Effect of vision-based treatments on visual acuity and motor function in children with amblyopia

Purpose: To investigate existing as well as novel vision-based treatments in children with amblyopia and determine the utility of motor function as a potential outcome measure. Methods: Three experiments were conducted. Experiment 1 was a meta-analysis that initially found 3346 articles through a comprehensive literature search in Ovid Embase, PubMed, the Cochrane Library, Vision Cite, and Scopus. The search was for randomized clinical trials (RCTs) from 1975 to June 2020 and investigated improvement in visual acuity (VA) of the amblyopic eye. The population was patients aged 4 – 17 years old with amblyopia undergoing vision-based treatment. Two independent reviewers narrowed the results to 36 articles. Meta-analyses and a meta-regression were conducted on a subset of these RCTs in order to determine if any one vision-based treatment was superior at improving VA of the amblyopic eye. The goal of Experiment 2 was to characterize the types of motor function deficits seen in children (aged 3 - >7) with amblyopia and binocular vision problems (anisometropia without amblyopia, and strabismus without amblyopia), compared to controls. A total of 64 participants were recruited. Visual acuity (HOTV), stereopsis (Randot Preschool Stereoacuity Test), suppression (Worth 4 dot test) and motor function scores were assessed (Movement Assessment Battery for Children 2nd edition). Experiment 3 involved developing a binocular video treatment for use in a multi-site RCT. This treatment aimed for children aged 3 – 6 with amblyopia was created by transforming an existing cartoon (Q Pootle 5, provided by the British Broadcasting Corporation) into a dichoptic format. The goal was to create a video treatment that inspired high adherence rates and could separate specific, key characters between the eyes. Results: In Experiment 1, of the 3346 studies identified, 36 were included in a narrative synthesis. A random effects meta-analysis (five studies) compared the efficacy of binocular treatments versus patching: mean difference −0.03 logMAR; 95% CI 0.01 to 0.04 (p<0.001), favouring patching. An exploratory study-level regression (18 studies) showed no statistically significant differences between vision-based treatments and a reference group of 2–5 hours of patching. Age, sample size and pre- randomisation optical treatment were not statistically significantly associated with changes in amblyopic eye acuity. A network meta-analysis (26 studies) comparing vision-based treatments to patching 2–5 hours found one statistically significant comparison, namely, the favouring of a combination of two treatment arms comparing combination and binocular treatments, against patching 2–5 hours: standard mean difference: 2.63; 95% CI 1.18 to 4.09. However, this result was an indirect comparison calculated from a single study. A linear regression analysis (17 studies) found a significant relationship between adherence and effect size, but the model did not completely fit the data: regression coefficient 0.022; 95% CI 0.004 to 0.040 (p=0.02). In Experiment 2, An ANCOVA did not find a significant main effect of patient group on total motor function standard scores F(2, 51) = 1.59, p = 0.82). None of the covariates (visual acuity and stereopsis) were significantly associated with total motor function scores (lowest p = 0.42). When investigating the sub-categories of the MABC-2, one-way ANOVAs showed no significant effect of group for manual dexterity, catching and throwing, and balance scores. A novel binocular treatment was developed from the ground up for Experiment 3. The resulting treatment separated key characters and/or items between the eyes, to ensure that the use of the amblyopic eye was essential for the patient to understand each scene. The cartoon was successfully ported to the New Nintendo 3DS XL, a handheld device that allows dichoptic videos to be shown without the need for glasses. This treatment is distinct from previous video treatments in the literature and we hypothesize that it will improve visual acuity of the amblyopic eye, stereopsis and fine and gross motor function skills in children with amblyopia. Conclusion: Clinicians have many available options for treatment that are just as efficacious as patching for 2-5 hours. This includes the possibility of binocular treatments, which may also improve stereopsis. More research on symptoms other than just visual acuity, such as motor function, should be further investigated in patients with amblyopia in order to provide a complete healthcare plan

Mejora de la sensibilidad al contraste en pacientes con ambliopía: revisión bibliográfica sistemática

