Bilateral phakic hypermetropic epikeratoplasty for accommodative esotropia

Optical correction of high hypermetropia with glasses is the primary treatment for accommodative esotropia. These glasses are often poorly accepted by adolescents and young adults for they are cosmetically undesirable, heavy, and esotropia occurs with their removal. We report an 11 1/2-year-old, physically mature female with high hypermetropia and accommodative esotropia corrected to orthophoria with glasses who was unable to be weaned from her glasses. She became intolerant to glasses wear, refused contact lenses, and was treated successfully with bilateral phakic hypermetropic epikeratoplasty. Two years postepikeratoplasty her visual acuity is 20/40 and 20/20 uncorrected and the vision in the amblyopic right eye has remained at its maximum preoperative level. She is orthophoric at distance and has a 2 prism diopter monofixational esophoria at near without glasses. Epikeratoplasty is an option in the treatment of accommodative esotropia for patients who are past the amblyopia forming age, have a stable angle of strabismus, and who require their full hypermetropic optical correction to maintain orthophoria.     

Treatment outcomes in refractive accommodative esotropia.

PURPOSE: To document and compare the clinical features and functional outcomes in patients with accommodative esotropia. To assess the efficacy of conventional management of accommodative esotropia, to determine functional outcomes of amblyopia and binocular vision, and to analyze possible risk factors involving the development of amblyopia. METHODS: We retrospectively reviewed the charts of 147 patients whose esotropia was corrected to within 10 prism diopters of orthotropia at both distance and near with use of full cycloplegic hyperopic correction. Multiple parameters were reviewed, including initial and final cycloplegic refraction, distance, and near deviation with and without glasses, stereoacuity, age of onset, and initiation of treatment, presence of anisometropia, and change in hyperopia. RESULTS: At presentation, 87 (59.2%) of the 147 patients were amblyopic, and anisometropia was found to be the only statistically significant risk factor for this (P = .001). Only 24.2% of these patients have stereo acuity between 40 and 100 sec/arc, 20.96% of patients have 200 to 800 sec/arc, and 22.58% of patients have 1980 to 3000 sec/arc; the remaining 32.26% had no stereo acuity. Fusion was achieved in 73.5% of the patients and later presentation (> 24 months) of esodeviation significantly determined their fusional ability (P = .031). Consecutive exotropia developed in 5.4 % of the patients an average of 5.5 years after institution of full optical correction. For clinical and functional outcomes we did not find any statistically significant difference between early onset (before 1 year old) and typical onset (2 to 3 years) age groups. The trend towards decreasing hyperopia was apparent, averaging -0.16 +/- 0.20 diopters annually in 80.5% of the patients with at least 5 years follow-up, although 23% of patients still had 20/40 or worse visual acuity in the amblyopic eye. CONCLUSIONS: Amblyopia is a commonly associated finding at presentation for patients with accommodative esotropia. Most of the patients developed good fusion but poor stereopsis at the end of treatment.     

Results of early alignment of congenital esotropia.

OBJECTIVE: To determine the long-term motor and sensory results after early surgical correction of patients with congenital esotropia. DESIGN: Noncomparative interventional case series. PARTICIPANTS: Ten infants with congenital esotropia. INTERVENTION: Patients had bimedial rectus recession between 83 and 159 days of age; were re-examined in a regular follow-up program; and were retreated when required for strabismus, amblyopia, and refractive errors. MAIN OUTCOME MEASURES: Final alignment, stereo acuity, variations in vision, alignment, refraction, and number and types of retreatments required during the period of observation. RESULTS: All patients were aligned initially with bimedial rectus recession of 8.0 to 10.0 mm measured from the limbus. A total of 11 additional surgical procedures were performed on 7 patients to maintain alignment. Four patients required hyperopic spectacle correction to maintain alignment, and two patients required short periods of patching. Visual acuity was 20/40 or better in 19 eyes at the most recent examination, which was between 8.3 and 11.8 years after initial surgery. All patients had final alignment to within 10 prism diopters (PD) of orthotropia at either distance or near. Nine of ten patients had dissociated vertical deviation (DVD), and four of ten patients had latent nystagmus. Four patients had measurable stereo acuity at their last visit, with two achieving a stereo acuity of 3000 seconds (the Titmus fly), one 400 seconds, and one 140 seconds. CONCLUSION: Surgical alignment of congenital esotropia can be achieved in the 4-month-old with bimedial rectus recession, but this does not ensure continued alignment. At least one additional surgical procedure is required on average to maintain alignment in the first 10 years after initial successful surgery. These patients can also be expected to have one or more of the following: DVD, latent nystagmus, refractive component, or latent strabismus. Regardless of outcome, patients with congenital esotropia have optokinetic asymmetry. Attainment of stereo acuity, including high-grade stereo acuity, may be enhanced by attainment of orthotropia or small-angle esotropia but is likely to be ultimately dependent on constitutional factors rather than age of alignment.     

