Hyperopic Anisometropia Research Articles

Assessment of the effects of myopic and hyperopic anisometropia on choroidal vascular structure in children using SS-OCTA.

To compare large- and medium-sized choroidal vascularity and the choriocapillaris (CC) flow area in children with different refractive errors using swept-source optical coherence tomography angiography (SS-OCTA). Forty-two anisometropic children were enrolled and divided into hyperopic anisometropia (HA) and myopic anisometropia (MA) groups. SS-OCTA was performed to analyse choroidal vascularity. Mean choroidal thickness (CT), choroidal vascularity volume (CVV), choroidal vascularity index (CVI) and CC flow area were compared between the two eyes. The inter-ocular differences between the two groups were also determined. Mean CT and CVV were highest in eyes with shorter axial lengths in both refractive groups, and the difference between the two eyes was positively correlated with the difference in axial length at the foveal region. Significant differences in the CVI in the MA group were only found in the parafoveal region. Inter-ocular differences in the CC were significantly reduced in eyes with longer axial lengths in the foveal and parafoveal regions of the HA and MA groups, respectively. Comparing inter-ocular differences, CC was significantly greater in the parafoveal region of the MA group than the HA group. All layers of choroidal vasculature were thinner in eyes with longer axial lengths in all groups. The inter-ocular CC difference was greater in the MA than in the HA group, with similar differences in axial length. This suggests that both medium-to-large choroidal vascular and choroidal capillaries may play a role in myopia development.

Prevalence of anisometropia and its associated factors in school-age children

ABSTRACT Purpose To determine the prevalence of anisometropia and the associated demographic and biometric risk factors in children. Methods This cross-sectional study was conducted on the elementary school children of Shahroud, east of Iran, in 2015. All rural students were recruited, while multistage cluster sampling was used to select the students in urban areas. All children underwent optometric examinations including the measurement of uncorrected and corrected visual acuity, autorefraction, and subjective refraction with cycloplegia. Biometric components were measured using the Allegro Biograph. Myopia and hyperopia were defined as a spherical equivalent ≤−0.5 and ≥ +2.00 diopter, respectively. Students with a history of ocular trauma or lack of cycloplegic refraction at least in one eye were excluded from the study. Results Of 6624 selected children, 5620 participated in the study. After applying the exclusion criteria, the data of 5357 students (boys: 52.8%, n = 2834) were analyzed. The mean age of the subjects was 9.2 ± 1.7 years (range: 6–12 years). The prevalence of anisometropia ≥ 1 D was 1.1% (95% CI: 0.8 to 1.4) in all children, 1.0% (95% CI: 0.7–1.3) in boys, 1.3% (95% CI: 0.8–1.7) in girls, 1.1% (95% CI: 0.8–1.4) in urban children, and 1.4% (95% CI: 0.5–2.3) in rural children. The prevalence of anisometropia was 8.8% (95% CI: 5.3–12.2) in myopic and 5.7% (95% CI: 2.8–8.5) in hyperopic children. Axial length asymmetry (OR = 40.9; 95%CI: 10.2–164.1), myopia (OR = 17.9; 95% CI: 9.4–33.9), and hyperopia (OR = 10.1; 95% CI: (5.1–19.7) were associated with anisometropia in multiple logistic regression model. More anisometropia was associated with more severe amblyopia. The odds of amblyopia (OR = 82.3: 38.2-177-3) and strabismus (OR = 17.6: 5.5–56.4) were significantly higher in anisometropic children. The prevalence of amblyopia was 21.7% in children with myopic anisometropia ≥ 3D, 66.7% in children with hyperopic anisometropia ≥ 3D, and 100% in cases with antimetropia ≥ 3D. Conclusion The prevalence of anisometropia was low in Iranian school children. However, a high percentage of anisometropic students had amblyopia and strabismus. Axial length was the most important biometric component associated with anisometropia.

Optic Coherence Tomography for Accommodation Control in Children with Hyperopic Anisometropia and Amblyopia

Optic Coherence Tomography for Accommodation Control in Children with Hyperopic Anisometropia and Amblyopia

Assessment of the effects of induced anisometropia on binocularity with glasses-free 3D technique.

