Impact of amblyopia on vision at age 12 years: findings from a population-based study

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 VA<6/12. 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 best-corrected 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 12-year-old Australian children. Amblyopic visual impairment was infrequent in this sample despite absence of mandatory vision screening.     

Long term visual outcome in amblyopia treatment

AIM: To evaluate long term visual outcome of treatment for amblyopia. METHODS: In a previous study, 44 children with unilateral amblyopia caused by strabismus or anisometropia were enrolled in a prospective study investigating the results of treatment. All children were regularly examined up to at least 8 years of age and outcome was evaluated. All subjects were invited to a re-examination and in total 26 subjects attended. Two of these were excluded because of insufficient records. The final sample consists of 24 subjects. Mean follow up time was 10.4 (SD 1.9) years. RESULTS: For the amblyopic eyes, 17% deteriorated in visual acuity, 50% were stable, and 33% gained in visual acuity. For the non-amblyopic eyes, 8% lost one line in visual acuity, 38% were stable, and 54% gained in visual acuity. No eye in any subject shifted more than 0.2 logMAR units. The increase in visual acuity for the non-amblyopic eyes was significant, while the increase for the amblyopic eyes was not. All straight eyed anisometropic amblyopes showed a distinct decrease in magnitude of anisometropia. CONCLUSIONS: Visual acuity was essentially stable in the amblyopic eyes 10 years after cessation of treatment in the studied population.     

The Prevalence of Anisometropia,Amblyopia and Strabismus in Schoolchildren of Shiraz,Iran

Purpose: To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.

Materials and Methods: A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.

Results: Mean age of 2638 schoolchildren was 12.5 years (response rate?=?86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p?=?0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.

Conclusions: Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.     

Refractive adaptation in amblyopia: quantification of effect and implications for practice

AIM: To describe the visual response to spectacle correction ("refractive adaptation") for children with unilateral amblyopia as a function of age, type of amblyopia, and category of refractive error. METHOD: Measurement of corrected amblyopic and fellow eye logMAR visual acuity in newly diagnosed children. Measurements repeated at 6 weekly intervals for a total 18 weeks. RESULTS: Data were collected from 65 children of mean (SD) age 5.1 (1.4) years with previously untreated amblyopia and significant refractive error. Amblyopia was associated with anisometropia in 18 (5.5 (1.4) years), strabismus in 16 (4.2 (0.98) years), and mixed in 31 (5.2 (1.5) years) of the study participants. Mean (SD) corrected visual acuity of amblyopic eyes improved significantly (p<0.001) from 0.67 (0.38) to 0.43 (0.37) logMAR: a mean improvement of 0.24 (0.18), range 0.0-0.6 log units. Change in logMAR visual acuity did not significantly differ as a function of amblyopia type (p = 0.29) (anisometropia 0.22 (0.13); mixed 0.18 (0.14); strabismic 0.30 (0.24)) or for age (p = 0.38) ("under 4 years" 0.23 (0.18); "4-6 years" 0.24 (0.20); "over 6 years" 0.16 (0.23)). CONCLUSION: Refractive adaptation is a distinct component of amblyopia treatment. To appropriately evaluate mainstream therapies such as occlusion and penalisation, the beneficial effects of refractive adaptation need to be fully differentiated. A consequence for clinical practice is that children may start occlusion with improved visual acuity, possibly enhancing compliance, and in some cases unnecessary patching will be avoided.     

