Childhood Amblyopia Research Articles

Patch-free streaming contrast-rebalanced dichoptic cartoons versus patching for treatment of amblyopia in children aged 3 to 5 years: a pilot, randomized clinical trial

BackgroundWe developed and tested a dichoptic treatment designed for younger children that can be viewed freely and involves a dichoptic manipulation of a popular animation series that enables contrast-rebalancing without disrupting fusion. Our aim was to assess whether this novel amblyopia treatment is superior to patching in children aged 3-5 years. MethodsA total of 34 children with amblyopia were randomly assigned to contrast-rebalanced dichoptic cartoons (4 hours/week) or patching (14 hours/week) for 2 weeks. Children in the cartoon group continued watching cartoons for an additional 2 weeks. Designed to target the youngest and most treatable children, the dichoptic cartoons presented the entire scene to the amblyopic eye at 100% contrast, while the fellow eye view was presented at reduced contrast with the main character omitted. Best-corrected visual acuity (BCVA), stereoacuity, suppression, and manual dexterity were measured at each visit. ResultsAfter 2 weeks, improvement in amblyopic eye BCVA was greater for dichoptic treatment than for patching, with a mean improvement of 0.11 ± 0.08 versus 0.06 ± 0.09 logMAR, respectively (P = 0.04). Stereoacuity, suppression, and manual dexterity did not improve significantly more in the dichoptic group than the patching group at 2 weeks. After 4 weeks of dichoptic cartoon treatment, mean visual acuity improvement in the dichoptic group was 0.16 logMAR (95% CI, 0.10-0.21). ConclusionsIn our study cohort, a contrast-rebalanced dichoptic cartoon was more effective than patching in treating childhood amblyopia after 2 weeks. Dichoptic cartoons that rebalance contrast to overcome suppression provide an additional treatment option for amblyopia in young children.

Amblyopia and physical activity in adolescents

ABSTRACT Introduction: Physical activity in adolescence plays an important role in reducing the lifetime risk of chronic disease. Recent studies have shown that individuals with amblyopia may have difficulties with coordinating balance and may be at greater risk of developing fine motor impairments. The purpose of this study was to determine if there is an association between the presence of amblyopia and physical activity (PA) in adolescents. Methods: Adolescent patients aged 12–18 years with a history of childhood amblyopia were age- and gender-matched to control patients with no other ocular pathology aside from refractive error. Each participant’s best corrected visual acuity and refractive error were recorded in addition to their height and weight to calculate body mass index (BMI). A 32-question electronic survey was used to calculate self-reported physical activity level (PAL) score and type of PA over the previous seven days. The Ainsworth Compendium of Physical Activities was taken as a reference to calculate Metabolic Equivalent of Task (MET) minutes for the most frequently performed activity. Results: A total of 26 adolescents with amblyopia (10 strabismic, 16 anisometropic) and 26 healthy controls were recruited. The MET-minute values were 2404.3 ± 2313.9 in the control group and 905.6 ± 1196.0 in the amblyopia group (p = .008). The PAL scores were similar between amblyopia and control groups (1.15 ± 0.70 versus 1.24 ± 0.60, p = .63); however, BMI was significantly higher in amblyopia participants (25.2 ± 6.3 versus 21.1 ± 5.4, p = .003). When compared with controls, amblyopes perceived physical activity to be of significantly lower importance in their lives compared to controls (p = .009). Discussion: Amblyopic adolescents may represent a population with increased vulnerability to significantly lower energy expenditure and higher BMI. Future studies with a larger number of participants and further investigation into the impact of refractive error on physical activity are warranted.

Cautious application of multifocal intraocular lenses in children with congenital cataracts

Multifocal intraocular lenses (MIOLs) have demonstrated efficacy and safety in adult cataract surgery, yet they encounter many challenges in pediatric applications. This article elaborates on the difficulties in biometric measurements in children, the unpredictability of postoperative refraction outcomes, the lack of long-term spectacle independence in children with MIOLs, the absence of significant advantages in correcting childhood amblyopia, and the potential increase in the rate of secondary surgeries. Due to the insufficient clinical evidence supporting the use of MIOLs in children at present, it is proposed that MIOLs be cautiously applied to children with congenital cataracts in clinical practice. Further research in this area is encouraged.