Treatment of bilateral refractive amblyopia in children three to less than 10 years of age

PURPOSE: To determine the amount and time course of binocular visual acuity improvement during treatment of bilateral refractive amblyopia in children three to less than 10 years of age. DESIGN: Prospective, multicenter, noncomparative intervention. METHODS: One hundred and thirteen children (mean age, 5.1 years) with previously untreated bilateral refractive amblyopia were enrolled at 27 community- and university-based sites and were provided with optimal spectacle correction. Bilateral refractive amblyopia was defined as 20/40 to 20/400 best-corrected binocular visual acuity in the presence of 4.00 diopters (D) or more of hypermetropia by spherical equivalent, 2.00 D or more of astigmatism, or both in each eye. Best-corrected binocular and monocular visual acuities were measured at baseline and at five, 13, 26, and 52 weeks. The primary study outcome was binocular acuity at one year. RESULTS: Mean binocular visual acuity improved from 0.50 logarithm of the minimum angle of resolution (logMAR) units (20/63) at baseline to 0.11 logMAR units (20/25) at one year (mean improvement, 3.9 lines; 95% confidence interval [CI], 3.5 to 4.2). Mean improvement at one year for the 84 children with baseline binocular acuity of 20/40 to 20/80 was 3.4 lines (95% CI, 3.2 to 3.7) and for the 16 children with baseline binocular acuity of 20/100 to 20/320 was 6.3 lines (95% CI, 5.1 to 7.5). The cumulative probability of binocular visual acuity of 20/25 or better was 21% at five weeks, 46% at 13 weeks, 59% at 26 weeks, and 74% at 52 weeks. CONCLUSIONS: Treatment of bilateral refractive amblyopia with spectacle correction improves binocular visual acuity in children three to less than 10 years of age, with most improving to 20/25 or better within one year.     

Ametropic amblyopia

Hypermetropia of more than 5 diopters or an astigmatism of 2 diopters or more is often the cause of amblyopia in the master eye, independent of the presence of a simultaneous strabismus or anisometropia. This amblyopia can be prevented with early spectacle correction. In the authors' study of 218 patients with high ametropia a correlation was not always present between visual acuity and the age of the first spectacle correction or the degree of ametropia. In some patients even correction of ametropia as late as seven to ten years of age led to spontaneous functional improvement of single optotypes acuity. The treatment of choice is to give the full ametropic correction at an early age.     

Visual prognosis of amblyopia associated with myelinated retinal nerve fibers

PURPOSE: To investigate the visual prognosis of amblyopia associated with anisomyopia and myelinated nerve fibers. DESIGN: Retrospective noncomparative case series. METHODS: Twelve children with amblyopia associated with anisomyopia and myelinated nerve fibers were treated with spectacle correction after cycloplegic refraction and occlusion therapy for amblyopia. Their visual acuity was measured at each visit to the clinic. The patients were divided into three groups according to their final visual acuity, and statistical analyses were performed to evaluate the differences among these groups in terms of the initial age, spherical equivalent, anisometropia, the area of myelination, final age, and follow-up period. RESULTS: The mean refractive error of the 12 children in spherical equivalents was -8.16 diopters (range -1.50 to approximately -13.00 diopters). The mean age at the initiation of therapy was 4.2 years (range 2.1 to 8.6) and the mean follow-up period was 2.6 years (range 0.5 to 5.1). After the occlusion treatment, visual acuity improved to 20/30 in four patients, and to 20/60 in one patient. In the remaining six patients, visual acuity remained at 20/200 or worse. The amount of anisometropia and the area of myelination were significantly different between the group with a final visual acuity of 20/40 or better and the group with a final visual acuity of worse than 20/200. CONCLUSION: The visual acuity of about one third of the amblyopes with myelinated nerve fibers improved to 20/30. The prognostic factors for the visual improvement were the amount of anisometropia and the area of myelination.     