Visual deficits in anisometropia

Amblyopia is usually associated with the presence of anisometropia, strabismus or both early in life. We set out to explore quantitative relationships between the degree of anisometropia and the loss of visual function, and to examine how the presence of strabismus affects visual function in observers with anisometropia. We measured optotype acuity, Pelli-Robson contrast sensitivity and stereoacuity in 84 persons with anisometropia and compared their results with those of 27 persons with high bilateral refractive error (isoametropia) and 101 persons with both strabismus and anisometropia. All subjects participated in a large-scale study of amblyopia (McKee et al., 2003). We found no consistent visual abnormalities in the strong eye, and therefore report only on vision in the weaker, defined as the eye with lower acuity. LogMAR acuity falls off markedly with increasing anisometropia in non-strabismic anisometropes, while contrast sensitivity is much less affected. Acuity degrades rapidly with increases in both hyperopic and myopic anisometropia, but the risk of amblyopia is about twice as great in hyperopic than myopic anisometropes of comparable refractive imbalance. For a given degree of refractive imbalance, strabismic anisometropes perform considerably worse than anisometropes without strabismus - visual acuity for strabismics was on average 2.5 times worse than for non-strabismics with similar anisometropia. For observers with equal refractive error in the two eyes there is very little change in acuity or sensitivity with increasing (bilateral) refractive error except for one extreme individual (bilaterally refractive error of -15 D). Most pure anisometropes with interocular differences less than 4 D retain some stereopsis, and the degree is correlated with the acuity of the weak eye. We conclude that even modest interocular differences in refractive error can influence visual function.     

Relationship between anisometropia, patient age, and the development of amblyopia

PURPOSE: Previous studies evaluating the effect of anisometropia on amblyopia development have been biased because subject selection occurred as a result of decreased acuity. Photoscreening identifies anisometropic children in a manner that is not biased by acuity, and allows an opportunity to evaluate how patient age influences the prevalence and depth of amblyopia. DESIGN: Retrospective observational study of preschool children with anisometropia. METHODS: A statewide preschool photoscreening program screened 119,311 children and identified 792 with anisometropia >1.0 diopters. We correlated age with visual acuity and amblyopia depth. Results were compared with 562 strabismic children similarly identified. RESULTS: Only 14% (six of 44) of anisometropic children aged 1 year or younger had amblyopia. Amblyopia was detected in 40% (32 of 80) of 2-year-olds, 65% (119 of 182) of 3-year-olds, and 76% of 5-year-olds. Amblyopia depth also increased with age. Moderate amblyopia prevalence was 2% (ages 0 to 1), 17% (age 2), and rose steadily to 45% (ages 6 to 7). Severe amblyopia was rare for children aged 0 to 3, 9% at age 4, and 14% at age 5. Children with strabismus had a relatively stable prevalence (30% ages 0 to 2; 42% ages 3 to 4; and 44% ages 5 to 7) and depth of amblyopia. CONCLUSIONS: Younger children with anisometropia have a lower prevalence and depth of amblyopia than older children. By age 3, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding or even preventing the development of amblyopia.     

儿童弱视治疗研究进展

弱视是视觉发育期内由于异常视觉经验(单眼斜视、屈光参差、高度屈光不正以及形觉剥夺)引起的单眼或双眼最佳矫正视力下降,眼部检查无器质性病变。儿童弱视治疗一直是眼科的热点研究问题,近些年来弱视治疗的研究有所进展且应用的方法多种多样,但是根据不同类型、程度,弱视的最佳治疗方案还在研究进行中。我们参考近年来国内外关于儿童弱视治疗的文献,对目前最新儿童弱视治疗方法以及其中存在的问题进行综述。     

Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Purpose:

To investigate ambylopia and amblyopia risk factors of children who underwent nasolacrimal duct (NLD) irrigation and probing for congenital nasolacrimal duct obstruction (CNLDO).

Materials and Methods:

The medical records of patients who had undergone NLD irrigation and probing for CNLDO at an age of 3 years or younger were reviewed, and 51 of the patients were recalled between October 1 and December 31, 2011 for a detailed ophthalmic examination to determinate amblyopia or amblyopia risk factors. Amblyopia was accepted as difference in visual acuity of two or more Snellen lines between the two eyes or visual acuity of 20/30 or worse in either eye.

Results:

The median age of the 51 patients to whom NLD irrigation and probing were attempted for CNLDO was 23 months. CNLDO affected a total of 70 eyes. All patients were reviewed for best-corrected visual acuity, refractive errors, and strabismus at a median age of 70.5 months (range 31-95 months). Amblyopia or amblyopia risk factors were identified in 14 patients (27.5%). One child (7.15%) had only strabismus, six children (42.8%) had only amblyogenic refractive errors, two (14.3%) had a combination of two, one child (7.15%) had a family history for amblyopia, but four children (28.6%) had no amblyopia risk factors but had amblyopia.