Exploring the Relationship Between Maternal Nutrition During Pregnancy and Childhood Amblyopia and Myopia Risk: Longitudinal Cohort Studies

This study aimed to investigate the relationship between pregnancy and myopia onset or progression in young adult women, utilizing a longitudinal cohort design with a substantial sample size. Myopia is a prevalent refractive error with significant public health and economic implications. There are genetic and environmental risk factors for myopia; however, the role of pregnancy in the development of myopia is unknown. No longitudinal studies with extensive sample sizes have clarified the relationship between pregnancy and myopia. This study included 100 women aged 20–50 years, who were followed up biennially for up to 14 years. Pregnancy occurrences and myopia assessments were recorded. A comparison of individuals with and without pregnancies revealed differences in the incidence of myopia and amblyopia, their ages, and body mass index. Hazard ratios for myopia onset or progression were significantly lower in individuals with at least one pregnancy, particularly during the early follow-up periods. Sensitivity analyses and adjustments for confounders supported these findings. This study demonstrated that pregnancy may prevent myopia onset or progression, particularly during early adulthood. Future research should confirm these findings and investigate the underlying mechanisms, informing clinical decisions, including refractive surgery timing in women of childbearing age.

Efficacy of Amblyopia Treatments in Children Up to Seven Years Old: A Systematic Review.

Amblyopia is a neurodevelopmental disorder of the visual system that impairs the vision of millions of children worldwide. Amblyopia is best treated within the sensitive period of visual development when a child is up to seven years of age. Currently, the gold standard for early treatment of childhood amblyopia is patching, with new treatments emerging in recent years. We aim to evaluate the effectiveness of these newly developed treatments for amblyopia in children aged seven years and younger while comparing them to the current industry standard of patching. We searched online databases including PubMed, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and narrative reviews relating to amblyopia treatment in children aged seven and younger. We only included articles and studies completed within the last five years and those written in the English language. After compiling a list of 297 articles, we removed duplicates, articles without an available full text, and those not relevant to our topic. Of the remaining 51 articles, we were left with 22 after reading abstracts and removing further irrelevant articles. We did a quality assessment on the remaining 22 articles and were left with 14 articles for our systematic review after removing eight low-quality articles. Of the 14 articles, we had eight RCTs, two systematic reviews, one comparative interventional study, and three narrative reviews. Seven of the articles contained data reinforcing the effectiveness of patching while comparing it to other treatment modalities. Three of the articles had data supporting spectacle correction, including a novel form called alternative flicker glass which delivers occlusion therapy via a spectacle frame with unique lenses, and ultimately deemed it at least as effective or more than patching. Data from three articles supported the use of surgery to successfully correct the angle of strabismus. Findings from five articles backed the use of pharmacologic therapy, specifically atropine when used alongside patching as a more effective alternative to patching solely. However, levodopa plus patching had no advantage over patching alone. Additionally, seven articles addressed the use of virtual reality (VR) and dichoptic therapy as prospective treatments for childhood amblyopia. VR therapy proved beneficial when used within one week after strabismus surgery. Dichoptic training was also effective in improving amblyopic-eye visual acuity when used on its own or in conjunction with spectacles. Furthermore, dichopticmovie therapy was found to be more effective than patching. Thus, we found multiple highly effective treatments for childhood amblyopia that are as effective or more than patching. Future studies should consider prescribing these treatments to larger cohorts while also performing a cost-benefit analysis for each treatment. In addition, more needs to be learned about the potential adverse side effects of these treatments, especially for pharmaceutical therapy.