To assess the effect of experimentally induced anisometropia on binocularity in normal adults with glasses-free three-dimensional (3D) technique. Totally 54 healthy medical students with normal binocularity in the cross-sectional study were enrolled. Anisometropia was induced by placing trail lenses over the right eye, in 0.5 D steps including lenses of -0.5, -1, -1.5, -2, -2.5 D (hyperopic anisometropia) and lenses of +0.5, +1, +1.5, +2, +2.5 D (myopic anisometropia). The glasses-free 3D technique was used to evaluated not only fine stereopsis, but also coarse stereopsis, dynamic stereopsis, foveal suppression, and peripheral suppression in these subjects. One-way analysis of variance was used to compare quantitative data such as fine stereopsis, coarse stereopsis. Pearson's Chi-square test was performed to compare categorical data such as dynamic stereopsis, foveal suppression and peripheral suppression. The subjects showed a statistically significant decline in fine stereopsis, coarse stereopsis, and dynamic stereopsis with increasing levels of anisometropia (P<0.001). Binocularity was affected when induced anisometropia was more than 1 D (P<0.05). Foveal suppression and peripheral suppression were evident and increased in proportion to anisometropia (P<0.001). The relatively low degrees of anisometropia may have a potentially significant effect on high-grade binocular interaction. The mechanisms underlying the defect of binocularity seem to involve not only foveal suppression, but also peripheral suppression.

Ocular blood flow evaluation by laser speckle flowgraphy in pediatric patients with anisometropia.

To determine the differences and reproducibility of blood flow among hyperopic anisometropic, fellow, and control eyes. We retrospectively studied 38 eyes of 19 patients with hyperopic anisometropia (8.2 ± 3.0 years of age) and 13 eyes of eight control patients (6.8 ± 1.9 years). We measured the optic nerve head (ONH) and choroidal circulation using laser speckle flowgraphy (LSFG) and analyzed the choroidal mean blur rate (MBR-choroid), MBR-A (mean of all values in ONH), MBR-V (vessel mean), MBR-T (tissue mean), and sample size (sample), which are thought to reflect the ONH area ratio, area ratio of the blood stream (ARBS). We then assessed the coefficient of variation (COV) and intraclass correlation coefficient (ICC) and compared the differences among amblyopic, fellow, and control eyes in MBR, sample, and ARBS. The ONH, MBR-A, MBR-T, and ARBS of amblyopic eyes were significantly higher than those of fellow eyes (P < 0.01, P < 0.05, and P < 0.05, respectively), and control eyes (MBR-A and ARBS, P < 0.05, for both comparisons). The sample-T (size of tissue component) in amblyopic eyes was significantly smaller than that in fellow and control eyes (P < 0.05). Blood flow in the choroid did not differ significantly between the eyes. The COVs of the MBR, sample, and ARBS were all ≤10%. All ICCs were ≥0.7. The COVs of pulse waveform parameter fluctuation, blowout score (BOS), blowout time (BOT), and resistivity index (RI) in the ONH and choroid were ≤10%. The MBR value of the LSFG in children exhibited reproducibility. Thus, this method can be used in clinical studies. The MBR values of the ONH in amblyopic eyes were significantly high. It has been suggested that measuring ONH blood flow using LSFG could detect the anisometropic amblyopic eyes.

Отдаленные (10-летние) клинико-функциональные результаты ФемтоЛАЗИК у ребенка с гиперметропией, гиперметропической анизометропией и амблиопией

Purpose. Evaluation of 10-year clinical and functional results of femtolaser-assisted in situ keratomileusis (FemtoLASIK) in a child with high hyperopia, hyperopic anisometropia and amblyopia. Patient Ch., 8 years old after an ineffective two-year conservative treatment, the FemtoLASIK operation was done. Visual acuity and refraction OD = 0,05 sph +5,5 = 0,1; OS = 0,6 sph +1,25 = 0,7. Cycloplegic refractometry by the spherical component OD – sph 7.25; cyl –0.50, ax 72°, OS – sph 1.25; cyl –0.00, ax 0. The value of anisometropia was 6,0 diopters. The vision was monocular. Results. During 10 years after FemtoLASIK and conservative treatment the uncorrected visual acuity of the operated eye was changed from 0,05 to 0,3; corrected visual acuity – from 0,1 to 0,4. Cycloplegic refractometry was changed from +7,25 to +2,50 diopters, anisometropia decreased from +6.0 to +1.75 diopters, vision became binocular. During the examination of unbiased adaptation on the Righton Speedy-K device, the accomodogramma of a lazy eye became more stable (proof of stability tended to the lower limit of normal and amounted to 0.27 conventional units and less tense (the microfluctuation coefficient reached normal values and amounted to 56.22µF/min). Objective reserves of accommodation of both eyes with the use Grand Seiko WR-5100K «open field» autorefractometer was –2,0. The accommodation was stability. Conclusion. Thus, FemtoLASIK in a child with high hyperopia and 6.0 diopters anisometropia due to a decrease in the degree of refractive disturbance and aniseikonia resulted in the creation of favorable conditions for increasing visual functions, reducing the degree of amblyopia and eliminating anisoaccomodation in the conservative treatment. Key words: accommodation, FemtoLASIK, hyperopia, anisometropia

