Childhood amblyopia: current management and new trends (original) (raw)
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Amblyopia in children (aged 7 years or less)
BMJ clinical evidence, 2016
Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7-8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years. We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for amblyopia in children aged 7 years or less? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titl...
Detection and treatment of amblyopia in children
Medical review, 2011
Refractive errors are a common cause of decreased visual acuity. They can be found in 2-4% of preschool children. If not discovered on time and not properly treated, they can lead to amblyopia and strabismus. The active participation of parents and paediatricians is of great importance in timely discovering and treatment of amblyopia. The most common causes of amblyopia are strabismus (50.1%) and refractive error (44.7%). The best treatment results are achieved in amblyopic children with strabismus. The cooperation of physicians of all specialties, above all paediatricians and ophthalmologists, as well as a good collaboration of parents based on their being well-informed, must exist in the process of timely diagnosing and treating of amblyopia.
Randomized Trial of Treatment of Amblyopia in Children Aged 7 to 17 Years
2005
Objective: To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years. Methods: At 49 clinical sites, 507 patients with amblyopic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then randomized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (Ն2 lines) by 24 weeks were considered responders.
Objective: To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years. Methods: At 49 clinical sites, 507 patients with ambly-opic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then ran-domized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (2 lines) by 24 weeks were considered responders. Results: In the 7-to 12-year-olds (n = 404), 53% of the treatment group were responders compared with 25% of the optical correction group (P.001). In the 13-to 17-year-olds (n=103), the responder rates were 25% and 23%, respectively, overall (adjusted P=.22) but 47% and 20%, respectively, among patients not previously treated with patching and/or atropine for amblyopia (adjusted P=.03). Most patients, including responders, were left with a residual visual acuity deficit. Conclusions: Amblyopia improves with optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acu-ity when amblyopia has not been previously treated but appears to be of little benefit if amblyopia was previously treated with patching. We do not yet know whether visual acuity improvement will be sustained once treatment is discontinued; therefore, conclusions regarding the long-term benefit of treatment and the development of treatment recommendations for amblyopia in children 7 years and older await the results of a follow-up study we are conducting on the patients who responded to treatment.
Screening for amblyopia in childhood
Reviews, 2004
Background Amblyopia is a reversible deficit of vision that has to be treated within the sensitive period for visual development. Screening programmes have been set up to detect this largely asymptomatic condition and refer children for treatment while an improvement in vision is still possible. The value of such programmes and the optimum protocol for administering them remain controversial. Objectives The objective of this review was to evaluate the effectiveness of vision screening in reducing the prevalence of amblyopia.
Clinical Profile of Amblyopia Patients Between 5-15 Years of Age
BACKGROUND The aim of the study is to-1. Diagnose strabismic, anisometropic and mixed amblyopia in age group 5-15 years. 2. Analyse these patients for age, sex, type of refractive error, type of squint, type of fixation pattern and classify them aetiologically. 3. Study effectiveness of different amblyopia treatments in this age group. MATERIALS AND METHODS Patients in 5-15 years of age in a period of two years were selected and assessed for amblyopia, which included a detailed history, visual acuity, retinoscopy, ocular movements and alignment, slit lamp examination, fundus examination. Patients were given amblyopia treatment and assessed for improvement. Settings and Design-Hospital-based descriptive study in a period of two years. RESULTS In 32 amblyopic patients, maximum patients were of age group between 5-7 years. 53.12% of patients were females. Amblyopia was predominant among anisometropic patients (75%) with maximum of refractive error difference between 2.00 D to 4.00 D. Amongst them, maximum amblyopes were having hypermetropia with astigmatism (37.50%). In the strabismic type, esotropia was more common. Patients showing more than 2 Snellen's line improvements after patching for 2 hrs. were 77.27% and for 6 hrs. were 22.72%. After part-time patching, maximum improvement in BCVA (best corrected visual acuity) was seen in anisometropes (P<0.0001) followed by strabismic (P=0.025) and least with mixed (P=0.026) amblyopes. CONCLUSION Amblyopia is treatable if detected earlier. Lack of community or preschool vision screening was the main cause for late pickup of amblyopic children for timely management and hence significant visual impairment associated with the condition.