Use of atropine to predict the accommodative component in esotropia with hypermetropia

This cohort study included children with esotropia and hypermetropia of ≥ +2.0 diopters (D). The deviation was measured at presentation, under atropine cycloplegia and 3 months after full refractive correction. Of 44 children with a mean age of 5.2 ± 2.4 years, 25 were males. Eighteen (41%) had fully refractive accommodative esotropia (RAE), 10 (23%) had partial accommodative esotropia (PAE), and 5 (11%) had nonaccommodative esotropia (NAE). Eleven (25%) had convergence excess (CE). Under cycloplegia, all with RAE and RAE with CE had orthotropia. There was no significant change in the deviation in the patients with NAE. The deviation under cycloplegia and that with full refractive correction in PAE and PAE with CE (with +3.0 D addition) were not different. The intraclass correlation coefficient for deviation under cycloplegia and after full refractive correction (+3.0 D addition for CE) was 0.89. It was concluded that ocular deviation under cycloplegia can help to predict the accommodative component in esotropia with hypermetropia.     

温州市区小学生弱视的筛选及屈光状态分析

目的 研究弱视在小学生中的发病率、屈光状态分布和主要影响因素。方法 在全市视力 小学生中,用列镜筛选,再用扩瞳检影验光进行屈光测定,选择矫正视力≤４．９;眼科检查无器质性病变的弱视患者,分别检查注视性质,眼位、单视功能及询问填写调查表。并分别作统计学处理。结果 在受检６３６００眼中,确诊弱视１２０５人,２２６６只眼,患病为３．７８％;以屈光不正弱视为主,其中远视性弱视最高。弱视程度与屈光度、注视性     

Refraction as a basis for screening children for squint and amblyopia.

+2-00 to +2-75 dioptres of spherical hypermetropia in the more emmetropic of a pair of eyes is significantly associated with esotropia (P less than 0-001) and the presence of amblyopia (P less than 0-01). Anisometropia is not significantly associated with esotropia (P = 0-31) unless there is spherical hypermetropia of +2-00 dioptres or more in the more emmetropic eye (P less than 0-001). Hypermetropic anisometropia of +1-00 DS or +1-00 D.Cyl. is associated with the presence of amblyopia (P less than 0-001). In the absence of esotropia there is also a significant association between the amount of anisometropia and the initial depth of amblyopia (P less than 0-01). The additional presence of esotropia increases the depth of amblyopia further (P less than 0-05) but not the incidence of amblyopia (P greater than 0-30). The level of significance of the association of refractive errors with squint/amblyopia was itself significantly higher (P less than 0-01) than that between a family history of squint or "lazy eye" on the one hand and squint and/or amblyopia on the other hand. 72 +/- 3% of all cases of esotropia and/or amblyopia in this sample of children had a refractive error of +2-00 DS or more spherical hypermetropia in the more emmetropic eye, or +1-00 D. or more spherical or cylindrical anisometropia. Since there is a close association between the refraction and how, when, and whether a child presents with squint and/or amblyopia, it would seem reasonable to reconsider refraction as a basis for screening young children for visual defects.     

Visual acuity outcome in isometropic hyperopia

Refractive amblyopia may occur as a unilateral or bilateral condition. Although bilateral refractive amblyopia may account for 1 to 2% of all refractive amblyopia, there is little consistent information in the literature regarding isoametropic amblyopia resulting from bilateral hyperopia. Hence, this retrospective study investigated the prevalence of reduced aided acuity in patients aged 10 years and younger (mean age 3.97 years) with 5 D or more of isometropic hyperopia and considered the following factors that may influence visual acuity: (1) age at first correction; (2) magnitude of hyperopia; and (3) duration of refractive correction of the hyperopia. The results indicate that the majority of patients (87%) have aided acuity poorer than 6/6 at initial correction of refractive error. However, if the full hyperopic correction was worn for 1 year or longer, only 43% of these patients demonstrated acuity poorer than 6/6 and none showed acuity poorer than 6/12. The magnitude of the hyperopia appeared to have the greatest influence on the visual acuity outcome both at initial correction of refractive error and 1 year or longer after correction. Duration of correction also influenced the visual acuity outcome, but to a lesser extent than the magnitude of refractive error. In contrast, the age of first correction showed little correlation with visual acuity either at the time of first refractive correction or after a minimum of 1 year of correction.     

