Purpose: To evaluate factors that can influence the prevalence of amblyopia in children with anisometropia. Methods: We retrospectively reviewed the records of 63 children 2 to 13 years of age who had anisometropic amblyopia with a difference in the refractive errors between the eyes of at least two diopters (D). The type of anisometropia (myopia, hyperopia, and astigmatism), degree of anisometropia (＜2-3 D, ＜3-4 D, or ＞4 D), best corrected visual acuity (BCVA) of the amblyopic eye at the time of initial examination, BCVA differences between sound and amblyopic eyes, whether or not occlusion therapy was performed, compliance with occlusion therapy, and the patient’s age when eyeglasses were first worn were investigated. Results: There was an increase in the risk of amblyopia with increased magnitude of anisometropia (p=0.021). The prevalence of amblyopia was higher in the BCVA ＜20/40 group and in patients with BCVA differences ＞4 lines between sound and amblyopic eyes (p=0.008 and p=0.045, respectively). There was no statistical relationship between the prevalence of amblyopia and the type of anisometropia or the age when eyeglasses were first worn. Poor compliance with occlusion therapy was less likely to achieve successful outcome (p=0.015). Conclusions: Eyes with poor initial visual acuities of ＜20/40, a high magnitude of anisometropia, and a ＞4 line difference in the BCVA between sound and amblyopic eyes at the initial visit may require active treatment.

/pdf/factors-influencing-the-prevalence-of-amblyopia-in-children-1la3n7hr84.pdf

Factors influencing the prevalence of amblyopia in children with anisometropia.

Purpose
To determine the outcome of part-time occlusion therapy in children with anisometropic amblyopia detected after they were 8 years of age.

https://synapse.koreamed.org/upload/SynapseData/PDFData/0065kjo/kjo-20-171.pdf

Part-time occlusion therapy for anisometropic amblyopia detected in children eight years of age and older.

PURPOSE To determine the incidence and related risk factors of reoperation among patients with infantile exotropia who were operated on at Imam Hossein Medical Center, Tehran, Iran, from 2001 to 2015. METHODS In this study, 82 children (55 girls and 27 boys) with infantile exotropia were divided into two groups 3 months after their first operation: children with horizontal deviation of 10 prism diopters (PD) or less (n = 64; success group) and those with horizontal deviation greater than 10 PD (n = 18; failure group). Patients with deviation of 20 PD or greater were indicated for reoperation. Factors including age at the first operation, preoperative angle of deviation, inferior oblique muscle overaction, dissociated vertical deviation, and A- or V-pattern in relation to reoperation were studied. Sensory status of children older than 5 years was also evaluated using Worth 4-dot and Titmus tests. RESULTS Reoperation was indicated in 18.3% (n = 15) of patients after 11.5 ± 19 months of follow-up. Preoperative angle of deviation (P < .001) and surgical approach (P = .017) were statistically different between the failure and success groups. The majority of patients (71%) achieved fusion and gross stereopsis (< 3,000 seconds of arc) after surgery. CONCLUSIONS According to the results, 18.3% of patients with infantile exotropia, especially those with more preoperative exotropia, needed reoperation to achieve good alignment. Although the recession-resection method had better motor results, the authors could not recommend it as a first operation for all patients with infantile exotropia because it was only performed on patients with amblyopia. Gross stereopsis and binocular fusion were seen in the majority of patients. [J Pediatr Ophthalmol Strabismus. 2017;54(1):22-30.].