PROPÒSIT: Realitzar una revisió bibliogràfica sistemàtica sobre l'avaluació i millora de la sensibilitat al contrast en pacients ambliopes estràbics, refractius i / o mixtes. MÈTODES: Es va realitzar una recerca bibliogràfica a través de les bases de dades Medline i PubMed, seguint la metodologia PRISMA, d'articles científics publicats els darrers deu anys. Es va realitzar el procés d'identificació, selecció i inclusió dels 71 estudis que van ser analitzats en el treball. RESULTATS: La revisió bibliogràfica sistemàtica mostra la importància de la valoració de la sensibilitat al contrast en pacients ambliopes. S'observa la quantitat de tractaments passius en què s'obté una millora significativa dels resultats, sent més rellevant el tractament amb oclusió. També, en el tractament d'aprenentatge perceptual i entrenament dicóptic s'observa l'obtenció de millors resultats a diferència d'altres tractaments, sent aquestes la millor opció per millorar la sensibilitat al contrast en els pacients ambliopes. CONCLUSIÓ: S'observen diversos tractaments per tractar la ambliopia que milloren la sensibilitat al contrast tant en ambliopes estràbics com anisometrópicos. Sent l'oclusió, l'aprenentatge perceptual i l'entrenament dicóptico mitjançant realitat virtual i videojocs els que suggereixen obtenir millors resultats. És per això, que són necessaris més estudis de qualitat que puguin demostrar la validesa de la millora de la sensibilitat al contrast en altres àrees dels tractaments passius i actius.PROPÓSITO: Realizar una revisión bibliográfica sistemática sobre la evaluación y mejora de la sensibilidad al contraste en pacientes ambliopes estrábicos, refractivos y/o mixtos. MÉTODOS: Se realizó una búsqueda bibliográfica a través de las bases de datos Medline y PubMed, siguiendo la metodología PRISMA, de artículos científicos publicados los últimos diez años. Se realizó el proceso de identificación, selección e inclusión de los 71 estudios que fueron analizados en el trabajo. RESULTADOS: La revisión bibliográfica sistemática muestra la importancia de la valoración de la sensibilidad al contraste en pacientes ambliopes. Se observa la cantidad de tratamientos pasivos en los que se obtiene una mejora significativa de los resultados, siendo más relevante el tratamiento con oclusión. También, en el tratamiento de aprendizaje perceptual y entrenamiento dicóptico se observa la obtención de mejores resultados a diferencia de otros tratamientos, siendo estas la mejor opción para mejorar la sensibilidad al contraste en los pacientes ambliopes. CONCLUSIÓN: Se observan diversos tratamientos para tratar la ambliopía que mejoran la sensibilidad al contraste tanto en ambliopes estrábicos como anisometrópicos. Siendo la oclusión, el aprendizaje perceptual y el entrenamiento dicóptico mediante realidad virtual y videojuegos los que sugieren obtener mejores resultados. Es por eso, que son necesarios más estudios de calidad que puedan demostrar la validez de la mejora de la sensibilidad al contraste en otras áreas de los tratamientos pasivos y activos.PURPOSE: To conduct a systematic literature review on whether contrast sensitivity is evaluated and improved in strabismic, refractive and/or mixed amblyopic patients. METHODS: A literature search was carried out using the Medline and PubMed databases, following the PRISMA methodology, of scientific articles published in the last ten years. The process of identification, selection and inclusion of the 71 studies that were analysed in the study was carried out. RESULTS: The systematic literature review shows the importance of contrast sensitivity evaluation in amblyopic patients. The amount of passive treatments in which a significant improvement in results is obtained is observed, the treatment with occlusion being more relevant. Also, in the perceptual learning treatment and dichoptic training, better results were obtained than in other treatments, these being the best option for improving contrast sensitivity in amblyopic patients. CONCLUSION: Various treatments for amblyopia are observed to improve contrast sensitivity in both strabismic and anisometropic amblyopes. Occlusion, perceptual learning and dichoptic training using virtual reality and video games suggest the best results. Therefore, more quality studies are needed to demonstrate the validity of contrast sensitivity enhancement in other areas of passive and active treatments

Yale Medicine : Alumni Bulletin of the School of Medicine, Fall 1996- Fall 1998

This volume contains Yale medicine: alumni bulletin of the School of Medicine, v.31 (Fall 1996) through v.32 (Fall 1998). Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes are called Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965). Digitized with funding from the Arcadia fund, 2017.https://elischolar.library.yale.edu/yale_med_alumni_newsletters/1013/thumbnail.jp

UMSL Bulletin 2015-2016

https://irl.umsl.edu/bulletin/1000/thumbnail.jp