Conclusion:

Amblyogenic risk factors are found higher in patients with CNLDO and patients undergoing NLD irrigation and probing in comparison to normal population. Therefore, we recommend these children to routinely undergo cycloplegic refractions and full ophthalmic examinations.     

Amblyopia in myopia in patients with strabismus and without strabismus

PURPOSE: To determine factors, which have influence on presence of strabismus among myopic patients with amblyopia. MATERIAL AND METHODS: Material covers 21 myopic patients with amblyopia, aged 6-15. All children presented have a different amount of anisometropia, 12 of them had strabismus. Authors, compared the group of patients with amblyopia and strabismus (12) with the group of patients with pure anisometropic amblyopia (9), according to the following criteria: age of presentation, best corrected visual acuity, mean refraction error of amblyopic eye, mean amount of anisometropia, percentage of patients with central fixation and binocular vision. RESULTS: Patients with strabismus presented oneself earlier than patients without squint. Best corrected visual acuity was better in patients without strabismus. Refraction error in both groups has similar value. Amount of anisometropia was slightly smaller in the group with squint. Central fixation and binocular vision were better preserved among patients without strabismus. Authors didn't find the following correlations too: correlation between amount of anisometropia and amount of amblyopia in both groups, correlation between amount of anisometropia and the amount of the deviation of squinting eye, correlation between depth of amblyopia and the amount of deviation of the squinting eye. CONCLUSION: It seems, that primary factor leading to presence of strabismus among patients with anisometropic myopia, is motor dysfunction of extraocular muscles.     

Cumulative Table of Contents

AIM: To investigate the frequency of stimulus deprivation amblyopia (SDA) in comparison with other reasons for amblyopia in human congenital ptosis. METHODS: The frequency and causes of amblyopia were evaluated in the 200 eyes of 100 patients. Congenital ptosis was present in 128 eyes (72 unilateral, 28 bilateral). The age at investigation was one year and older, with an average of 11 years and 10 months. Amblyopia was defined as best corrected visual acuity less than 1.0 or a difference between the two eyes of at least 0.2. The following causes of amblyopia were identified: amblyopiogenic refractive errors: astigmatism = 1 dpt, anisometropia = 1 dpt (79% cycloplegia) and strabismus. In cases with no other reasons for amblyopia, SDA was assumed. Statistical analysis was performed using the chi-square and the sign tests. RESULTS: The overall incidence of amblyopia in ptotic eyes was 89/128 (70%). In 3.9% of the cases (5/128; 2 eyes with unilateral and 3 eyes with bilateral ptosis) we assumed SDA. A comparison of ptotic eyes with (unilateral: n=35, bilateral: n= 34) and without covered optical axis revealed the following: in the case of unilateral ptosis, amblyopia was found more often in ptotic eyes with covered optical axis: 30 out of 35 vs. 24 out of 37 (p=0.06); in the case of bilateral ptosis this difference was significant: 27 out of 34 vs. 8 out of 22 (p&;lt;0.05). In the case of SDA, the optical axis was covered in only a single eye, in a patient with bilateral ptosis. There was no difference in the incidence of anisometropia: 19 out of 53 vs. 14 out of 47 (p=0.52). Astigmatism was found more frequently in ptotic eyes with covered optical axis in unilateral ptosis: 23 out of 35 vs. 16 out of 37 (p=0.06) but not in bilateral ptosis: 21 out of 34 vs. 13 out of 22 (p&;gt;0.9). Strabismus was found significantly more frequently in ptotic eyes with covered optical axis: 13 out of 35 vs. 4 out of 37 (p&;lt;0.05) in unilateral ptosis and 7 out of 34 vs. 1 out of 22 (p=0.13) in bilateral ptosis. CONCLUSION: In contrast to the classical animal models of stimulus deprivation amblyopia, this entity is rare in human congenital ptosis, perhaps because of the countereffect of compensating head posture. Disruption of fusion resulting in strabismus might be an additional indirect cause of amblyopia in congenital ptosis. Prophylactic amblyopia treatment in ptosis cases is important as long as no testing of visual acuity is possible in a child.     

