Spontane Visusbesserung bei amblyopen Erwachsenen nach Funktionsverlust des Führungsauges?

Abstract

The prognosis of functional improvement after vision loss in the non-amblyopic eye in adulthood is important for counselling of the patients, but uncertain for a number of reasons. Our study focuses on two aspects. Firstly, a questionnaire was developed asking ophthalmologists and orthoptists for their opinion about the chances of significant spontaneous improvement; secondly, patient data were analysed with respect to acuity data acquisition and documentation as reasons for uncertainty concerning the prognosis. In the context of a project about age limits of amblyopia treatment, a questionnaire was developed which comprised also an item about the estimation of the prognosis after loss of vision in the non-amblyopic eye. It was distributed to ophthalmologists and orthoptists, and the answers were analysed in connection with two large, published studies about this topic . Furthermore, acuity data of three adult amblyopes were analysed after loss of function in the non-amblyopic eye. The questionnaire was answered by 109 ophthalmologists and 128 orthoptists, all working in Germany. Almost 50% of the answers concerning the chances of spontaneous improvement were in agreement with the data of the two published studies, which stated that the chances of spontaneous improvement were 10% or 17.4%, respectively. More than 25% of the answers underestimated the chances for spontaneous improvement (answer: 0 to 5%). On the other hand, a number of orthoptists and ophthalmologists estimated the chances much too optimistically, some anticipating more than a 60% chance of spontaneous improvement. The analysis of the patient data showed that both acquisition and documentation of acuity data gave reasons for uncertainties concerning the prognosis for visual acuity. In addition to new ways of assessing treatment compliance and quality of life, knowledge about the opinion of the treating personnel concerning various aspects of a disease may lead to more evidence-based treatment. In amblyopic patients, the inclusion of certain details into the documentation (type and separation of the optotypes, optical correction) may be essential.