parents pity their amblyopic child when they think that they suffer from occlusion therapy. We measured health-related quality of life during occlusion therapy.
BACKGROUND
Parents pity their amblyopic child when they think that they suffer from occlusion therapy. We measured health-related quality of life during occlusion therapy.
METHODS
We developed the Amblyopia Parents and Children Occlusion Questionnaire (APCOQ). It was designed by a focus group of patients, orthoptists and ophthalmologists and consisted of twelve items concerning skin contact of patch, activities, contact with other children, emotions and awareness of necessity to patch. Parents filled out the Proxy Version shortly before the Child Version was obtained from their child. Child Version item scores were compared with Proxy Version item scores and related to the child's age, visual acuity, refraction, angle of strabismus, and cause of amblyopia.
RESULTS
63 children were recruited by orthoptists, and their parents agreed to participate. Three children were excluded: one child with Down-syndrome, one child with cerebral palsy, and one child who had been treated by occlusion therapy. Included were 60 children (mean age 4.57 ± 1.34 SD) and 56 parents. Children had occluded 128 ± 45 SD days at interview. Prior to occlusion, 54 children had worn glasses. Cronbach's α was 0.74 for the Child Version and 0.76 for the Proxy Version. Children judged their quality of life better than their parents did, especially pertaining to skin contact and activities like games and watching TV. Notably, 13 children with initial visual acuity ≥ 0.6 logMAR in the amblyopic eye experienced little trouble with games during occlusion. Quality of life in eight children with strabismus of five years and older correlated negatively (Spearman rank mean rho = -0.43) with angle of strabismus. Children with amblyopia due to both refractive error and strabismus (n = 14) had, relatively, lowest quality of life, also according to their parents, as proxy. Several children did not know why they wore a patch, contrary to what their parents thought.
CONCLUSIONS
Children's quality of life during occlusion therapy is affected less than their parents think, especially regarding skin contact, playing games and watching TV during occlusion. Quality of life correlates negatively with the angle of strabismus in children five years and older. Children do not know why they wear a patch, contrary to what their parents think. Notably, children with low visual acuity in the amblyopic eye, had little difficulty playing games.
Topics: Amblyopia; Child; Child, Preschool; Humans; Parents; Quality of Life; Surveys and Questionnaires; Visual Acuity
PubMed: 35337271
DOI: 10.1186/s12886-022-02342-w -
Vision Research Oct 2009Amblyopia is a developmental abnormality that results from physiological alterations in the visual cortex and impairs form vision. It is a consequence of abnormal... (Review)
Review
Amblyopia is a developmental abnormality that results from physiological alterations in the visual cortex and impairs form vision. It is a consequence of abnormal binocular visual experience during the "sensitive period" early in life. While amblyopia can often be reversed when treated early, conventional treatment is generally not undertaken in older children and adults. A number of studies over the last twelve years or so suggest that Perceptual Learning (PL) may provide an important new method for treating amblyopia. The aim of this mini-review is to provide a critical review and "meta-analysis" of perceptual learning in adults and children with amblyopia, with a view to extracting principles that might make PL more effective and efficient. Specifically we evaluate: 1). What factors influence the outcome of perceptual learning? 2). Specificity and generalization - two sides of the coin. 3). Do the improvements last? 4). How does PL improve visual function? 5). Should PL be part of the treatment armamentarium? A review of the extant studies makes it clear that practicing a visual task results in a long-lasting improvement in performance in an amblyopic eye. The improvement is generally strongest for the trained eye, task, stimulus and orientation, but appears to have a broader spatial frequency bandwidth than in normal vision. Importantly, practicing on a variety of different tasks and stimuli seems to transfer to improved visual acuity. Perceptual learning operates via a reduction of internal neural noise and/or through more efficient use of the stimulus information by retuning the weighting of the information. The success of PL raises the question of whether it should become a standard part of the armamentarium for the clinical treatment of amblyopia, and suggests several important principles for effective perceptual learning in amblyopia.