屈光参差性弱视与斜视性弱视临床疗效的比较

目的:分析比较屈光参差性与斜视性弱视的治疗效果。方法:前瞻性研究。2018-07/2020-01在我院门诊确诊的并首次接受治疗的单眼弱视患者46例,平均年龄9±3岁,其中男26例,女20例,按照临床诊断分为斜视性弱视组(无屈光不正),共23例,平均年龄9±3岁,其中男12例,女11例。以及屈光参差性弱视组,共23例,平均年龄9±3岁,其中男14例,女9例。对两组患者采用遮盖及精细训练治疗弱视,于治疗前及治疗后采用国际标准视力表检测视力、用Titmus图谱行立体视锐度的检测。比较两组患者经弱视治疗前后最佳矫正视力及立体视恢复的差异。结果:治疗前两组患者弱视眼的最佳矫正视力无差异(t=-0.475,P>0.05),但斜视性弱视患者的立体视功能明显低于屈光参差性弱视患者(t=-3.919,P<0.001);通过2mo的治疗,两组患者最佳矫正视力提高值有明显差异(t=-2.946,P<0.01),而两组患者立体视提高值无差异(t=1.305,P>0.05);通过6mo的治疗,两组患者最佳矫正视力提高差值有明显差异(t=-2.353,P<0.05),两组患者立体视提...     

Evaluation of relationship of ocular parameters and depth of anisometropic amblyopia with the degree of anisometropia

PURPOSE: (1) To find out the relationship of the depth of amblyopia with the degree of anisometropia, in untreated cases of anisometropic amblyopia without strabismus, for both myopic and hypermetropic individuals. (2) To find out the relationship between various ocular parameters, such as axial length and corneal curvature, with the degree of anisometropia between the two eyes. MATERIALS AND METHODS: This prospective study was conducted between January 2001 and March 2003, in 85 cases of untreated anisometropic amblyopia, who attended the author's out patient department. All these patients were subjected to a meticulous ocular examination, with special emphasis on (1) refraction under cycloplegia (2) best corrected visual acuity (3) measurement of axial length by A Scan (4) keratometry . The depth of amblyopia was calculated in two ways: (1) By finding out decimal visual acuity for each eye and subsequently calculating their difference. (2) By converting the Snellen acuity into Log MAR units, which was calculated by finding the Logarithm of the reciprocal of the decimal visual acuity for the two eyes, followed by calculating the difference between the two. The difference in refraction between the two eyes as a measure of anisometropia, was determined by the difference in spherical equivalent between the refraction for each eye. RESULTS: On comparing hypermetropic and myopic cases, a significant correlation was found between depth of amblyopia and the degree of anisometropia, in both myopic and hypermetropic patients. The correlation coefficients were however, found to be greater for hypermetropic than myopic individuals. It was observed that the difference between the axial length of the two eyes contributed to a major part of anisometropia, more so in myopic cases. CONCLUSIONS: The depth of amblyopia correlates with the degree of anisometropia in previously untreated anisometropic amblyopia patients.     

Anisometropic amblyopia treated with spectacle correction alone: possible factors predicting success and time to start patching

PURPOSE: To evaluate factors predicting resolution of amblyopia and the time course of improvement in VA in children 3 to 7 years old with anisometropic amblyopia treated with spectacles alone. DESIGN: Prospective, noncomparative intervention. METHODS: Measurement of corrected amblyopic logMAR visual acuity (VA) in newly diagnosed children at four-weekly intervals until VA stabilized or amblyopia resolved. The time course of improvement in VA and the factors related to amblyopia resolution were assessed. RESULTS: Sixty children with a mean age of 5.3 years and mean anisometropia of 2.95 diopters (D) were included. Amblyopia improved by 2 or more logMAR lines in 56 patients (93%) and resolved in 27 patients (45%), with a mean improvement in VA of 0.38 logMAR. The improvement in VA in the amblyopic eye was considerable at four to 12 weeks then reached a plateau, after which it improved only slowly. Resolution of amblyopia was related to better initial VA (0.2 to 0.6 logMAR) and lesser amounts of anisometropia (<4 D). The time to resolution ranged from four to 40 weeks, but no patient with residual amblyopia showed an improvement in VA of more than 0.1 logMAR over four consecutive visits. CONCLUSIONS: With spectacle correction alone, 3- to 7-year-old children with previously untreated anisometropic amblyopia achieved approximately four-line improvement and resolved nearly in half. The nearly two-month plateau periods during improvement of VA should be noticed. After four months with no improvement in VA, occlusion therapy or atropine penalization may be considered.     