Associations between unilateral amblyopia in childhood and cardiometabolic disorders in adult life: a cross-sectional and longitudinal analysis of the UK Biobank

Amblyopia is a common neurodevelopmental condition and leading cause of childhood visual impairment. Given the known association between neurodevelopmental impairment and cardiometabolic dysfunction in later life, we investigated whether children with amblyopia have increased risk of cardiometabolic disorders in adult life. This was a cross-sectional and longitudinal analysis of 126,399 United Kingdom Biobank cohort participants who underwent ocular examination. A subset of 67,321 of these received retinal imaging. Data analysis was conducted between November 1st 2021 and October 15th 2022. Our primary objective was to investigate the association between amblyopia and a number of components of metabolic syndrome and individual cardiometabolic diseases. Childhood amblyopia, dichotomised as resolved or persisting by adulthood, cardiometabolic disease and mortality were defined using ophthalmic assessment, self-reported, hospital admissions and death records. Morphological features of the optic nerve and retinal vasculature and sublayers were extracted from retinal photography and optical coherence tomography. Associations between amblyopia and cardiometabolic disorders as well as retinal markers were investigated in multivariable-adjusted regression models. Individuals with persisting amblyopia (n=2647) were more likely to be obese (adjusted odds ratio (95% confidence interval): 1.16 (1.05; 1.28)), hypertensive (1.25 (1.13; 1.38)) and diabetic (1.29 (1.04; 1.59)) than individuals without amblyopia (controls, (n=18,481)). Amblyopia was also associated with an increased risk of myocardial infarction (adjusted hazard ratio: 1.38 (1.11; 1.72)) and death (1.36 (1.15; 1.60)). On retinal imaging, amblyopic eyes had significantly increased venular caliber (0.29 units (0.21; 0.36)), increased tortuosity (0.11 units (0.03; 0.19)), but lower fractal dimension (-0.23 units (-0.30;-0.16)) and thinner ganglion cell-inner plexiform layer (mGC-IPL,-2.85 microns (-3.47;-2.22)). Unaffected fellow eyes of individuals with amblyopia also had significantly lower retinal fractal dimension (-0.08 units (-0.15;-0.01)) and thinner mGC-IPL (-1.14 microns (-1.74;-0.54)). Amblyopic eyes with a persisting visual deficit had smaller optic nerve disc height (-0.17 units (-0.25;-0.08)) and width (-0.13 units (-0.21;-0.04)) compared to control eyes. Although further research is needed to understand the basis of the observed associations, healthcare professionals should be cognisant of greater cardiometabolic dysfunction in adults who had childhood amblyopia. Differences in retinal features in both the amblyopic eye and the unaffected non-amblyopic suggest generalised versus local processes. Medical Research Council (MR/T000953/1) and the National Institute for Health and Care Research.

Childhood amblyopia: A systematic review of recent management options.

This study reviews the current information on treatment of childhood amblyopia, with the goal of improving visual functions. The authors searched various online databases including PubMed, Web of Science, ProQuest, Scopus, Google Scholar, Ebsco, and Medline. The articles, published between 2002 and 2023, included in this study were used to assess the different modalities for the management of different types of childhood amblyopia. The final systematic review included 41 studies from different countries, covering 4060 children with a mean age 6.8 ± 124 years. The findings showed that childhood amblyopia commonly treated through a systemic approach, i.e., starting with treatment of refractive errors with given optical adaptation time, followed by visually stimulating amblyopic eye by covering the dominant eye with patching, Atropine or Bangerter filters. Refractive adaptation period of 18-22 weeks has proven to show a significant improvement in visual acuity. It has been confirmed that 2 h patching is effective for the first time treated amblyopes, and if there is no improvement, increase the period to 6 h daily. Novel methods that improve binocular function such as dichoptic, perceptual training, video gaming, and drugs that facilitate visual neuroplasticity, are useful in the treatment of amblyopia that is not responsive to conventional therapy. The study concludes that significant evidence show that childhood amblyopia is treated through a systemic approach. Starting from correcting refractive errors with a period of optical adaptation, followed by patching therapy and atropine penalization. New methods that improve the binocular functions and medications that facilitate visual neuroplasticity have found to be useful in the treatment of amblyopia that is not responsive to conventional treatment.