The Incidence of Reoperation and Related Risk Factors Among Patients With Infantile Exotropia

Purpose: The objective of this study was to compare prospectively the efficacy between intermittent atropine penalization and part-time occlusion therapy for amblyopia in patients younger than 10 years old. Methods: The patients with newly diagnosed amblyopia were randomly assigned to either atropine penalization (Group A) or occlusion therapy (Group O). One drop of atropine was instilled into the sound eyes of patients in group A twice per week, while each patient in group O underwent daily patching for 6 hours in their sound eyes. The minimum follow-up time was 3 months after treatment. Best corrected visual acuity and compliance were compared for both groups. Results: A total of 43 patients were enrolled in this study, with 18 assigned to group A and 25 to group O. The follow-up period was not significantly different between group A and group O (6.3 and 7.0 months, respectively; p=0.437). The final corrected visual acuity (LogMAR) scores of amblyopic eyes in both groups showed significant improvement in the visual acuity of amblyopic eyes compared with that at baseline (0.28 in group A and 0.19 in group O). Group A had a higher level of compliance than group O (97.0 and 91.5%, respectively; p=0.007). There was no difference in the groups with regard to visual acuity in amblyopic eyes, which showed similar improvement (3.5:3.4 lines, respectively; p=0.867). Conclusions: This study shows that for treating amblyopia in children younger than 10 years old, intermittent atropine penalization seems to be as effective as part-time occlusion. J Korean Ophthalmol Soc 49(6):958-966, 2008

https://synapse.koreamed.org/upload/SynapseData/PDFData/0035jkos/jkos-49-958.pdf

The Prospective Comparison of the Efficacy of Intermittent Atropine Penalization and Part-time Occlusion Therapy.

Objective To evaluate the relationship between fundus extorsion before surgery and the development of inferior oblique overaction (IOOA) and dissociated vertical deviation (DVD) after surgery in patients with infantile esotropia. Design Retrospective comparative observational study. Participants Forty patients who had not had preoperative IOOA or DVD, and had undergone surgery for infantile esotropia were included. Methods A fundus examination was carried out under general anesthesia before surgery. There were 21 subjects with preoperative fundus extorsion (extorsion group), and 19 subjects without torsion (no torsion group). The development of IOOA and DVD after surgery was evaluated. Results After surgery, IOOA developed in 14 patients (66.7%) and DVD in 17 patients (80%) in the extorsion group. In contrast, IOOA developed in 2 patients (10.5%) and DVD in 6 patients (31.6%) in the no torsion group ( p p = 0.002, respectively). Conclusions When patients with infantile esotropia had fundus extorsion assessed on general anesthesia before surgery, IOOA and DVD were more likely to develop after surgery.

Can the preoperative fundus extorsion in infantile esotropia predict the development of postoperative inferior oblique overaction and dissociated vertical deviation

Purpose: To evaluate the factors affecting treatment outcome of children with anisometropic amblyopia. Methods: We retrospectively investigated the treatment outcome of 57 children who were diagnosed as anisometropic amblyopia. The age at initial treatment, initial best corrected visual acuity of the amblyopic eye, amount and type of anisometropia, strabismus and compliance of treatment were investigated. Results: The mean age and standard deviation at initial treatment was 5.3±1.8(3-9) years. The absolute average values of spherical and cylindrical anisometropia were 2.87±1.99D and 1.87±2.24D respectively. While compliance was significantly related to treatment outcome, the age at initial treatment, visual acuity on amblyopic eye, amount and type of anisometropia, and strabismus had no significant influence on treatment outcome. Conclusions: Treatment compliance was the most significant factor in the treatment of anisometropic amblyopia.

The Effect on Outcome of Amblyopia Treatment in Children with Anisometropic Amblyopia

Purpose: To assess in monocular amblyopia patients the effectiveness of solitary part-time occlusion in overcoming the disadvantages of full-time occlusion. Methods: Forty monocular amblyopia patients, aged from 3 to 8 years, who had more than 0.7 in visual acuity of the sound eye and more than 2 lines in binocular difference of visual acuity, were treated only with part-time occlusion for 6 hours per day. Patients were classified into three age groups: 34 years, 56 years, and 78 years. We compared best corrected visual acuity (BCVA) and binocular difference of visual acuity, before and after 6-hour patching. We also compared the difference at the end of patching with that at the last follow-up visit. Results: BCVA and binocular difference of visual acuity were significantly improved (p13.0 months (955months). Thirty-two of 40 patients had less than 2 lines of binocular difference of visual acuity after patching. Visual acuity of each age group was also significantly improved but there was no difference in the degree of improvement or the duration of occlusion among the three age groups. It was also maintained well until the last follow-up visit. Conclusions: For the treatment of amblyopia patients, solitary, 6-hour, part-time occlusion revealed effective improvement of BCVA and good maintenance of the improvement.