Prevalence and outcomes of childhood visual disorders

PURPOSE: This population-based study examines the prevalence of childhood visual disorders: amblyopia (strabismus, refractive errors) and organic disease. It also assesses treatment outcomes, visual impairment and residual amblyopia. METHODS: 1582 children were retrospectively analysed on treatment completion (age 8-9 years). Significant visual disorders included: esotropia, exotropia, anisometropia (hyperopia > or = 1.50DS, astigmatism > or = 1.00DC, myopia > or = 1.50DS), ametropia (hyperopia > or = 1.50DS, astigmatism > or = 1.0DC, myopia > or = 0.75DS) and organic defects. RESULTS: 198 children (12.5%) had a significant visual disorder: strabismus (3.98%), eso:exo rate 5:1, anisometropia (2.34%), ametropia (5.82%), organic defects (0.38%). Organic disease caused visual handicap (< 6/18 in better eye) in 0.13%. Amblyopic visual impairment (6/18; 6/24-6/60) occurred in 1.13%; 2.02% had residual amblyopia (6/12 or worse). CONCLUSIONS: Childhood visual disorders are a common problem. Unfavourable visual outcomes in esotropia are related to two sub-groups and particularly with poor concordance to treatment. Suggested strategies to improve outcomes include health promotion, an "Amblyopia Nurse" and a "Patch Club".     

Stereoacuity and ocular associations at age 12 years: findings from a population-based study.

PURPOSE: To report the distribution of stereoacuity thresholds and ocular characteristics associated with reduced stereoacuity in a representative sample of 12-year-old Australian children. METHODS: Stereoacuity thresholds were determined using the three quantitative plates of the TNO test in 2343 children, either unaided or with spectacles, if worn. Logarithm of minimum angle of resolution (logMAR) visual acuity was measured. Cycloplegic autorefraction (using cyclopentolate), cover testing, and dilated fundus examination were performed. Reduced stereoacuity was defined as > 120 arcsec. Myopia was defined as spherical equivalent refraction (SER) < or = -0.50 D hyperopia as spherical equivalent refraction > or = +2.0 D, anisometropia as spherical equivalent refraction difference between eyes > or =1.00 D, and astigmatism as cylinder > or = 1.0 D. RESULTS: Stereoacuity was based on unaided visual acuity in 1975 children (84.3%) and on spectacle-corrected visual acuity in 368 children (15.7%); 87 children (3.7%) had reduced stereoacuity. Amblyopia was the most common identifiable cause, accounting for 32%, followed by strabismus (15%) and anisometropia (14%). Presence of anisometropia was significantly associated with reduced stereoacuity; 78.6% of anisometropic children achieved normal stereoacuity versus 98.9% without anisometropia (p < 0.0001). CONCLUSIONS: Reduced stereoacuity was relatively uncommon in a population of 12-year-old Australian children. Its functional and psychosocial impact on individuals and on the whole population remains uncertain.     

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.     

Visual screening of Swedish children: an ophthalmological evaluation

PURPOSE: This study describes the various ophthalmological conditions detected in the Swedish visual screening program for children. METHODS: The study was longitudinal and retrospective. All children (3126) born in 1982 in three Swedish municipalities have been followed from birth to ten years of age. Visual acuity was examined at the ages of 4, 5.5, 7 and 10 years. Before the age of 4, a gross examination of the eyes was performed. RESULTS: The prevalence of ametropia in the population was 7.7%, the prevalence of strabismus 3.1%, and the prevalence of organic lesions 0.6%. Seven children (0.2%) were visually handicapped (visual acuity 相似文献   

Electronically measured compliance with occlusion therapy for amblyopia is related to visual acuity increase