Changes in accommodation in children with hyperopic anisometropia and unilateral amblyopia after laser refractive surgery and pleoptic treatment

This study comparatively analyzes the state of accommodation in children with hyperopic anisometropia and amblyopia after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) combined with pleoptic treatment, and after conventional pleoptic treatment. The first group consisted of 30 children with medium and high hyperopia, high and medium amblyopia, and anisometropia greater than 3.0 diopters, who underwent Femto-LASIK in the amblyopic eye. The second group consisted of 28 children with similar local status, who were prescribed traditional correction and received conservative treatment. The follow-up period was 1.5 years. After 1.5 years, higher visual acuity (p<0.05) was achieved in the first group. A significant increase in the coefficient of accommodative response (CAR) was observed in the operated amblyopic eyes in group 1 - by 0.1±0.02 c.u. compared to the control group (p<0.05). In both groups there was an upwards trend for the coefficient of microfluctuations (CMF) in the amblyopic eye, but in the first group CMF increased more significantly (p<0.05). The objective accommodative response (OAR) and positive relative accommodation (PRA) of the amblyopic eye showed a double increase - by 1.0±0.23 and 0.9±0.38 diopters, respectively, at the end of treatment in the first group. The increase in similar indicators in the second group was insignificant (p<0.05). In children of the first group the difference in ciliary muscle thickness (CMT) of the amblyopic eye with disabled and enabled accommodation increased by 0.04±0.01 mm (p<0.05) in the anterior part of the ciliary muscle at the levels of CMTmax and CMT1. The data obtained in this study indicate the strong effect of refractive laser surgery in combination with pleoptic treatment on improving the visual acuity and the state of accommodation of the amblyopic and paired dominant eyes in children with hyperopic anisometropia, in contrast to conventional methods of treatment.

Сравнительная оценка эффективности рефракционной лазерной коррекции и контактной коррекции в лечении нарушений аккомодации у детей с гиперметропической анизометропией и амблиопией

Purpose. А comparative study of accommodation disorders during the treatment of amblyopia in children with hyperopic anisometropia and amblyopia after femtolaser-assisted laser intrastromal keratomileusis (FS-LASIK) and children with contact correction. Material and methods. All of the patients were divided into two groups: I group consisted of 20 children who had FS-LASIK, performed according to indications in the amblyopic eye and II group consisted of 12 children who had contact correction. Results. After one year, the objective accommodative response (OAR) of the amblyopic eye was –1.8 ± 0.2 diopters in the 1st group and –1.42 ± 0.55 diopters in the 2nd group (рm-u = 0.04). At the end of the period, the first and second groups' objective reserves of relative accommodation (ORRA) were –1.5 ± 0.3 and –1.4 ± 0.4, respectively. The accommodogram coefficients also increased. The coefficient of accommodative response (CAO) in the first group was 0,1 ± 0,06 conv. units and microfluctuations coefficient (CMF) was 63,5 ± 4,1µF/min. CAO in the second group was within 0,0 ± 0,1 conv. units (рm-u = 0.12), CMF was 60.6 ± 4.0µF/min (рm-u = 0.05). Conclusion. The use of a soft contact lens in children provides a complete correction and improves amblyopic eye accommodation, resulting in an increase in OAR, ORRA and CMF. At the same time, the increase in OAR, CMF and CAO in children after femtosecond laser intrastromal keratomileusis in situ is more effective (p &lt; 0.05). The improvement of these indicators is associated with the provision of permanent full correction of the amblyopic eye. Keywords: anisometropia, hypermetropia, FS-LASIK, contact correction

Anterior Chamber Iris-Fixated Phakic Intraocular Lens Implantation for Treatment of High Anisometropia in Children: Long-term Results.

