Amblyopia In Children Research Articles

4 Week’s Report for Virtual Reality on Children Amblyopia Therapy

Purpose: To compare safety and Visual Acuity (VA) improvement in children with amblyopia treated with Virtual Reality (VR) plus spectacle correction and patching versus. spectacle correction and patching only. Design: Multicenter randomized clinical trial. Subjects: Twenty-eight subjects aged 4 to 12 years with amblyopia (20/400 to 20/25) from strabismus, refractive amblyopia, and visual deprivation amblyopia or combined types according to “Consensus of experts in the diagnosis of Amblyopia” in 2011 by Chinese Ophthalmology Society. Subjects were required to have never been treated or stopped treatment of patching over 4 weeks prior to enrollment. Subjects were randomly assigned to either VR games for 0.5 hour a day with patching and spectacles correction (12 subjects; VR group) or patching and spectacles correction (18 subjects; control group). Study follow-up visits were scheduled at 4, 8, and 13 weeks. This paper was only for 4 weeks. Methods: Eligible subjects (mean baseline corrected logMarVA was 0.54±0.28) were randomly assigned to treatment for 4 weeks with the VR binocular therapy (prescribed for 30min per day 3 days per week) plus spectacle correction and patching if needed (n=12) or spectacle correction with patching if needed (n=16). Main outcome measures: Advent event in VR group and change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner. Results: Safety: All 28 children reported no severe adverse event or device failure rate during 4 weeks of treatment; There was no significant difference between the dropping BCVA of fellow eye between VR group and control group. There were 12 and 16 experimental groups and control groups in baseline group, respectively, 8 and 6 completed complete 4-week treatment and follow-up. Effective: At Week 4, the VR group had a significant improvement in BCVA (logMarVA=0.4±0.35) compared to baseline BCVA (logMarVA=0.575±0.34) (P=0.029, t-test); The BCVA of the relatively good eyes in the experimental group improved but was not significant (logMarVA increased from baseline 0.169 to 0.115); At the baseline, there was no significant difference between the baseline and the control group, with the average BCVA of 0.575 to 0.34, 0.588 to 0.26 (P=0.914), and after 4 weeks of treatment, the VR group had an average BCVA (0.40±0.35, n=6), higher than the control group’s average BCVA (0.525 ± 0.26, n=8), but the difference was not significant (P=0.458). Conclusions: Caterna Virtual Reality was safe with a viable treatment option for the children amblyopia. Combining therapy of VR, spectacles and patching at baseline significantly improved the BCVA at 4 weeks.

Assessment of amblyopic children undergoing occlusion therapy by pattern visual evoked potentials and contrast sensitivity tests.

Background: Amblyopia is a case where one or less commonly, both eyes have impaired visual performance, even with the best optical correction and no visible disease of the visual system. Objectives: To assess contrast sensitivity tests (CST) and pattern visual evoked potentials (PVEP) results in amblyopic children who have already started occlusion therapy for durations ranging from 6 to 12 months. Methods: This cross-sectional study was conducted on 200 eyes of 50 patients with monocular amblyopia and 50 age and sex matched controls. Both patients and controls underwent ophthalmological assessment, PVEP, and CST. Results: There was no statistically significant difference in the results of P100 latencies of qualitative PVEP in amblyopic eyes compared to non-amblyopic eyes and control eyes, while the qualitative CST showed a highly statistically significant difference, being affected in 98% of amblyopic eyes compared to unaffected eyes (4%) and control eyes (4%). The maximum contrast level and minimal contrast level of quantitative CST were significantly lower in amblyopic eyes compared to non-amblyopic and control eyes. The cutoff value of maximal contrast level at mean frequencies of 2.5 ± 0.9 Hz, and a range of (1.1-4.1) for amblyopic eyes is ≤21 dB, while the cutoff value of minimal contrast level at mean frequencies of 13.4 ± 2.6 Hz, and a range of (6.7-18) for amblyopic eyes is ≤12 dB. Conclusion: Detection of amblyopia by CST is a noninvasive and easy procedure, which represents a promising tool to support the diagnosis of amblyopia.