【In Press】 Clinical features of strabismus and nystagmus in bilateral congenital cataracts

AIM: To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS: This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS: Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION: Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation were lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus was associated with poor visual prognosis.     

Clinical features of strabismus and nystagmus in bilateral congenital cataracts

AIM: To evaluate the prevalence, clinical features, and the factors affecting onset of strabismus and nystagmus in patients with bilateral congenital cataracts. METHODS: This study evaluated 116 eyes of 58 patients who underwent lens removal for the treatment of bilateral congenital cataracts between January 1999 and January 2011. The presence and type of strabismus and nystagmus were determined before and after surgery. Type of strabismus and final visual acuity were compared in patients with and without nystagmus. Patients were divided into three groups (orthotropia/orthotropia, orthotropia/strabismus, and strabismus/strabismus) according to their preoperative and postoperative ocular alignment. Age at cataract surgery and associations of nystagmus and primary intraocular lens (IOL) implantation with strabismus were analyzed. RESULTS: Six patients (10.3%) had strabismus preoperatively and an additional 11 (19.0%) developed postoperative strabismus. Exotropia was more common than esotropia both preoperatively and postoperatively. Eighteen patients (31.0%) had postoperative nystagmus, with sensory nystagmus being the most common type. Of the 18 patients with nystagmus, 10 had strabismus, with exotropia being more common than esotropia. Postoperative visual acuity was poor in patients with nystagmus. Age at cataract surgery and rate of primary IOL implantation were significantly lower, and postoperative nystagmus was more common, in the orthotropia/strabismus group than in the other two groups. CONCLUSION: Exotropia and sensory nystagmus are common in patients with bilateral congenital cataracts. Age at cataract surgery and rate of IOL implantation are lower and nystagmus more common in patients with postoperative onset of strabismus. Nystagmus is associated with poor visual prognosis.     

Strabismus and amblyopia in bilateral Peters anomaly.

BACKGROUND: Peters anomaly is a rare form of anterior segment dysgenesis in which abnormal cleavage of the anterior chamber occurs at the end of the third week of gestation. We examined the prevalence of strabismus and amblyopia and analyzed predictive factors for their development, as well as the visual outcome and associated anomalies in patients with bilateral Peters anomaly. METHODS: Using a retrospective review, we identified 25 consecutive patients with bilateral Peters anomaly who were observed between August 1995 and February 2005. Ocular structural and systemic anomalies, amblyopia therapy, visual acuity, and binocular alignment at last visit were recorded. Fisher's exact test was used to identify any association between defined predictive factors and the development of strabismus. RESULTS: Mean follow-up time was 5.1 year (range, 0.5-21 years). Median age at presentation was 2.5 months (range, 1 day to 13 years). Penetrating keratoplasties were performed on 34 eyes in 20 patients. Final best-corrected visual acuity ranged from 20/25 to no light perception. Thirteen of 18 patients with recorded motility (72%) developed strabismus: esotropia (n = 7), exotropia (n = 5), and variable (n = 1); one also had dissociated vertical deviation. Patients with equal vision were either orthophoric (n = 4) or had intermittent esotropia (n = 1), whereas strabismus occurred in 100% of patients whose vision was asymmetric by more than 1.5 octaves. Asymmetric vision was the only statistically significant predictive factor for the development of strabismus (P = 0.002). Amblyopia treatment resulted in improved vision in 3 of 5 patients. CONCLUSION: Strabismus occurs frequently in bilateral Peters anomaly. Asymmetric vision, (because of ocular structural anomalies) postoperative complications, and amblyopia may predispose to strabismus. Despite ocular structural limitations, amblyopia therapy is recommended in the aggressive rehabilitation of these eyes.     