PURPOSE: We set out to determine whether the children who have low compliance (measured electronically) with occlusion therapy for amblyopia are those with insufficient increase of visual acuity. METHODS: In 14 newly identified amblyopic children (mean age 4.3+/-1.9 years), compliance was measured electronically over a period of 1 week, 6 months after the start of occlusion therapy. Compliance was measured with an Occlusion Dose Monitor (ODM). The measurements took place during planned domiciliary visits. The children were diagnosed with anisometropia (n=5), strabismus (n=4) and anisometropia and strabismus (n=5). Compliance was expressed in percentages of the electronically registered time compared with the prescribed occlusion time. Satisfactory acuity increase following 6 months of occlusion therapy was defined on reaching any of the following criteria: acuity increase expressed as a ratio between acuity of the amblyopic eye and acuity of the good eye of more than 0.75, acuity of the amblyopic eye exceeding 0.5 as measured on the E-Chart or Landolt-C, or three LogMAR lines of increase in acuity. RESULTS: Measured compliance averaged 80% in the eight children who had a satisfactory acuity increase and 34% in the six children who had an unsatisfactory visual acuity increase. Children with low acuity increase had statistically significantly lower compliance (P=0.038). CONCLUSION: The general assumption among orthoptists, that compliance with occlusion therapy for amblyopia is low in children with insufficient acuity increase, has been validated by electronic, objective means.     

Accuracy of the Lang II stereotest in screening for binocular disorders in 6-year-old children

PURPOSE: To assess the accuracy of the Lang II stereotest in screening for strabismus, amblyopia, and anisometropia in 6-year-old children. DESIGN: Cross-sectional population-based study. METHODS: The Sydney Myopia Study examined 1765 6-year-old children (78.9% of eligible) who were identified by random cluster sampling of 34 schools in Sydney, Australia. Sensitivity and specificity of the Lang II stereotest was determined by best stereoacuity. Cycloplegic autorefraction, assessment of visual acuity, and ocular motility were conducted. RESULTS: Test sensitivity ranged from 21.4% for anisometropia (> or =1.0 diopter) to 31.3% for amblyopia. The detection rate for new cases of amblyopia ranged from 20% to 40%; the detection rate for new cases of strabismus was 30%. Specificity was >98% in all three conditions. Children with false-negative results included newly diagnosed cases of strabismus (14 of 25 children) or amblyopia (5 of 12 children). CONCLUSION: The Lang II stereotest, when used alone, has very limited value as a screening test of binocular dysfunction.     

Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children

PURPOSE: To evaluate the visual and refractive results of photorefractive keratectomy (PRK) and laser-assisted subepithelial keratectomy (LASEK) for high myopic anisometropia with amblyopia and contact lens (CL) intolerance in children. Setting: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: This prospective comparative study comprised 27 children with high myopic anisometropia and amblyopia. The mean age of the children was 5.4 years (range 4 to 7 years). Multizonal PRK (13 eyes) or LASEK (14 eyes) was performed in the more myopic eye under general anesthesia using the Nidek EC-5000 excimer laser. After surgery, the dominant eye was patched. The postoperative visual and refractive outcomes were analyzed; all children had a 2-year follow-up. The 27 children (Group A) were compared with a control group of 30 children (mean age 5.1 years) (Group B) in whom myopic anisometropia and amblyopia were treated conventionally by CLs and patching the dominant eye. The visual acuity and binocular vision outcomes in both groups were analyzed and compared. RESULTS: In Group A, the mean spherical equivalent refraction was -8.25 diopters (D) +/- 2.37 (SD) (range -6.00 to -11.25 D) preoperatively and -1.61 +/- 0.73 D (range +0.50 to -2.25 D) postoperatively. The mean best corrected visual acuity (BCVA) was 0.23 +/- 0.21 preoperatively and 0.78 +/- 0.19 at 2 years. In Group B, the mean BCVA was 0.16 +/- 0.19 at the start of CL correction and amblyopia therapy and improved to 0.42 +/- 0.15 after 2 years. The mean BCVA at the final examination was significantly better in Group A (P<.05). Binocular vision improvement expressed by the proportion of patients who gained fusion and stereopsis was better overall in Group A (78%) than in Group B (33%) (P<.05). There were no complications postoperatively. CONCLUSIONS: Photorefractive keratectomy and LASEK were effective and safe methods for correcting high myopic anisometropia and improving amblyopia in children aged 4 to 7 years who were CL intolerant. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of anisometropia than in those who were treated conventionally by CLs.