How do parents experience patching or dichoptic action video gaming as amblyopia treatment? A qualitative study exploring treatment preferences and information needs to facilitate decision‐making

To explore parents' experiences, preferences and information needs when either patching treatment or dichoptic action video gaming is used as an amblyopia treatment for their child. A qualitative study was carried out on parents whose newly diagnosed amblyopic children participated in a randomised controlled trial (RCT) comparing the effects of dichoptic action video gaming versus patching. A purposive heterogenic sample was selected for an additional interview after the study period. Semi-structured interviews were conducted with one or both parents and transcribed verbatim, and a thematic analysis was performed. Ten families agreed to participate: seven in the patching group and three in the gaming group. Two themes emerged from the data exploring experiences with treatment: (1) factors influencing compliance and (2) burden with treatment. Parents reported creating a routine which improved compliance with patching, as opposed to gaming where parents felt less need to conduct the treatment themselves as it was performed in the outpatient clinic. In both groups, parents experienced an information hiatus regarding the role of refractive error. In deciding the type of treatment to be used, parents preferred to deliberate the choice with the healthcare professional and discuss considerations resulting in shared decisions. The emerging themes were (1) effect and efficiency of treatment, (2) organisational aspects of treatments and (3) their child's traits. This study provides insight into the experiences of parents whose children underwent different types of amblyopia therapy. Both treatments have their own advantages and disadvantages. For parents, the effectiveness and efficiency of treatment were the most important aspects when deciding the method of management. Parents wish to come to a well-informed, shared decision regarding the type of amblyopia treatment.

Комбинированный подход к лечению анизометропической амблиопии у детей (клинический случай)

A clinical case of patient K., 12 years old, with a diagnosis of anisometropia, anisometropic amblyopia, mixed astigmatism of the right eye, mild myopia, complex myopic astigmatism of the left eye is presented. Due to the intolerance of eyeglass and contact correction, the preservation of residual amblyopia against the background of regularly performed pleoptic treatment, the patient underwent laser refractive surgery of the amblyopic eye by Femto LASIK method in order to eliminate aniseikonia, which made it possible to successfully select glasses for permanent wearing with correction of the myopic eye and carry out further treatment in conditions of free haploscopy on a binarimeter with obtaining a high functional result. When observed in dynamics after 1 month and six months, the stability of anatomical and functional indicators was noted, which makes it possible to consider a highly effective combined approach in the treatment of anisometropic form of amblyopia in children. Keywords: amblyopia, children, anisometropia, FemtoLASIK, binarimetry

The Visual Rehabilitation of Bilateral Posterior Lens Luxation In Children: A Case Report

Introduction: Dislocated lens can be subluxated (partial) or luxated (complete), which can cause visual impairment in children. Conservative visual rehabilitation is an option for luxated lens treatment. Purpose: This study reports the possibility for visual rehabilitation of bilateral of bilateral luxated lens in children. Case Report: A 3-year-old boy came to the outpatient clinic of Dr. Saiful Anwar General Hospital with complaints of blurred vision on both eyes. The child would always bring objects close to his eyes since the past year. There was no history of ocular injury nor development disorder. Uncorrected visual acuities with LEA symbol on both right and left eyes were 6/114. The best-corrected visual acuity (BCVA) of the right eye was 6/45 and left eye was 6/9 with both S+11.00. Iridodonesis and aphakic lenses were found during slit-lamp examination of both eyes. The intraocular pressures were 14.2 mmHg on the right eye and 17.3 mmHg on the left eye. The lenses were seen in the vitreous cavities during funduscopy and ultrasonography examination. After 1 month of using spectacles, the BCVA of the right eye was 6/18 and that of the left eye was 6/18 with the binocular BCVA was 6/15. Lensectomy with pars plana vitrectomy was planned to prevent complication. Conclusion: Conservative visual rehabilitation is important to prevent amblyopia in children with luxated lenses and surgical treatment is needed to prevent complication. In this patient, aphakic spectacles were given for visual rehabilitation pending operative treatment.

Amblyopia in Children with Strabismus

Amblyopia in Children with Strabismus

A clinical trial on phakic intraocular lens for the treatment of refractive amblyopia in children and adolescents.