Amblyopia characterization, treatment, and prophylaxis

Amblyopia has a 1.6-3.6% prevalence, higher in the medically underserved. It is more complex than simply visual acuity loss and the better eye has sub-clinical deficits. Functional limitations appear more extensive and loss of vision in the better eye of amblyopes more prevalent than previously thought. Amblyopia screening and treatment are efficacious, but cost-effectiveness concerns remain. Refractive correction alone may successfully treat anisometropic amblyopia and it, minimal occlusion, and/or catecholamine treatment can provide initial vision improvement that may improve compliance with subsequent long-duration treatment. Atropine penalization appears as effective as occlusion for moderate amblyopia, with limited-day penalization as effective as full-time. Cytidin-5'-diphosphocholine may hold promise as a medical treatment. Interpretation of much of the amblyopia literature is made difficult by: inaccurate visual acuity measurement at initial visit, lack of adequate refractive correction prior to and during treatment, and lack of long-term follow-up results. Successful treatment can be achieved in at most 63-83% of patients. Treatment outcome is a function of initial visual acuity and type of amblyopia, and a reciprocal product of treatment efficacy, duration, and compliance. Age at treatment onset is not predictive of outcome in many studies but detection under versus over 2-3 years of age may be. Multiple screenings prior to that age, and prompt treatment, reduce prevalence. Would a single early cycloplegic photoscreening be as, or more, successful at detection or prediction than the multiple screenings, and more cost-effective? Penalization and occlusion have minimal incidence of reverse amblyopia and/or side-effects, no significant influence on emmetropization, and no consistent effect on sign or size of post-treatment changes in strabismic deviation. There may be a physiologic basis for better age-indifferent outcome than tapped by current treatment methodologies. Infant refractive correction substantially reduces accommodative esotropia and amblyopia incidence without interference with emmetropization. Compensatory prism, alone or post-operatively, and/or minus lens treatment, and/or wide-field fusional amplitude training, may reduce risk of early onset esotropia. Multivariate screening using continuous-scale measurements may be more effective than traditional single-test dichotomous pass/fail measures. Pigmentation may be one parameter because Caucasians are at higher risk for esotropia than non-whites.     

Functional differences between free alternators and non-alternators successfully treated for strabismic amblyopia

Visual acuity was examined in patients successfully treated for strabismic amblyopia, and with equal refractive error in the two eyes (no more of 4 diopters of hyperopia). Patients able to freely alternate fixation showed equal visual acuity in the two eyes without optical correction. An optical correction in front of the ex-amblyopic eye was needed, in order to achieve equal visual acuity in patients unable to freely alternate fixation. No correction was necessary for the sound eye. This difference is attributed to a residual anomaly of accomodation of the ex-amblyopic eye. It is concluded that the concept of cure of strabismic amblyopia based on the attainment of equal visual acuity needs re-evaluation.     

Costs and methods of preventive visual screening and the relation between esotropia and increasing hypermetropia

Atkinson has shown that early correction of hypermetropia reduces the incidence of esotropia. If esotropia is reduced by prescribing glasses early, the rate of esotropia-induced amblyopia can be similarly reduced; this would have important economic consequences. We have studied (1) how costs compare to benefits in early visual screening, (2) how videorefraction as used by Atkinson compares to retinoscopy, and (3) whether esotropia is more likely to occur in children who have increasing as opposed to decreasing hypermetropia. The costs of the study so far have been high. It was exceedingly difficult to get all infants invited, come to the clinic and examined. Videorefraction did not compare favourably with retinoscopy in terms of costs and precision, whereas the amount of skill and time needed was approximately equal. The third question, whether esotropia is more likely to occur in children who have increasing as opposed to decreasing hypermetropia, arose from the controversy whether, in the general population, refraction increases or decreases during the first years of life. We found that papers reporting a decrease of hypermetropia in early childhood were studies of large cross-sections of the general population, whereas papers that reported an initial increase originated from ophthalmological practices or strabismus departments. These conflicting results could be reconciled by assuming a population bias: if esotropia is more likely to occur in children with increasing hypermetropia, children with increasing hypermetropia will preferentially be seen by ophthalmologists. It seems natural that children with increasing hypermetropia are more likely to squint, because additional accommodation, needed to overcome increasing hypermetropia, will inevitably confer additional convergence. This relationship has meanwhile been confirmed by others.     