To evaluate the long-term efficacy of anterior chamber iris-fixated phakic intraocular lens (PIOL) implantation in the treatment of high myopic (> -9.00 diopters [D]) or hyperopic (> +6.00 D) anisometropia in children with intolerance to spectacles or contact lenses. A total of 58 children with anisometropic myopia (range: -9.25 to -18.50 diopters [D]) and 13 children with anisometropic hyperopia (range: +6.00 to +8.50 D) underwent unilateral iris-claw PIOL implantation from 2008 to 2018. The mean age was 6.7 years. The mean follow-up was 38.5 months. Target refraction was emmetropia. The cycloplegic refraction (mean spherical equivalent) improved from -12.47 D (range: -9.25 to -18.50 D) to -0.73 D (range: +0.75 to -1.50 D) in myopic eyes and reduced from +7.15 D (range: +6.00 to +8.50 D) to +0.94 D (range: -0.50 to + 1.75 D) in hyperopic eyes. Eighty-four percent of eyes were corrected to within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity (UDVA) improved from 1.74 ± 0.36 to 0.45 ± 0.28 logarithm of the minimum angle of resolution (logMAR) (P = .0014). The mean corrected distance visual acuity (CDVA) changed from 0.68 ± 0.32 to 0.27 ± 0.15 logMAR (P = .02179). The safety index was 2.18 and the efficacy index was 1.51. The mean preoperative endothelial cell count of 2,874.7 cells/mm2 changed to 2,685.3 cells/mm2 at 2 to 6 years postoperatively. Binocular vision quality was improved in 55 patients. No patient had serious complications or lost any Snellen lines of CDVA. Iris-fixated PIOL implantation is an effective and safe method in the treatment of high anisome-tropic myopia and hyperopia and amblyopia in pediatric patients who are noncompliant with spectacles or contact lenses. [J Pediatr Ophthalmol Strabismus. 2023;60(3):203-209.].

Analysis of Macular Retinal Thickness and Microvascular System Changes in Children with Monocular Hyperopic Anisometropia and Severe Amblyopia.

Objective To study the changes of macular retinal thickness and microvascular system in children with monocular hyperopic anisometropia and severe amblyopia using optical coherence tomography angiography (OCTA) and to explore the value of OCTA in the diagnosis and treatment of amblyopia. Methods Thirty-two children with monocular hyperopic anisometropia and severe amblyopia who were treated in the Department of Ophthalmology of the First Affiliated Hospital of Gannan Medical College from January 2020 to December 2020 were included in the study. Eyes with amblyopia (n = 32) served as the experimental group, and the contralateral healthy eyes (n = 32 eyes) served as the control group. All children underwent comprehensive ophthalmological examination including slit lamp, eye position, visual acuity, optometry, eye movement, intraocular pressure, ocular axis, and fundus examination to rule out organic lesions. Macular 6 mm × 6 mm scans were performed on both eyes of all subjects by the same experienced clinician using an OCTA instrument. After ImageJ processing, the vessel density, inner layer, and full-layer retinal thickness (RT) of superficial retinal capillary plexus (SCP) were obtained. All data were analyzed by SPSS21.0 software, and a paired t-test was used for comparison between groups. P < 0.05 was considered to indicate statistical significance. Results The vessel densities of macular SCP in the amblyopia and control groups were 47.66 ± 2.36% and 50.37 ± 2.24% in the outer superior, 49.19 ± 2.64% and 51.44 ± 2.44% in the inner inferior, 49.63 ± 2.51% and 51.41 ± 3.03% in the outer inferior, and 45.56 ± 3.44% and 50.44 ± 3.52% in the outer temporal regions, respectively. The vessel density of macular SCP in the amblyopia group was significantly lower than that in contralateral healthy eyes in the outer superior, inner inferior, outer inferior, outer temporal, and central regions. There was no significant difference between the two groups in the inner superior, inner nasal, outer nasal, and inner temporal regions. The macular RT in the amblyopia group and the control group is 90.38 ± 6.09 μm and 87.56 ± 5.55 μm in the outer temporal, respectively. The RT in the macular inner layer in the outer temporal region of the amblyopia group was thicker than that of the control group (P < 0.05). There was no significant difference in the other eight regions between the two groups. The whole macular RT in the amblyopia group was thicker than that in the control group in nine regions, and the central area of macular RT in the amblyopia and control groups was 229.06 ± 6.70 μm and 214.50 ± 10.36 μm, respectively. Conclusion The OCTA results showed the overall RT of macula in 9 areas in the amblyopia group was thicker than that in the control group, which could show that the macular retinal thickness can be a potential way to distinguish the children with monocular hyperopic anisometropia and severe amblyopia.