To analyze the demographics and clinical outcomes of posterior chamber phakic intraocular (IOL) implantation for refractive amblyopia in children and adolescents. A prospective interventional study was performed on children and adolescents with amblyopia at a tertiary eye care center from January 2021 to August 2022. Twenty-three eyes of 21 anisomyopic and isomyopic amblyopia patients operated for posterior chamber phakic IOL (Eyecryl phakic IOL) as a treatment for amblyopia were included in the study. Patient demographics, pre- and postoperative visual acuity, cycloplegic refraction, anterior and posterior segment examination, intraocular pressure, pachymetry, contrast sensitivity, endothelial count, and patient satisfaction scores were evaluated. Patients were followed up at day 1, 6 weeks, 3 months, and 1 year after surgery, and visual outcomes and complications were documented. The mean age of patients was 14.16 ± 3.49 years (range: 10-19 years). The mean intraocular lens power was - 12.20 diopter spherical (DS) in 23 eyes and - 2.25 diopter cylindrical (DC) in four patients. The mean unaided distant visual acuity (UDVA) and best-corrected visual acuity (BCVA) were 1.39 ± 0.25 and 0.40 ± 0.21 preoperatively on the log of minimum angle of resolution (logMAR) chart. Postoperatively, the visual acuity improved by 2.6 lines in 3 months period and maintained till 1 year. Postsurgery, contrast sensitivity in the amblyopic eyes significantly improved, and the average endothelial loss recorded was 5.78% at 1 year, which was statistically insignificant. Patient satisfaction score was statistically significant, with 4.736/5 recorded on the Likert scale. Posterior chamber phakic IOL is a safe, effective, and alternative method for treating amblyopia patients who are noncompliant with glasses, contact lenses, and keratorefractive procedures.

Microvasculature evaluation of anisometropic amblyopia children by Angio-OCT

To compare and assess the choroidal and retinal microstructural vascularity in amblyopic eyes with the fellow eyes in anisometropic amblyopic children using angiography optical coherence tomography (Angio-OCT). Twenty-seven children (54 eyes; 5.59 ± 1.08 years old; 59.3% girls) were enrolled in this study. Choroidal thickness (CT) was measured with the use of the enhanced depth imaging mode in Angio-OCT. Parafoveal/peripapillary vascular density indices and the foveal avascular zone (FAZ) size were analyzed by MATLAB code programming on Angio-OCT images. The mean FAZ size of the amblyopic eyes were larger both in superficial and deep capillary plexus layer (SCPL/DCPL). Compared with the contralateral eyes (BCVA were normal), all the vascular density indices of SCPL and DCPL in the parafoveal and peripapillary zones were lower in the amblyopic eyes, however, the difference was insignificant (p > 0.05). No significant decrease was observed in four quadrants analyses of the amblyopic eyes (p > 0.05). Except for the measurement at 2000 µm and 1500 µm from the fovea in temple, CT in amblyopic eyes were significantly thicken than the fellow eyes (p < 0.05). Compared with the fellow eyes, the CT of certain areas were thicker in the amblyopic eyes. Though the FAZ size of the amblyopic eyes was larger in SCPL/DCPL layers, the retinal vascular density indices in SCPL/DCPL were lower in amblyopia eyes without statistical difference. Angio-OCT may be an effective way to evaluate the status of the choroidal and retinal vascular system in amblyopic children.

Binocular treatment for amblyopic children: a review.

The narrative review was planned to investigate the efficiency of binocular treatment for amblyopic children, and to compare it with the standard methods. Literature search was conducted for articles in English language available on PubMed, Cochrane Library, Embase, Medline and PsycInfo databases as well as through bibliographies of peer-reviewed studies. Studies in the field of binocular treatment for amblyopia were included. Visual outcomes considered were visual acuity, types of amblyopia and stereoacuity. Studies on deprivation amblyopia, animal studies, literature review of amblyopia treatment, case reports, and trials targeting participants in whom previous amblyopia treatment had failed were excluded. Of the 40 studies found, 21(52.5%) met the inclusion criteria. Visual acuity and binocular function improved with binocular treatment for treating amblyopia in children by decreasing suppression depth extent and increasing stereopsis. Binocular treatment for amblyopic children was found to be an effective and fast process for the recovery of visual functions, especially in the critical time of visual development.

Evaluating the Psychological Impacts of Patching Treatment on Parents in Qassim Region, Saudi Arabia