The incidence and prevalence of amblyopia detected in childhood
Public health, 1991
We present incidence estimates for amblyopia using data from a study of a cohort of 364 children from a single English county who were referred during 1983 for occlusion therapy. Using a criterion of a visual acuity of 6/12 or worse to define amblyopia, we estimate that 3.0% of the county's children develop the condition. Successful treatment of some of these children means that 1.9% will remain amblyopic as adults.
The Clinical Profile of Moderate Amblyopia in Children Younger Than 7 Years
Archives of Ophthalmology, 2002
To describe the demographic and clinical characteristics of a cohort of children with moderate amblyopia participating in the Amblyopia Treatment Study 1, a randomized trial comparing atropine and patching. Methods: The children enrolled were younger than 7 years and had strabismic, anisometropic, or combined strabismic and anisometropic amblyopia. Visual acuity, measured with a standardized testing protocol using single-surround HOTV optotypes, was 20/40 to 20/100 in the amblyopic eye, with an intereye acuity difference of 3 or more logMAR lines. There were 419 children enrolled, 409 of whom met these criteria and were included in the analyses. The mean age of the 409 children was 5.3 years. The cause of the amblyopia was strabismus in 38%, anisometropia in 37%, and both strabismus and anisometropia in 24%. The mean visual acuity of the amblyopic eyes (ap-proximately 20/60) was similar among the strabismic, anisometropic, and combined groups (P=.24), but visual acuity of the sound eyes was worse in the strabismic group compared with the anisometropic group (PϽ.001). For the patients randomized into the patching group, 43% were initially treated for 6 hours per day, whereas 17% underwent full-time patching. Patients with poorer visual acuity in the amblyopic eye were prescribed more hours of patching than patients with better acuity (P=.003). Conclusions: In the Amblyopia Treatment Study 1, there were nearly equal proportions of patients with strabismic and anisometropic amblyopia. A similar level of visual impairment was found irrespective of the cause of amblyopia. There was considerable variation in treatment practices with regard to the number of hours of initial patching prescribed.
Impact of amblyopia on vision at age 12 years: findings from a population-based study
Eye, 2008
Aims To report prevalence of amblyopia and long-term impact of its treatment on vision in a population-based sample of 12-year-old Australian children. Methods Logarithm of minimum angle of resolution (logMAR) visual acuity (VA) was measured in 2353 children (response rate 75.3%); visual impairment was defined as VAo6/12. Amblyopia was defined using various criteria of best-corrected VA, together with an amblyogenic factor and absence of significant organic pathology. Corroborative historical data on previous diagnosis and treatment were obtained from parental questionnaires. Results Forty-four children (1.9%) were diagnosed with amblyopia, unilateral in 40 and bilateral in four. Isolated anisometropia was the most frequent cause (41%), followed by strabismus (25%), combined anisometropia and strabismus (23%), and high ametropia (9%). Myopia, hyperopia, and astigmatism were present in 28, 51, and 44% of amblyopic children, respectively, compared to 12, 4, and 9% of non-amblyopic children. Mean bestcorrected VA in amblyopic eyes was 44.5 logMAR letters (Snellen equivalent 6/9), range: 11-60 letters. Most children with amblyopia (84%) had been treated. Only 27% were visually impaired in their amblyopic eye. Conclusions This report documents a low amblyopia prevalence in a population of 12year-old Australian children. Amblyopic visual impairment was infrequent in this sample despite absence of mandatory vision screening.
Effect of Age on Response to Amblyopia Treatment in Children
Archives of Ophthalmology, 2011
Objective-To determine whether age at initiation of amblyopia treatment influences the response among children 3 to <13 years of age with unilateral amblyopia 20/40 to 20/400. Methods-A meta-analysis of individual subject data from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol. Age was categorized (3 to <5 years, 5 to <7 years, and 7 to <13 years) because there was a non-linear relationship between age and improvement in amblyopic eye acuity.