Novel CRYGC Mutation in Conserved Ultraviolet-Protective Tryptophan (p.Trp131Arg) Is Linked to Autosomal Dominant Congenital Cataract

Congenital cataract (CC), the most prevalent cause of childhood blindness and amblyopia, necessitates prompt and precise genetic diagnosis. The objective of this study is to identify the underlying genetic cause in a Swiss patient with isolated CC. Whole exome sequencing (WES) and copy number variation (CNV) analysis were conducted for variant identification in a patient born with a total binocular CC without a family history of CC. Sanger Sequencing was used to confirm the variant and segregation analysis was used to screen the non-affected parents. The first de novo missense mutation at c.391T>C was identified in exon 3 of CRYGC on chromosome 2 causing the substitution of a highly conserved Tryptophan to an Arginine located at p.Trp131Arg. Previous studies exhibit significant changes in the tertiary structure of the crystallin family in the following variant locus, making CRYGC prone to aggregation aggravated by photodamage resulting in cataract. The variant can be classified as pathogenic according to the American College of Medical Genetics and Genomics (ACMG) criteria (PP3 + PM1 + PM2 + PS2; scoring 10 points). The identification of this novel variant expands the existing knowledge on the range of variants found in the CRYGC gene and contributes to a better comprehension of cataract heterogeneity.

Personalised versus standardised dosing of occlusion therapy for amblyopia: A randomised controlled trial

ObjectivesTo compare a novel, model-based personalised dosing strategy (PDS) with a standardised (best practice) occlusion dosing strategy (SDS) for the treatment of childhood amblyopia. We have utilised archived clinical trial data sets to develop a statistical model that aims to optimise the prescription of occlusion therapy. This approach, whose effectiveness has not previously been evaluated, incorporates within its underlying model: patient age, severity and type of amblyopia. MethodsRandomised, parallel group design with PDS and SDS arms each having within or pre-trial optical treatment. Actual worn occlusion for both PDS and SDS groups was objectively recorded using occlusion dose monitors (ODMs). ResultsOf the 94 initially enrolled participants, 50 were male, 44 female, mean [IQR] age 5.53 [4.79–6.02] years. The improvement in logMAR acuity in the 68 participants remaining in the trial subsequent to optical treatment and not having withdrawn did not differ (p = 0.641) between the PDS and SDS groups: median [IQR] improvement 0.250 [0.13−0.39] in the PDS group, 0.225 [0.14−0.32] in the SDS group. A subset (n = 28) of participants were objectively observed to have occluded for every day prescribed. In these, we found that, after allowing for slightly higher prescribed doses of occlusion in the SDS group, adherence in the PDS group to be ∼20% greater than in the SDS group. ConclusionWhilst the PDS and SDS groups demonstrated equivalent visual performance and temporal outcomes, there is evidence that the PDS results in improved adherence with therapy likely to have arisen due to increased patient engagement with this novel regimen.

Factors affecting the benefit of glasses alone in treating childhood amblyopia: an analysis of PEDIG data

BackgroundTo evaluate factors associated with better outcomes from optical treatment alone in amblyopic children from 3 up to 7 years.MethodsData extracted from two studies with similar protocols, Amblyopic Treatment Studies 5 (n = 152) and 13 (n = 128) from the Pediatric Eye Disease Investigator Group database, were used to determine by regression analysis the factors associated with improvements in visual acuity in the amblyopic eye, inter-ocular visual acuity difference and stereoacuity. Input variables were aetiology of amblyopia (anisometropic, strabismic and combined-mechanism amblyopia), treatment compliance, visual acuity, interocular visual acuity difference, stereoacuity, tropia size at distance and near, age and refractive error at baseline.ResultsDespite the range of clinical factors considered, our models explain only a modest proportion of the variance in optical treatment outcomes. The better predictors of the degree of optical treatment success in amblyopic children are visual acuity of the amblyopic eye, interocular visual acuity difference, stereoacuity, treatment compliance and the amblyopic eye spherical-equivalent refractive error. While the aetiology of the amblyopia does not exert a major influence upon treatment outcome, combined-mechanism amblyopes experience the smallest improvement in visual acuity, tropia and stereoacuity and may need longer optical treatment periods.ConclusionsWhile results identify the factors influencing optical treatment outcome in amblyopic children, clinicians will be unable to predict accurately the benefits of optical treatment in individual patients. Whether this is because relevant clinical or non-clinical factors (e.g. nature and volume of daily activities undertaken) influences the outcomes from optical treatment has not yet been identified and remains to be discovered.

