The Effect of Amblyopia Therapy on Ocular Alignment

Purpose: We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment. Methods: A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up. Results: At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8Δ), and 105 (29%) had a heterotropia >8Δ. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8Δ. Microtropia at enrollment progressed to a deviation greater than 8Δ with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8Δ at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period. Conclusions: Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases

Retinal nerve fiber layer thickness in amblyopic eyes

To compare the peripapillary retinal nerve fiber layer (RNFL) thickness of amblyopic and fellow eyes. We hypothesized that the RNFL of the amblyopic eye may be thinner. Prospective, cross-sectional, observational case series. Optical coherence tomography of the peripapillary RNFL thickness of amblyopic and fellow eyes was performed in 37 patients 7 to 12 years of age (mean age +/- standard deviation, 9.2 +/- 1.5 years) with unilateral strabismic, anisometropic, or combined-mechanism amblyopia enrolled in a randomized treatment trial. Mean global RNFL thickness of the amblyopic and fellow eyes was 111.4 and 109.6 microm, respectively (mean difference, 1.8 microm thicker in the amblyopic eyes; 95% confidence interval, -0.6 to 4.3 microm). The amblyopic eye was 8 microm or more thicker than the fellow eye in 9 patients (24%); the fellow eye was 8 microm or more thicker than the amblyopic eye in 2 patients (5%); and the difference was within test-retest variability (7 microm) in 26 patients (70%). Our findings do not indicate that peripapillary RNFL thickness is thinner in eyes with moderate amblyopia compared with their fellow eyes

Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial

To compare patching with atropine eyedrops in the treatment of moderate amblyopia (visual acuity, 20/40-20/100) in children aged 7 to 12 years. In a randomized, multicenter clinical trial, 193 children with amblyopia were assigned to receive weekend atropine or patching of the sound eye 2 hours per day. Main Outcome Measure Masked assessment of visual acuity in the amblyopic eye using the electronic Early Treatment Diabetic Retinopathy Study testing protocol at 17 weeks. At 17 weeks, visual acuity had improved from baseline by an average of 7.6 letters in the atropine group and 8.6 letters in the patching group. The mean difference between groups (patching - atropine) adjusted for baseline acuity was 1.2 letters (ends of complementary 1-sided 95% confidence intervals for noninferiority, -0.7, 3.1 letters). This difference met the prespecified definition for equivalence (confidence interval <5 letters). Visual acuity in the amblyopic eye was 20/25 or better in 15 participants in the atropine group (17%) and 20 in the patching group (24%; difference, 7%; 95% confidence interval, -3% to 17%). Treatment with atropine or patching led to similar degrees of improvement among 7- to 12-year-olds with moderate amblyopia. About 1 in 5 achieved visual acuity of 20/25 or better in the amblyopic eye. Atropine and patching achieve similar results among older children with unilateral amblyopia. (clinicaltrials.gov) Identifier: NCT00315328

Visual acuity through Bangerter filters in nonamblyopic eyes

To describe the amount of visual acuity degradation induced by Bangerter filters in the better seeing eye and to evaluate its stability over time in children with moderate amblyopia. Visual acuity with and without a Bangerter filter was measured in the nonamblyopic eye of 186 children with moderate amblyopia who were then treated with either patching or the Bangerter filters. A 0.2 filter was used for amblyopia of 20/80 and a 0.3 filter for amblyopia from 20/40 to 20/63. For the 89 children randomized to Bangerter filters, visual acuity was also measured in the nonamblyopic eye with and without the filters at both 6 weeks and 12 weeks after initiating treatment. Mean degradation in visual acuity of the nonamblyopic eye at baseline was 5.1 logMAR lines with the 0.2 filter and 4.8 logMAR lines with the 0.3 filter. The degradation with each filter did not always agree with the manufacturer's specifications. Over time, the amount of degradation with the filters decreased. The 0.2 and 0.3 Bangerter filters degrade nonamblyopic eye visual acuity sufficiently in amblyopic children. Because the amount of degradation decreases over time, it is recommended to periodically apply a new filter when using this type of amblyopia treatment

Feasibility of a Clinical Trial of Vision Therapy for Treatment of Amblyopia

North elevation of the west pavilion, general view; n 1715-1724 a two-storey palace was built with a central section flanked by two projecting bays; the original architect is unknown, but further construction followed the designs of Le Blond and Niccolò Michetti. Empress Elizabeth (reigned 1741-1762) commissioned Bartolomeo Francesco Rastrelli to enlarge the palace. Between 1745 and 1755 he raised the building to three storeys and added three-storey wings facing the Upper Park, with galleries ending in two domed pavilions. Of the early 18th-century interiors, the Tsar’s study, with oak panelling in Rococo style by Nicolas Pineau, remains unchanged, as does the oak staircase. Rastrelli designed five staterooms and a series of reception-rooms, which were sumptuously decorated with gilded wood-carving, ceilings painted by Bartolomeo Tarsia, Ivan Vishnyakov and others, mirrors, decorative parquet floors, vases and statues. In 1763 the Chinese lobbies were decorated to a design by Jean-Baptiste Vallen de la Motte, with lacquered panels and paintings by A. Perizinotti and the brothers Aleksey Bel’sky (1730-1796) and Ivan Bel’sky (1719-1799). In the second half of the 18th century the state Chesma Hall, Throne Room, White Dining-room and other ceremonial reception-rooms were reworked in a Neo-classical style by Yury Fel’ten and Vallen de la Motte. Source: Grove Art Online; http://www.oxfordartonline.com/ (accessed 6/17/2009