Effects of Solitary Part-time Occlusion for the Treatment of Monocular Amblyopia Patients

Purpose: To study the clinical manifestations and surgical outcome of infantile esotropia. Methods: This review retrospectively examined 165 patients of infantile esotropia who had undergone recession of bilateral medial rectus muscles from April 1991 to September 2001 at our institute. We measured the binocular alignment and analyzed the long term surgical outcome. Results: The average angle of deviation of 165 patients was 45.913.99PD (25~90PD) and the average refractive error was +sph 1.182.25D (-sph 7.00~+sph 6.00D). Amblyopia was found in 48.4% of the patients, DVD in 12.7%, IOOA in 11.3%, and manifest latent nystagmus in 6.0%. A binocular alignment within 10 PD was achieved in 73.9% and 57.9% at the 2nd and 4th post-operative year respectively. Conclusions: The surgical outcome of bimedial rectus muscle recession in infantile esotropia was satisfactory in 74%, and 58% of the patients at the 2nd and 4th post-operative year respectively.

Clinical Manifestations and Surgical Outcome of Infantile Esotropia

Purpose: We examined the effect of induced interocular difference of retinal illuminanace on stereopsis. Methods: Fifty adults who have normal binocularity were examined with neutral density filters. The mean age was 29.1 years. While the monocular retinal illuminance was gradually reduced by increasing the value of neutral density filters, we measured the best corrected visual acuity and stereoacuity with Titmus test and Lang test. We used neutral density filter from 1.0 neutral density (ND, 10% transmit) to 3.0ND (0.1% transmit) with intervals of 0.2ND. Results: The best corrected visual acuity began to decrease significantly when the value of neutral density filter reached 2.0ND (1% transmit). Stereoacuity also began to decline when the value was 1.4ND(4% transmit) with Titmus test and 1.6ND (2.5% transmit) with Lang test. Conclusions: Change of retinal illuminance effects more on stereoacuity than visual acuity as stereoacuity decreased earlier by increasing the value of density filters. These results imply that the stereopsis test could be more useful than visual acuity test for detecting ocular abnormalities influencing the retinal illuminance.

Effect of Difference of Binocular Retinal Illuminance on Stereopsis

Purpose: To study the characteristics of the accompanying amblyopia and strabismus in patients with anisometropia. Methods: We retrospectively reviewed the medical records of 193 patients, who had either spherical or cylindrical anisometropia of more than 1.00D. Patients were divided into four groups: spherical hyperopic anisometropia, spherical myopic anisometropia, cylindrical hyperopic anisometropia, and cylindrical myopic anisometropia. We investigated the accompanying amblyopia and strabismus. Amblyopia was treated with lens correction and patch therapy and we analyzed the results for 78 patients who fulfilled six-month follow-up examinations. Results: There was no significant difference in the frequency of amblyopia between spherical and cylindrical anisometropia. Spherical myopic anisometropia of more than 3.00D showed a significant increase in the incidence of amblyopia (p=0.001). Spherical hyperopic anisometropia of more than 1.00D, cylindrical hyperopic anisometropia of more than 2.00D, and cylindrical myopic anisometropia of more than 2.00D showed an increased tendency for amblyopia. Between spherical and cylindrical anisometropia, there were no significant differences in the results and duration of amblyopia treatment, and type and frequency of strabismus. Conclusions: In spherical anisometropia, hyperopic anisometropia has a higher risk for developing amblyopia. We could find the threshold for the development of amblyopia.

The Amblyopia and Strabismus Accompanied with Anisometropia

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