BACKGROUND: The previous studies showed that patching treatment for amblyopia in children may have adverse psychological effects on children and families. AIM: The aim of the study was to investigate the reliability and validity of an Arabic version of the Amblyopia Treatment Index questionnaire and to evaluate the psychosocial impacts of patching treatment on parents of amblyopic children. METHODS: This was a cross-sectional study of 239 parents or guardians of amblyopic children who had at least five weeks of patching treatment experience in the past 6 months before enrolment. Eligible parent was either enrolled in the study from Qassim University Medical City eye clinics or referred by optometrists and ophthalmologists from 6 hospitals in Qassim province. Twenty parents were asked to repeat the same questionnaire after 14 days ± 2 days for test-retest reliability. RESULTS: The findings showed good internal validity and reliability for the Arabic version of the Amblyopia Treatment Index questionnaire among Saudi amblyopic patients. The factor analysis revealed that 16 of 21 items were strongly correlated through the questionnaire’s internal consistency ≥0.5 under three factors. Seven items were strongly correlated with the factor of adverse effects of amblyopia treatment. Similarly, seven items were strongly correlated with the lack of amblyopia treatment adherence, and only two were strongly correlated with the factor of social stigma. Reliability tested by Cronbach’s α coefficient showed good internal reliability and consistency (0.774). Cronbach’s α coefficient for the three factors was 0.734 for adverse effect, 0.644 for lack of treatment adherence, and 0.723 for social stigma. There is no significant association between parents’ education level and the final questionnaire score. CONCLUSION: The Arabic version of the amblyopia treatment index questionnaire showed high validity and reliability for factors related to patching therapy and was useful for Saudi children. Treatment of amblyopia in the Saudi community is strongly affected by adverse effects, adherence, and social stigma of adhesive patching.

Slow Binocular Reading in Amblyopic Children Is a Fellow Eye Deficit.

Amblyopic children read 25% slower than their peers during binocular silent reading. We compared binocular reading to fellow eye reading to determine whether slow reading in amblyopic children is due to binocular inhibition; that is, the amblyopic eye is interfering during binocular reading. In a cross-sectional study, 38 children with amblyopia and 36 age-similar control children who completed grades 1 to 6 were enrolled. Children silently read grade-appropriate paragraphs during binocular reading and fellow eye reading while wearing ReadAlyzer eye-tracking goggles (Compevo AB, Stockholm, Sweden). Reading rate, number of forward saccades, number of regressive saccades, and fixation duration were analyzed between groups and between viewing conditions. We also examined whether sensory factors (amblyopia severity, stereoacuity, suppression) were related to slow reading. For amblyopic children, binocular reading versus fellow eye reading did not differ for reading rate (176 ± 60 vs. 173 ± 53 words per minute, P = .69), number of forward saccades (104 ± 35 vs. 97 ± 33 saccades/100 words, P = .18), number of regressive saccades (21 ± 15 vs. 22 ± 13 saccades/100 words, P = .75), or fixation duration (0.31 ± 0.06 vs. 0.32 ± 0.07 seconds, P = .44). As expected, amblyopic children had a slower reading rate and more forward saccades than control children during binocular reading and fellow eye reading. Slow reading was not related to any sensory factors. Binocular reading did not differ from fellow eye reading in amblyopic children. Thus, binocular inhibition is unlikely to play a role in slow binocular reading and is instead a fellow eye deficit that emerges from a disruption in binocular visual experience during development.

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

Recent Advances in Management of Amblyopia

Amblyopia is the most common cause of monocular vision loss in children. Global incidence is 3.7%. It may be due to early deprivation of vision or defocus in one eye, reflects an imbalance of input from the eyes to visual cortex .Not only monocular vision is reduced but binocular vision is also affected. Fellow Human brain is designed to allow both eyes to work together. If signals from one eye are blurred, brain blocks the visual input from that eye. In the visual pathway, the synapses are broken due to disuse of amblyopic eye. Along with visual coordination deficit, eye to hand and reading can be affected and selfperception may be diminished. A variety of amblyopia therapy options have been developed to treat amblyopia in children and adults. Amblyopia therapy options have traditionally been limited to penalization of non-amblyopic eye with either patching or medicinal penalization. Traditional approaches to diagnose and treatment have limited effectiveness, are uncomfortable for the patients and their families. Recent evidences shows that amblyopes possess binocular cortical mechanisms for both threshold and supra-threshold stimuli. Hence strategy may be based on binocular stimulation methods, aims to stimulate either eye leading to a concomitant improvement in monocular vision with reduction in suppression and strengthening of binocular vision.

The use of occlusive contact lenses after failure of conventional for treatment of amblyopia.

The purpose of this study was to evaluate the usefulness and assess the risks associated with occlusive contact lenses (OCLs) use to treat refractory amblyopia in children who failed the conventional amblyopia treatment with patching and atropine penalization. This was a retrospective case series of all children treated with an OCL in the sound eye over an 8-year period. Data were collected on the age, gender, and type of amblyopia, previous treatment received, and its duration. The compliance, tolerance, and adverse effects of OCL were recorded. There were 12 patients of which 10 were male. The mean age at the time of OCL use was 47.3 months (range 26-86 months). Anisometropic amblyopia was present in 1, combined anisometropia and strabismus in 3, strabismic amblyopia in 5, and stimulus deprivation amblyopia in 3. All patients had conventional patching for a mean period of 14 months, followed by atropine penalization in nine patients for a mean period of 4 months. The mean duration of OCL use ranged from 2 weeks to 6 months. There were nine patients with visual improvement (75%). The mean improvement seen was 0.4 log of the minimum angle of resolution. There was no occlusion amblyopia. Four patients had conjunctivitis; one had a peripheral corneal abrasion. The OCL is a useful adjunct in the treatment of amblyopia that is refractory to conventional treatment. The side effect profile is acceptable, but patients require close monitoring.

