The challenges of amblyopia treatment.

The treatment of amblyopia, particularly anisometropic (difference in refractive correction) and/or strabismic (turn of one eye) amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 1998. Since this review, a number of publications have revealed new findings in the treatment of amblyopia. This includes the finding that less intensive occlusion treatments can be successful in treating amblyopia. A relationship between adherence to treatment and visual acuity has also been established and has been shown to be influenced by the use of intervention material. In addition, there is growing evidence of that a period of glasses wearing only can significantly improve visual acuity alone without any other modes of treatment. This review article reports findings since the Snowdon's report

Survey of management of acquired nystagmus in the United Kingdom

Purpose: To determine the current management of acquired nystagmus by ophthalmologists and neurologists. Methods: Questionnaires were sent to ophthalmologists (850) and neurologists (434) in the United Kingdom. Estimated numbers of patients seen with acquired nystagmus, treatment options used and the results of treatment of the patients were collected. Results: Response rate was 37% for ophthalmologists and 34% for neurologists. The most common causes of acquired nystagmus were estimated to be multiple sclerosis and stroke. 58% of ophthalmologists and 94.5% of neurologists reported seeing patients with nystagmus. The most common used medical treatment was gabapentin and baclofen. Other drugs used were clonazepam, carbamazepine, benzhexol, ondansetrone, buspirone, memantine and botulinum toxin (n=3). 11 ophthalmologists and 52 neurologists noted symptomatic improvement with medical treatment. 11 ophthalmologists and 44 neurologists noted improvement in visual acuity (VA). Occurrence of side effects noted with baclofen and gabapentin treatments were similar. Conclusion: A variety of drugs are used to treat acquired nystagmus in the UK. Baclofen and gabapentin are the drugs most commonly used and are reported to cause significant improvement in symptoms and VA. Better knowledge of the action of drugs in nystagmus is needed to establish guidelines and to give patients wider access to treatment

Resolution of Superior Oblique Myokymia with Memantine

Resolution of Superior Oblique Myokymia with Memantin

The effect of font size on reading performance in strabismic amblyopia: an eye movement investigation.

PURPOSE: We investigated the effect of font size on reading speed and ocular motor performance in strabismic amblyopes during text reading under monocular and binocular viewing conditions. METHODS: Eye movements were recorded at 250 Hz using a head-mounted infrared video eye tracker in 15 strabismic amblyopes and 18 age-matched controls while silently reading paragraphs of text at font sizes equivalent to 1.0 to 0.2 logMAR acuity. Reading under monocular viewing with amblyopic eye/nondominant eye and nonamblyopic/dominant eye was compared to binocular viewing. Mean reading speed; number, amplitude, and direction of saccades; and fixation duration were calculated for each font size and viewing condition. RESULTS: Reading speed was significantly slower in amblyopes compared to controls for all font sizes during monocular reading with the amblyopic eye (P = 0.004), but only for smaller font sizes for reading with the nonamblyopic eye (P = 0.045) and binocularly (P = 0.038). The most significant ocular motor change was that strabismic amblyopes made more saccades per line than controls irrespective of font size and viewing conditions (P < 0.05 for all). There was no significant difference in saccadic amplitudes and fixation duration was only significantly longer in strabismic amblyopes when reading smaller fonts with the amblyopic eye viewing. CONCLUSIONS: Ocular motor deficits exist in strabismic amblyopes during reading even when reading speeds are normal and when visual acuity is not a limiting factor; that is, when reading larger font sizes with nonamblyopic eye viewing and binocular viewing. This suggests that these abnormalities are not related to crowding

Pediatric Optical Coherence Tomography in Clinical Practice-Recent Progress

PURPOSE: Optical coherence tomography (OCT) has revolutionized the diagnosis and management of adult retinal and optic nerve disease. Children were deprived of this technology until the recent development of handheld spectral-domain OCT (HH-SDOCT). In this article, we review the applications of OCT imaging in pediatric ophthalmology. METHODS: This study was a review of the literature. RESULTS: The acquisition and interpretation of pediatric tomograms differ significantly from those for adults, with adjustments needed to account for the shorter axial lengths, higher refractive errors, and ongoing retinal and optic nerve development in the pediatric eye. Handheld SDOCT is increasingly being used as an adjunctive diagnostic tool in retinopathy of prematurity (ROP) and nonaccidental injury (NAI) by providing additional morphologic information that is not normally clinically discernible. The role of HH-SDOCT in streamlining diagnosis in infantile nystagmus syndrome, retinal dystrophies, and degenerations has been established. Optical coherence tomography can also help differentiate between pediatric intraocular tumors, for example, hamartomas and retinoblastoma; monitor tumor progression; and monitor treatment response. In addition, HH-SDOCT is establishing its role as a noninvasive monitoring tool in children affected by optic nerve pathology such as glaucoma, optic nerve atrophy and hypoplasia, optic pathway glioma, and pseudotumor cerebri. CONCLUSIONS: Handheld SDOCT can provide novel insights into the natural history of retinal and optic nerve diseases in young children. For example, in achromatopsia and albinism, in vivo OCT studies have provided evidence of altered but ongoing retinal development in early childhood, which suggests that potentially targeting treatment at an earlier age may optimize visual function by normalizing retinal development

Handheld Optical Coherence Tomography in a Young Infant With Albinism and Fovea Plana.

