Risk factors for treatment failure of anisometropic amblyopia (original) (raw)

2004, Journal of Analytical and Applied Pyrolysis

This study sought to explore factors which might predict the lack of vision improvement following therapy of anisometropic amblyopia. Methods: We retrospectively reviewed the records of 104 children aged 3 to 8 years who had anisometropic amblyopia with a difference in the refractive power between the two eyes of at least 1 diopter, a difference in corrected visual acuity between the two eyes of at least 3 logMAR units, visual acuity in the amblyopic eye of 20/50 or worse, and no ocular structural abnormalities. Patients were treated with either patching or atropine penalization therapy. Patients with strabismus were included. Treatment failure was defined in two ways: (1) functional failure indicating a final visual acuity in the amblyopic eye worse than 20/40 and (2) relative failure indicating less than three lines of logMAR visual acuity improvement regardless of final vision. Results: Failure risk factors were as follows: age above 6 at the onset of treatment (adjusted odds ratio [OR] (95% confidence limits [CL] ϭ 4.69 [1.55, 14.2]), the presence astigmatism of more than 1.50 diopters in the amblyopic eye (adjusted [OR] (95% CL) ϭ 5.78 [1.27, 26.5]), poor compliance with treatment (adjusted [OR] (95% CL) ϭ 5.47 [1.70, 17.6]), and initial visual acuity in the amblyopic eye of 20/200 or worse (adjusted [OR] (95% CL) ϭ 3.79 [1.28, 11.2]). Strabismus was not found to be a significant risk factor. Neither the type or amount of refractive error nor the difference in the refractive power between the two eyes was a significant risk factor for treatment failure. Conclusion: Eyes with poor initial visual acuity, the presence of significant astigmatism, and age over 6 years were less likely to achieve successful outcome. The clinical profile of patients with anisometropic amblyopia may be useful in predicting response to therapy, but compliance with treatment has a major effect on response to therapy. (J AAPOS 2004; 8:429-434) A nisometropia is a common cause of amblyopia. 1,2 Unequal refractive error between the two eyes produces abnormal binocular interaction and/or from visual deprivation, when severe. Knowledge of risk factors for treatment failure could help with early identification of patients who are likely to fail the conventional treatment. More aggressive treatment and closer follow-up might be warranted to help increase the chances of success in children with identifiable failure risk factors. Additionally, early utilization of nonconventional treatment such as refractive surgery might warrant consideration. The aim of this study was to determine and analyze factors identified early in the treatment course that might predict failure of amblyopia therapy in children with anisometropic amblyopia.