Topics: Adolescent; Adult; Amblyopia; Child; Humans; Learning; Middle Aged; Neuronal Plasticity; Practice, Psychological; Psychophysics; Recovery of Function; Sensory Deprivation; Visual Perception; Young Adult
PubMed: 19250947
DOI: 10.1016/j.visres.2009.02.010 -
The British Journal of Ophthalmology Feb 1992
Topics: Amblyopia; Child, Preschool; Humans; Infant; Vision Screening
PubMed: 1739712
DOI: 10.1136/bjo.76.2.126-b -
Asia-Pacific Journal of Ophthalmology... Jan 2022This review summarizes clinically relevant outcomes from the Vision in Preschoolers (VIP) and VIP-Hyperopia in Preschoolers (VIP-HIP) studies. In VIP, refraction tests... (Review)
Review
Vision Screening, Vision Disorders, and Impacts of Hyperopia in Young Children: Outcomes of the Vision in Preschoolers (VIP) and Vision in Preschoolers - Hyperopia in Preschoolers (VIP-HIP) Studies.
This review summarizes clinically relevant outcomes from the Vision in Preschoolers (VIP) and VIP-Hyperopia in Preschoolers (VIP-HIP) studies. In VIP, refraction tests (retinoscopy, Retinomax, SureSight) and Lea Symbols Visual Acuity performed best in identifying children with vision disorders. For lay screeners, Lea Symbols single, crowded visual acuity (VA) testing (VIP, 5-foot) was significantly better than linear, crowded testing (10-foot). Children unable to perform the tests (<2%) were more likely to have vision disorders than children who passed and should be referred for vision evaluation. Among racial/ethnic groups, the prevalence of amblyopia and strabismus was similar while that of hyperopia, astigmatism, and anisometropia varied. The presence of strabismus and significant refractive errors were risk factors for unilateral amblyopia, while bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. A greater risk of astigmatism was associated with Hispanic, African American, and Asian race, and myopic and hyperopic refractive error. The presence and severity of hyperopia were associated with higher rates of amblyopia, strabismus, and other associated refractive error. In the VIP-HIP study, compared to emmetropes, meaningful deficits in early literacy were observed in uncorrected hyperopic 4- and 5-year-olds [≥+4.0 diopter (D) or ≥+3.0 D to ≤+6.0 D associated with reduced near visual function (near VA 20/40 or worse; stereoacuity worse than 240")]. Hyperopia with reduced near visual function also was associated with attention deficits. Compared to emmetropic children, VA (distance, near), accommodative accuracy, and stereoacuity were significantly reduced in moderate hyperopes, with the greatest risk in those with higher hyperopia. Increasing hyperopia was associated with decreasing visual function.
Topics: Amblyopia; Child; Child, Preschool; Humans; Hyperopia; Refractive Errors; Vision Disorders; Vision Screening
PubMed: 35044337
DOI: 10.1097/APO.0000000000000483 -
Singapore Medical Journal Jun 2019Amblyopia treatment in the form of glasses and/or patching in children poses a great challenge to parents. This study aimed to assess the factors that influence visual... (Observational Study)
Observational Study
INTRODUCTION
Amblyopia treatment in the form of glasses and/or patching in children poses a great challenge to parents. This study aimed to assess the factors that influence visual outcome in amblyopia and children's perception towards treatment.
METHODS
180 children (aged 3.0-7.0 years) with newly diagnosed amblyopia were recruited. The effects of age, gender, type of amblyopia, treatment and compliance on visual outcome at one year were assessed. Parents completed a questionnaire on children's attitudes towards amblyopia treatment.