We present handheld optical coherence tomography (OCT) diagnosis of Grade 4 foveal hypoplasia (fovea plana) in a 28-day-old infant with albinism. Grade 4 foveal hypoplasia is characterized by the absence of the foveal pit, absence of outer segment lengthening, and absence of outer nuclear layer widening. Binocular visual acuity at 58 months follow-up was 1.2 logarithm of the minimal angle of resolution (logMAR). We describe our handheld OCT acquisition protocol and compare the morphological features with a healthy, age-matched control subject

Response to spectral-domain optical coherence tomography foveal morphology as a prognostic factor for vision performance in congenital aniridia

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Anterior Chamber Measurements in Healthy Children: A Cross-Sectional Study Using Optical Coherence Tomography

Purpose: To establish anterior chamber measurements in children and investigate the influence of demographic factors on anterior chamber development. Methods: Handheld optical coherence tomography was used to scan the anterior chamber of participants’ eyes, without sedation. Image J was used to generate quantitative anterior chamber measurements, including central corneal thickness (CCT), anterior chamber width, trabecular meshwork length (TML), Schwalbe’s line–angle opening distance (SL-AOD), and trabecular iris surface area (SL-TISA). The average anterior chamber measurements per age group, with 95% prediction intervals, were estimated using fractional polynomial modeling. Mixed regression models were used to evaluate the influence of age, gender, eye, angle, and refractive error variation on anterior chamber measurements. Results: Scans from 223 healthy children (2 days to 15 years of age) and 59 adults (16 to 47 years of age)were included. The anterior chamber width, TML, Schwalbe’s line–angle opening distance, and Schwalbe’s line–trabecular iris surface area significantly increased, whereas CCT decreased with aging (all P 0.05). The temporal TML development was significantly greater than the nasal TML (P < 0.05). CCT development was negatively correlated with refractive power. Conclusions: This novel, non-invasive study describes the postnatal development of anterior chamber in newborn children. Translational Relevance: Our established quantitative measurements have potential clinical use in understanding anterior segment diseases

BCVA data for EUPATCH randomised controlled trial

This is a dataset associated with the publication: "Extended Optical Treatment versus Early Patching with a High-Dose Patching Regimen in Amblyopia: A Multicentre Randomized Controlled Trial",  published by the EUPATCH consortium. Authors: Frank Proudlock, Michael Hisaund, Gail Maconachie, Eleni Papageorgiou, Ali Manouchehrinia, Annegret Dahlmann-Noor, Payal Khandelwal, Jay Self Christina Beisse and Irene Gottlob. The dataset contains best-corrected visual acuity data from amblyopic and fellow eyes at key points in the trial along with demographic data. For furthe information on how to gain access please contact Frank Proudlock ([email protected]), Michael Hisaund ([email protected]) or Irene Gottlob ([email protected])</p

The Development of a Nystagmus Specific Quality of Life Questionnaire

Purpose To develop a nystagmus-specific quality-of-life (QOL) questionnaire derived from patient concerns based on eudaimonic aspects of well-being. Design Cross-sectional study. Participants A total of 206 participants with nystagmus for factor analysis phase and an additional 42 participants with nystagmus for construct validity phase. Methods Questionnaire items were written on the basis of the 6 domains of everyday living affected by nystagmus that were elicited by previous semistructured interviews conducted with 21 people with nystagmus. After consultation with 8 nystagmus experts, 37 items were administered to 206 people with nystagmus. Factor analysis was used to identify latent factors among the items and identify items to propose new nystagmus QOL scales. Cronbach's alpha was used to assess the internal reliability of the new scales. To assess for discriminate and concurrent validity between the new nystagmus scales and an existing vision-related QOL tool, the Visual Function Questionnaire-25 (VFQ-25) was administered to 42 additional participants. Main Outcome Measures Questionnaire response scores on nystagmus-specific QOL items. Results The factor analysis revealed the retention of 29 items to form a measure comprising 2 distinct subscales reflecting “personal and social” and “physical and environmental” functioning as relating to nystagmus-specific QOL. The Cronbach's alpha coefficients for the “personal and social” functioning scale and “physical and environmental” functioning were 0.95 and 0.93, respectively. Tests for validity of the measure, consistent with a priori predictions, when compared with the VFQ-25, revealed the “physical and environmental” subscale showed concurrent validity (0.88), whereas the “personal and social” subscale was demonstrated to have discriminative validity (0.81). Conclusions We have developed a 29-item, nystagmus-specific QOL questionnaire (NYS-29) based on eudaimonic aspects of well-being with subscales that address not only physical functioning but also psycho-social issues. The NYS-29 is grounded in the perspectives and concerns of those who have nystagmus and can be used to determine the impact of nystagmus on daily living in terms of both physical and psychosocial aspects. Abbreviations and Acronyms AS-20, Adult Strabismus 20; EFA, exploratory factor analysis; NYS-29, 29-item, nystagmus-specific quality of life questionnaire; QOL, quality of life; VFQ-25, Visual Function Questionnaire-2