Current concepts in management of amblyopia- A major review

Amblyopia is the leading cause of preventable blindness in children and young. The prevalence of amblyopia in childhood varies between 1-5%, although these values may differ. Most of the visual impairment in amblyopia is reversible if treated early at appropriate time. Various treatment modalities in children include: refractive correction, patching, atropine penalization, binocular therapy, liquid crystal display eyeglasses and transcranial magnetic stimulation. Motive of this article is to give an emphasis on newer management strategy and newer trends in amblyopia therapy. A thorough search of literature was done in PubMed, Scopus, Embase and reference list of articles until December 15, 2020 containing “amblyopia treatment or therapy” was retrieved.

Recovery from amblyopia with cholinesterase inhibition

An elevated threshold for neuroplasticity limits visual gains with treatment of residual amblyopia in late childhood and adulthood. Donepezil, an acetylcholinesterase inhibitor, can enable visual neuroplasticity and promote recovery from amblyopia in adult mice. Motivated by these promising findings, we sought to determine whether donepezil can enable recovery in older children and adults with residual amblyopia.

The Clinical Characteristics of Amblyopia in Children Under 17 Years of Age in Qassim Region, Saudi Arabia.

PurposeTo provide the clinical characteristics of amblyopia in children under 17 years of age in Qassim Region, Saudi Arabia.Patients and MethodsThe study was a cross-sectional hospital-based, included 121 children with amblyopia aged between 3 and 17 years, referred from 6 hospitals in Qassim region to the paediatric optometry clinic at Qassim University medical city. Demographics and comprehensive ocular examination including visual acuity (VA), assessment of anterior and posterior segment, cycloplegic refraction (RE), angle of deviation, and cause of amblyopia were collected.ResultsThe mean age at diagnosis of amblyopia was 8.93 ± 3.67 years. The leading cause of amblyopia was strabismus and anisometropia shared the same percentage at 29.75%, and the combined-mechanism at 18.18%. Amblyopia was more common in males 57.85%, particularly strabismic amblyopia in 66.67% and anisometropic amblyopia in 61.11%, p = 0.408. Amblyopia was more predominant in the age group 6- to 9-year-old, particularly, strabismic amblyopia 44.44%, and amblyopia due to a combined mechanism of 36.36%, p = 0.066. The degree of hyperopia was not varied by the cause of amblyopia (P = 0.401), with slightly high hyperopia found in ametropic and strabismic amblyopia. Conversely, hyperopic astigmatism was significantly associated with amblyopia P = 0.020, with a high degree of hyperopic astigmatism found in meridional amblyopia and ametropic amblyopia.ConclusionThe commonest types of amblyopia in children were attributed to strabismus and anisometropia. Causes of amblyopia differed by age group with strabismus, anisometropia, and combined mechanism accounting for most children aged 6- to 9-years and strabismus for children aged less than 6 years. Hyperopic and myopic astigmatism were significantly associated with anisometropia and meridional amblyopia. Therefore, efforts should be made for early diagnosis and management of childhood amblyopia and uncorrected refractive errors to avoid their impact on quality of life.

Impact of Persisting Amblyopia on Socioeconomic, Health, and Well-Being Outcomes in Adult Life: Findings From the UK Biobank