Efficacy of amblyopia therapy initiated after 9 years of age

AIMS/PURPOSE: To evaluate the efficacy of occlusion therapy initiated after 9 years of age. METHODS: A total of 16 amblyopes of 9 years or older (range, 9.0-14.5 years; mean, 10.5 years) with a difference in visual acuity of over two lines between the eyes alter 4 weeks of first full-time spectacle wear were included. None of the children had undergone a previous ocular examination, had ever worn spectacles, received occlusion therapy, or had strabismus surgery. Initial worst visual acuity after 4 weeks of full-time spectacle wear was 20/100 in three patients, between 20/80 and 20/40 in 11 patients, and 20/30 in two patients. Full-time occlusion was performed in 14 patients and part-time occlusion in two patients. RESULTS: The final visual acuity of 15 out of 16 patients (94%) improved at least two lines. The final visual acuities ranged from 20/30 to 20/20 in 14 patients, 20/40 in one patient, and 20/50 in one remaining patient who began amblyopia therapy at 14.5 years of age, with the poorest compliance among the patients. CONCLUSIONS: Occlusion therapy for anisometropic and strabismic amblyopia can be successful even if initiated after the age of 9 years.     

Successful treatment of anisometropic amblyopia with spectacles alone.

BACKGROUND: The efficacy of treating anisometropic amblyopia with occlusion therapy is well known. However, this form of treatment can be associated with risks. Spectacle correction alone may be a successful and underutilized form of treatment. METHODS: The records of 28 patients treated successfully for anisometropic amblyopia with glasses alone were reviewed. Age, initial visual acuity and stereoacuity, and nature of anisometropia were analyzed to assess associations with time required for resolution, final visual acuity, and stereoacuity. Incidence of amblyopia recurrence and results of subsequent treatment, including patching, were also studied. RESULTS: Mean time to amblyopia resolution (interocular acuity difference 相似文献   

Laser in situ keratomileusis for myopic anisometropia in children.

PURPOSE: To evaluate the visual and refractive results of laser in situ keratomileusis (LASIK) in pediatric patients with myopic anisometropia and amblyopia, and to assess the predictability, safety, and efficacy of the procedure in children. METHODS: Fourteen patients aged 7 to 12 years with myopic anisometropia and amblyopia had LASIK in the more myopic eye (14 eyes) using the Chiron Automatic Corneal Shaper and the Chiron-Technolas Keracor 116 excimer laser. Preoperative spherical equivalent manifest refraction ranged from -4.62 to -12.50 D (mean, -7.87 D) and spectacle-corrected visual acuity ranged from 20/40 to 20/100 (median, 20/50). All patients completed a minimum follow-up of 12 months. RESULTS: One year after LASIK, spherical equivalent manifest refraction ranged from 0 to -1.50 D (mean, -0.55 D). Spectacle-corrected visual acuity improved in all eyes (range, 20/20 to 20/40; median, 20/25). Six eyes (42.9%) had a postoperative spectacle-corrected visual acuity of 20/20. Uncorrected visual acuity was 20/40 or better in 10 eyes (71.4%) (range, 20/20 to 20/70; median, 20/30). Uncorrected visual acuity exceeded preoperative spectacle-corrected visual acuity in all eyes by an average of 2 lines. There were no significant complications. CONCLUSION: LASIK was effective for correction of myopic anisometropia in this small group of children and reversed refractive amblyopia. LASIK in these children was safe, predictable, and provided good visual results.     

Results of a randomised trial of treating abnormal hypermetropia from the age of 6 months.

Children who were abnormally hypermetropic at the age of 6 months were randomly allocated treatment with spectacles or no treatment. The eventual incidence of squint was the same in both groups (approximately 24%). The last known visual acuity of the two groups was not significantly different either. Therefore there is no indication to screen infants with a view to preventing squint/amblyopia by optical correction of hypermetropia. If, however, the children allocated treatment are divided into two subgroups--those who wore glasses consistently and those who probably or certainly did not do so--the incidence of squint was the same, but the last known acuities of those who consistently wore glasses may be better than those who did not do so. This suggests that it may yet prove possible to prevent severe amblyopia.