RESULTS
150 (83%) children with a mean age of 5.2 ± 0.8 years returned for follow-up at one year. 130 (87%) had refractive amblyopia and 20 (13%) had strabismic and refractive-strabismic amblyopia. Visual acuity (VA) of 6/9 or better in the amblyopic eye was achieved in 121 (81%) children. On multivariable analysis, poor responders were more likely to have initial VA of worse than 6/15 (relative risk [RR] 4.17, 95% confidence interval [CI] 1.58-11.00, p = 0.004), prescribed combined (glasses and patching) treatment (RR 2.83, 95% CI 1.02-7.83, p = 0.045) and poor compliance (RR 6.10, 95% CI 1.90-19.57, p = 0.002) after adjustment for age, gender and type of amblyopia. While 7% of children initially reacted poorly to treatment, 5% remained uncooperative at the first follow-up visit. Children had difficulty with schoolwork (5%), mood changes (6%) and social problems (2%) associated with treatment.
CONCLUSION
Most children with amblyopia respond well to treatment, but more care (i.e. more parental education and closer follow-up) may be needed in children who are non-compliant and have poorer initial VA.
Topics: Amblyopia; Attitude to Health; Child; Child, Preschool; Eyeglasses; Female; Humans; Male; Occlusive Dressings; Prospective Studies; Singapore; Surveys and Questionnaires; Visual Acuity
PubMed: 30488078
DOI: 10.11622/smedj.2018151 -
Clinical & Experimental Optometry Jul 2018Amblyopia is a common cause of reduced vision in children. The clinical diagnosis is complicated and requires consideration of the severity of vision loss relative to... (Review)
Review
Amblyopia is a common cause of reduced vision in children. The clinical diagnosis is complicated and requires consideration of the severity of vision loss relative to the characteristics of the disrupting amblyogenic factor. Added to the challenge of a thorough examination of very young children, is the weight of consequence if the amblyogenic factor is not identified and treated appropriately within clinically recommended time frames. Further, the poor visual function may be a symptom of more sinister underlying pathology impacting the visual pathway. This review presents an evidence-based, pragmatic approach to the diagnosis of amblyopia, as a means for guiding best practice for the care of children who present with reduced vision.
Topics: Amblyopia; Child; Child, Preschool; Evidence-Based Practice; Humans; Infant; Physical Examination; Vision Disorders
PubMed: 29484709
DOI: 10.1111/cxo.12662 -
BMC Ophthalmology Jul 2009Amblyopia and amblyogenic factors like strabismus and refractive errors are the most common vision disorders in children. Although different studies suggest that... (Review)
Review
BACKGROUND
Amblyopia and amblyogenic factors like strabismus and refractive errors are the most common vision disorders in children. Although different studies suggest that preschool vision screening is associated with a reduced prevalence rate of amblyopia, the value of these programmes is the subject of a continuing scientific and health policy discussion. Therefore, this systematic review focuses on the question of whether screening for amblyopia in children up to the age of six years leads to better vision outcomes.
METHODS
Ten bibliographic databases were searched for randomised controlled trials, non-randomised controlled trials and cohort studies with no limitations to a specific year of publication and language. The searches were supplemented by handsearching the bibliographies of included studies and reviews to identify articles not captured through our main search strategy.
RESULTS
Five studies met the inclusion criteria. Of these, three studies suggested that screening is associated with an absolute reduction in the prevalence of amblyopia between 0.9% and 1.6% (relative reduction: between 45% and 62%). However, the studies showed weaknesses, limiting the validity and reliability of their findings. The main limitation was that studies with significant results considered only a proportion of the originally recruited children in their analysis. On the other hand, retrospective sample size calculation indicated that the power based on the cohort size was not sufficient to detect small changes between the groups. Outcome parameters such as quality of life or adverse effects of screening have not been adequately investigated in the literature currently available.
CONCLUSION
Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication.
Topics: Amblyopia; Child, Preschool; Epidemiologic Studies; Humans; Outcome Assessment, Health Care; Program Evaluation; Vision Screening
PubMed: 19607693
DOI: 10.1186/1471-2415-9-3