ObjectivesThis study aimed to investigate associations between persisting amblyopia into adulthood and its “real-life” impacts and inform the current debate about the value of childhood vision screening programs. MethodsAssociations between persisting amblyopia and diverse socioeconomic, health, and well-being outcomes were investigated in multivariable-adjusted (sex, age, ethnicity, deprivation) regression models, with 126 400 participants (aged 40-70 years) of the UK Biobank with complete ophthalmic data. Analysis by age group (cohort 1, 60-70 years; cohort 2, 50-59 years; cohort 3, 40-49 years) assessed temporal trends. ResultsOf 3395 (3%) participants with confirmed amblyopia, overall 77% (2627) had persisting amblyopia, declining from 78% in cohort 1 to 73% in cohort 3. The odds of persisting amblyopia were 5.91 (5.24-6.66) and 2.49 (2.21-2.81) times greater in cohort 1 and cohort 2, respectively, than cohort 3. The odds were also higher for more socioeconomically deprived groups and for white ethnicity. Reduced participation in sport, adverse general and mental health, and well-being were all independently associated with persisting amblyopia, with the strongest associations in the youngest cohorts. Associations with lower educational attainment and economic outcomes were only evident in the oldest cohort. ConclusionsThere has been a decline in the overall frequency of persisting amblyopia since the introduction of universal child vision screening in the United Kingdom. Nevertheless, most adults treated for amblyopia in childhood have persisting vision deficits. There was no evidence that persisting amblyopia has vision-mediated effects on educational, employment-related, or economic outcomes. The observed adverse outcomes were largely those not directly mediated by vision. Patients undergoing treatment should be counseled about long-term outcomes.

Attentional eye selection modulates sensory eye dominance

Brief periods of monocular deprivation significantly modify binocular visual processing. For example, patching one eye for a few hours alters the inter-ocular balance, with the previously patched eye becoming dominant once the patch is removed. However, the contribution of higher-level visual processing to this phenomenon is still unclear. Here, we compared changes in sensory eye dominance produced by three types of monocular manipulations in adult participants with normal binocular vision. One eye was covered for 150 min using either an opaque patch, a diffusing lens, or a prism that inverted the image. All three manipulations altered dominance duration and predominance during binocular rivalry (BR) in favour of the treated eye and the time courses of the changes were similar. These results indicate that modifications of luminance or contrast are not strictly necessary to drive shifts in eye dominance, as both were unaltered in the prism condition. Next, we found that shifts in eye dominance were dependent on attentional demands during the monocular treatment period, providing support for the role of attentional eye selection in modulating eye dominance. Finally, we found relatively rapid build-up of the ocular dominance shift after the onset of monocular treatment. Taken together, our results suggest that modifications to monocular input alter inter-ocular balance via selective attentional mechanisms that bias output towards the deprived eye. Eye-based attention may play an important role in conditions where normal input to one eye is disrupted, such as childhood amblyopia.

Prevalence and pattern of amblyopia in a rural hospital in Ghana

ABSTRACT Amblyopia is a developmental ocular disease of childhood-onset which may lead to persistent sequelae into adulthood. Early detection and management of amblyopia usually result in an improved visual outcome. The purpose of this study was to determine the prevalence and pattern of amblyopia in a rural hospital in Ghana. Clinical records of patients seen (from January 2014 to December 2018) at Westphalian Medical Center, Oyoko, Ashanti Region, Ghana, were reviewed retrospectively. Unilateral amblyopia was defined as a two-line interocular difference or more in visual acuity. Bilateral amblyopia was defined as best-corrected visual acuity (BCVA) of Snellen 6/12 or worse in both eyes, with evidence of bilateral ametropia or obstruction of the visual pathway. Following a review of 12,602 patient records, 258 cases of amblyopia were identified. The mean (±SD) presenting age of amblyopic patients was 24.3 ± 16.1 years, with a male-to-female ratio of 1:1.1. The period prevalence of amblyopia was 2.04%. The period prevalence of unilateral and bilateral amblyopia was 1.38% and 0.66%, respectively. The most prevalent form of amblyopia was refractive with a cumulative prevalence of 1.42%. Strabismic and stimulus deprivation amblyopia accounted for 0.36% and 0.21% of all amblyopic cases, respectively. A major cause of amblyopia in this population was refractive error, hence the use of spectacle correction for its initial management. Repeated assessment after an appropriate period of refractive adaptation would elucidate the proportion of amblyopias needing additional treatment modalities. Vision screening for early detection of amblyopia in childhood with accessible and effective management of amblyopia (including refractive correction and occlusion treatment) is necessary to reduce the impact of amblyopia in Ghana.