Stereoacuity in children with anisometropic amblyopia

PURPOSE: To determine factors associated with pretreatment and posttreatment stereoacuity in subjects with moderate anisometropic amblyopia. METHODS: Data for subjects enrolled in seven studies conducted by the Pediatric Eye Disease Investigator Group were pooled. The sample included 633 subjects aged 3 to <18 years with anisometropic amblyopia, no heterotropia observed by cover test, and baseline amblyopic eye acuity of 20/100 or better. A subset included 248 subjects who were treated with patching or Bangerter filters and had stereoacuity testing at both the baseline and outcome examinations. Multivariate regression models identified factors associated with baseline stereoacuity and with outcome stereoacuity as measured by the Randot Preschool Stereoacuity test. RESULTS: Better baseline stereoacuity was associated with better baseline amblyopic eye acuity (P < 0.001), less anisometropia (P = 0.03), and anisometropia due to astigmatism alone (P < 0.001). Better outcome stereoacuity was associated with better baseline stereoacuity (P < 0.001) and better amblyopic eye acuity at outcome (P < 0.001). Among 48 subjects whose amblyopic eye visual acuity at outcome was 20/25 or better and within one line of the fellow eye, stereoacuity was worse than that of children with normal vision of the same age. CONCLUSIONS: In children with anisometropic amblyopia of 20/40 to 20/100 inclusive, better posttreatment stereoacuity is associated with better baseline stereoacuity and better posttreatment amblyopic eye acuity. Even if their visual acuity deficit resolves, many children with anisometropic amblyopia have stereoacuity worse than that of nonamblyopic children of the same age

Stereoacuity in children with anisometropic amblyopia

To determine factors associated with pretreatment and posttreatment stereoacuity in subjects with moderate anisometropic amblyopia. Data for subjects enrolled in seven studies conducted by the Pediatric Eye Disease Investigator Group were pooled. The sample included 633 subjects aged 3 to <18 years with anisometropic amblyopia, no heterotropia observed by cover test, and baseline amblyopic eye acuity of 20/100 or better. A subset included 248 subjects who were treated with patching or Bangerter filters and had stereoacuity testing at both the baseline and outcome examinations. Multivariate regression models identified factors associated with baseline stereoacuity and with outcome stereoacuity as measured by the Randot Preschool Stereoacuity test. Better baseline stereoacuity was associated with better baseline amblyopic eye acuity ( P < 0.001), less anisometropia ( P = 0.03), and anisometropia due to astigmatism alone ( P < 0.001). Better outcome stereoacuity was associated with better baseline stereoacuity ( P < 0.001) and better amblyopic eye acuity at outcome ( P < 0.001). Among 48 subjects whose amblyopic eye visual acuity at outcome was 20/25 or better and within one line of the fellow eye, stereoacuity was worse than that of children with normal vision of the same age. In children with anisometropic amblyopia of 20/40 to 20/100 inclusive, better posttreatment stereoacuity is associated with better baseline stereoacuity and better posttreatment amblyopic eye acuity. Even if their visual acuity deficit resolves, many children with anisometropic amblyopia have stereoacuity worse than that of nonamblyopic children of the same age.

A randomized trial comparing part-time patching with observation for children 3 to 10 years of age with intermittent exotropia

To determine the effectiveness of prescribed part-time patching for treatment of intermittent exotropia (IXT) in children. Multicenter, randomized clinical trial. Three hundred fifty-eight children 3 to <11 years of age with previously untreated (except for refractive correction) IXT and near stereoacuity of 400 seconds of arc or better were enrolled. Intermittent exotropia met the following criteria: (1) IXT at distance OR constant exotropia at distance and either IXT or exophoria at near; (2) exodeviation (tropia or phoria) of at least 15 prism diopters (PD) at distance or near by prism and alternate cover test (PACT); and (3) exodeviation of at least 10 PD at distance by PACT. Participants were assigned randomly either to observation (no treatment for 6 months) or to patching for 3 hours daily for 5 months, with a 1-month washout period of no patching before the 6-month primary outcome examination. The primary outcome was deterioration at either the 3-month or the 6-month follow-up visit, defined as: (1) constant exotropia measuring at least 10 PD at distance and near by simultaneous prism and cover test, and/or (2) near stereoacuity decreased by at least 2 octaves from baseline, both assessed by a masked examiner and confirmed by a retest. Participants who were prescribed any nonrandomized treatment without first meeting either deterioration criteria also were counted as having deteriorated. Of the 324 participants (91%) completing the 6-month primary outcome examination, deterioration occurred in 10 of the 165 participants (6.1%) in the observation group (3 of these 10 started treatment without meeting deterioration criteria) and in 1 of the 159 participants (0.6%) in the part-time patching group (difference, 5.4%; lower limit of 1-sided exact 95% confidence interval, 2.0%; P = 0.004, 1-sided hypothesis test). Deterioration of previously untreated childhood IXT over a 6-month period is uncommon with or without patching treatment. Although there is a slightly lower deterioration rate with patching, both management approaches are reasonable for treating children 3 to 10 years of age with IXT