Study of different types of refractive errors in under-five children born preterm versus full term

Background: Preterm birth potentially plays an important role in visual development. Studies have shown that frequency of myopia, astigmatism, anisometropia, strabismus, and amblyopia in children born preterm is higher than term children.Objective: The aim is to study different types of refractive errors in children under-five years of age born preterm and term.Methods: Comparative cross-sectional study was carried out among 64 children aged 5 years or less. Age, gender, and social status were noted. Children were subjected to refraction according to their age. Detailed anterior segment and posterior segment examination as per the cooperation of the child was conducted with torch light or slit-lamp examination with Ziess, Appasamy AARU 2000. Visual acuity was examined with appropriate methods suitable for age.Results: Fifty percent were preterm and 50% were term. About 50% were male and 50% were female. The most common refractive error was hypermetropia (42%). Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters (17%). Compound types of refractive error were significantly more (62.5%) among the preterm compared to 31.2% among term; significantly more (91.7%) among those born <32 weeks of gestation compared to 45% and 45.5% among those born between 33 and 36 weeks and born >36 weeks of gestational, respectively; significantly more (88.9%) among low birth weight babies compared to 40% among normal birth weight babies. Age and gender were not significantly associated with compound types of refractive errors (P > 0.05).Conclusion: Most common refractive error was hypermetropia. Among those with compound types of refractive errors, the most common was compound myopic astigmatism ≥2 diopters. Being preterm, born at the gestational age of <32 weeks and low birth weight were significant risk factors for compound types of refractive errors.

Evaluation of retinal function and morphology in isoametropic amblyopia.

To observe the photoreceptor anomalies in cases of ametropic amblyopia. A prospective study with 25 isoametropic amblyopic children in the age group of 5-14 years and 25 age-matched controls was done. Examination included refraction, best-corrected visual acuity (BCVA), and color vision. Adaptive optics (AO) and multifocal electroretinogram (mf-ERG) were done to assess the anatomy and function of photoreceptors. The subgroup analysis of the improved and non-improved groups was done. The mean cone density in cases and control in the superior, temporal, and nasal quadrants was respectively as follows (21640 ± 5713, 24040 ± 3386, P = 0.01) (19755 ± 6282, 21832 ± 2911, P = 0.03) (19897 ± 5418, 22171 ± 3660, P = 0.01) (20768 ± 4799, 22819 ± 3241, P = 0.01). The amplitude of N1 wave and P1 wave in cases was significantly low compared to the controls. Cases with subnormal color vision had reduced BCVA (0.55 ± 0.018) in comparison to the children with normal response (0.350 ± 0.014). Cone density was also significantly reduced in children with subnormal color vision. Sixteen out of 25 cases showed BCVA improvement with spectacles. Baseline cone density was found to be significantly higher in the improved group. There was no correlation between BCVA and AO parameters. Patients with ametropic amblyopia show subnormal photoreceptor properties than controls. Low cone density may be associated with defective color vision and poor prognosis in these cases.

Association of Neighborhood Child Opportunity Index with presenting visual acuity in amblyopic children

To demonstrate the use of a novel measure of neighborhood quality, the Child Opportunity Index (COI), for investigating health disparities in pediatric ophthalmology. This study included children 2-12 years of age from a registry of patients diagnosed with amblyopia at an urban pediatric hospital between 2010 and 2014. Children previously treated for amblyopia were excluded. Patient demographics, residential addresses, and logMAR visual acuities were collected. The association between visual acuity at presentation and COI was examined using linear mixed-effects models adjusting for individual-level factors, including age, sex, race, ethnicity, and insurance type. This study included 1,050 amblyopic children, of whom 317 (37%) were non-White and 149 (19%) were Hispanic; 461 (44%) had public insurance. Regarding residence, 129 (12%) lived in areas of very low opportunity (COI <20); 489 (47%) in areas of very high opportunity (COI ≥80). Children residing in the lowest opportunity neighborhoods correctly identified approximately two fewer letters at presentation with their better-seeing eye compared with children from the highest opportunity neighborhoods after adjusting for individual-level factors (-0.0090 logMAR per 20 unit increase in COI; 95% CI, -0.0172 to -0.0008; P = 0.031). No difference was appreciated in the worse-seeing eye. Amblyopic children residing in communities with low neighborhood opportunity had slightly worse visual acuity in the better-seeing eye at presentation. Although statistically significant in the better-seeing eye, the two-letter difference attributable to neighborhood environment may not be clinically significant, and the impact of this disparity on treatment outcomes deserves further investigation.