Pattern of ocular morbidity in pediatrics age group in a tertiary centre in western Nepal

Introduction: Ocular morbidities are importantbecause of their impact on child’s development,education and future work. Ocular morbidities in children may not be diagnosed and treated in time due to inability to express their problems which leads to amblyopia by the time they can express it. This study was conducted with an objective to determine the pattern of ocular morbidity in children less than and equal to 14 years of age presenting in the Outpatient Department (OPD) of Gandaki Medical College, Pokhara.
 Materials/ Methods: This is a cross sectional observational study where we reviewed the profile of all of all patients of age group equal to or less than 14 years entering eye OPD from September 2016 to September 2018 for eye examination.
 Result: A total of 1471 patients presented to eye department of GMC. The mean age of the patient was 8.25 ±4.24 years among which 57.8% were males and 42.2% were females. Maximum number of the patients were in age group 11 to 14 years (38.1%) while minimum number of the patients were in the age group <1 year(10.6%).Conjunctival disorders (23.9%) was the most common ocular morbidity followed by refractive error in (18.2%), miscellaneous conditions (10.4%), eyelid diseases (8.6%), lacrimal system diseases (7.8%).
 Conclusion: Thestudy gives a picture and pattern of ocular diseases in pediatrics age group which not only helps in early diagnosis and treatment of ocular diseases but also in decreasing the magnitude of childhood blindness and amblyopia.

Binocular Treatment for Childhood Amblyopia

Amblyopia (‘lazy eye’) is the leading cause of monocular visual impairment in children. In addition to abnormal visual acuity, amblyopia can result in functional impairments in reading and fine motor abilities, and low self-esteem. The most common treatment is to patch the stronger eye to force use of the amblyopic eye, but normal visual acuity is not always achieved and normal binocular vision is rarely recovered. Patching can also be uncomfortable and an emotional burden for the child, resulting in low adherence. Recent advances in the treatment of childhood amblyopia have focused on binocular therapies consisting of games and movies that may reduce interocular suppression so the child can experience binocular vision. Laboratory and clinical trial data have shown improvements in visual acuity and binocular outcomes with as little as 2 to 4 weeks of binocular treatment in amblyopic children and adults. However, a few clinical trials have poor results with binocular treatment, possibly due to low adherence, small tropias, or a high prevalence of intractable amblyopia in older, previously treated participants. Although binocular treatments show promise, particularly in younger children, more research must be conducted to determine the most effective way to implement binocular treatment for maximum visual improvement, and to tease apart the mechanisms by which visual improvement occurs. Advanced binocular treatments have the potential to be added to the repertoire of standard-of-care treatment for childhood amblyopia, but questions remain to be answered before they can be used nationally and internationally in clinical settings.

Baseline and clinical factors associated with response to binocular amblyopia treatment

We previously reported results from our primary cohort (n = 28) enrolled in a randomized clinical trial (NCT02365090) that reported binocular amblyopia treatment was effective in treating childhood amblyopia and more efficacious than patching (Kelly, Jost et al JAMA Ophthalmol 2016). Completion of enrollment into our preplanned secondary cohort combined with the primary cohort (n = 48), has now provided sufficient power to determine whether there exist baseline and/or clinical factors that are predictive of response to binocular treatment.

Current Management of Childhood Amblyopia.

Amblyopia is defined as the reduction of best-corrected visual acuity of one or both eyes caused by conditions that affect normal visual development. The basic strategy to treat amblyopia is to obtain a clear retinal image in each eye and correct ocular dominance through forced use of the amblyopic eye. Treatment modalities include correcting any underlying organic disease, prescribing appropriate optical correction, and providing occlusion/penalization therapy for the non-amblyopic eye. Given the success of amblyopia treatment declines with increasing age, the detection and management of amblyopia should begin as early as possible during the sensitive period for visual development. Proper management of amblyopia during childhood can reduce the overall prevalence and severity of visual loss. This study aims to provide an update for the management of childhood amblyopia to provide better visual outcomes.