Binocular amblyopia treatment improves manual dexterity

To determine whether deficits in manual dexterity in children with amblyopia improve after binocular amblyopia treatment and whether improvements are related to age at treatment, baseline sensory status, or amount of improvement in sensory status with treatment. Manual dexterity (Movement Assessment Battery for Children-2), visual acuity, fusion, suppression, and stereoacuity were measured at baseline and after 4-8 weeks of binocular amblyopia in 134 children with amblyopia, including 75 children in the "younger group" (aged 3 to <7 years) and 59 in the "older group" (aged 7-10 years), and in 40 age-similar control children. Baseline manual dexterity standard scores of amblyopic children were significantly below those of controls in both the younger (8.81 ± 0.33 vs 11.80 ± 0.60 [P < 0.0001]) and older groups (7.19 ± 0.34 vs 9.75 ± 0.57 [P = 0.00013]). After 4-8 weeks of binocular amblyopia treatment, the younger group standard score improved to 9.85 ± 0.35 and the older group improved to 8.08 ± 0.39, but both groups remained significantly lower than controls (P = 0.03 and P = 0.01, resp.). Improvement in manual dexterity standard score was not associated with any baseline factors but was weakly correlated with the amount of visual acuity improvement (rs = 0.26; 95% CI, 0.09-0.41) CONCLUSIONS: Manual dexterity impairments are common among children with amblyopia. In our study cohort, binocular amblyopia treatment improved visual acuity and manual dexterity.

A novel eye-tracking-based binocular therapeutic improves visual performances in amblyopic children: a pilot study.

A novel eye-tracking-based binocular therapeutic improves visual performances in amblyopic children: a pilot study.

Assessment of choroidal vascularity and choriocapillaris blood perfusion in Chinese preschool-age anisometropic hyperopic amblyopia children.

To determine the macular and peripapillary area choroid microstructure parameters of hyperopic anisometropic amblyopia eyes and compare to fellow and age-matched control eyes. To assess the correlation between the axial length (AL), choroidal thickness (CT) and choroid microstructure parameters. This cross-sectional comparative, non-interventional study involved 52 hyperopic anisometropic amblyopia children and 48 age-matched heathy controls. 52 eyes with hyperopic anisometropic amblyopia and 48 age-matched control eyes were studied. The peripapillary and subfoveal CT were determined. The total choroidal area (TCA), luminal area (LA), and stromal area (SA) of the subfoveal and peripapillary choroid were measured. In addition, the correlation between the AL, CT and choroid microstructure parameters were calculated. The peripapillary and subfoveal CT of the amblyopic eyes was significantly thicker than the fellow and control eyes (all P < 0.05). The subfoveal and peripapillary choroidal SA, LA and TCA of the amblyopic eyes were significantly increased than that of the fellow and control eyes (all P < 0.05). The choroidal vascularity index (CVI) values of the amblyopic eye were significantly different among the three groups (P < 0.05). There was a statistically significant negative correlation between AL and subfoveal CT (SFCT), LA and TCA levels (P < 0.001, P = 0.039, P = 0.027, respectively). Spherical equivalent (SE) was positive correlated with SFCT, LA and TCA levels (P = 0.456, 0.229 and 0.240, respectively; all P < 0.05). There was a statistically significant positive correlation between SFCT, SE, LA, SA, TCA and CVI levels (all P < 0.05). The subfoveal and peripapillary CT of amblyopic children abnormally increased and correlated with shorter AL and higher SE. The choroidal structure of the amblyopic eyes was different from the fellow and control eyes, the hyperopic anisometropic amblyopic eyes had significantly thicker sub-foveal choroid, higher LA, SA, and TCA. AL and CT affect choroidal structure and vascular density. Choroidal blood flow may be increased in amblyopic eyes. The larger LA, SA, TCA, and lower CVI were characteristic of the amblyopic eye.