Association between Anisometropia as Well as Visual Acuity, Aniseikonia, and Stereopsis in the Absence of Strabismus

Objective: The current study aimed to assess the association between the type of anisometropia and its effects on monocular and binocular best-corrected vision acuity (BCVA), aniseikonia, and stereopsis in the absence of strabismus. Methods: In total, 162 individuals with anisometropia and healthy eyes and without a previous history of amblyopia therapy and eye surgery were included in the analysis. According to spherical and cylindrical components and spherical equivalent, they were divided into the spherical hyperopic anisometropia (SHA, n = 31), spherical myopic anisometropia (SMA, n = 45), astigmatic or cylindrical hyperopic anisometropia (CHA, n = 22), and astigmatic or cylindrical myopic anisometropia (CMA, n = 64) groups. Patients without anisometropia (NA, n = 188) were classified under the control group. The effects of anisometropia on monocular and binocular BCVA, aniseikonia, and stereoacuity were examined. Results: The NA group had a significantly lower LogMAR of BCVA of the right eye (RE), left eye (LE), worse eye than the SHA, SMA, CMA, and CHA groups. Moreover, the SMA group had significantly lower LogMAR of BCVA than the CHA group (p 10 arc seconds than the CHA (p 10 arc seconds than the CMA (p 10 arc seconds (r = 0.160; p = 0.041). Conclusion: Worse visual levels of the RE, LE, worse eye, BCVA difference, and lower stereopsis were evidenced in each type of anisometropia defined in this study. Cylindrical hyperopic anisometropia (CHA) resulted in a statically significant worsening VA level and stereopsis than cylindrical myopic (CMA) or spherical myopic anisometropia.

Hyperopic anisometropia with a shorter axial length ipsilateral to the ptotic eye in children with congenital ptosis

BackgroundTo investigate the clinical characteristics of children with congenital ptosis, with particular attention given to the incidence of anisometropia, and the difference in axial length (AL) between the right and left eyes.MethodsThe medical charts of 55 patients with congenital ptosis at Niigata University Medical and Dental Hospital were retrospectively analyzed. Clinical characteristics, including age, cycloplegic refraction, AL, and the presence of amblyopia and its causes were analyzed.ResultsAge at the initial visit was 16 ± 20 (mean ± standard deviation, the same applies below) months. Of the 49 patients whose cycloplegic refraction was measured, hyperopic anisometropia, defined as ≥ one-diopter difference in spherical equivalent (SE), was observed in 1/11, 9/27 and 5/11 patients with bilateral, right, and left ptosis, respectively. Among 14/38 patients with hyperopic anisometropia involving unilateral ptosis, 13 demonstrated a larger SE in the ptotic eye than in the non-ptotic eye. The inter-eye difference in AL (AL of the ptotic eye minus that of the non-ptotic eye) in six patients with unilateral ptosis and hyperopic anisometropia ipsilateral to the ptotic eye (-0.29 ± 0.40 mm) was significantly smaller than that in three patients with unilateral ptosis and no hyperopic anisometropia (0.38 ± 0.29 mm).ConclusionsAt our institute, children with congenital ptosis had a high incidence of hyperopic anisometropia ipsilateral to the ptotic eye. Furthermore, this condition was associated with a shorter axial length. These results indicate that refractive correction for hyperopic anisometropia is important for proper visual development in children with congenital ptosis.

Сравнительный анализ аккомодационной способности у детей с гиперметропией, анизометропией, амблиопией после интрастромального кератомилеза с фемтолазерным сопровождением

Purpose. Analysis of the accommodative ability in children with hyperopic anisometropia, amblyopia of operated amblyopic and paired leading eyes after femtolaser-assisted laser intrastromal keratomileusis (FS-LASIK). Material and methods. In the 1st group were 20 children with hyperopic anisometropia and amblyopia after FS-LASIK. In the 2nd were children receiving conservative treatment. Results. After 6 months, when analyzing the accommodation, the coefficient of the accommodative response (CAR) of amblyopic eye in the 1st group was 0.05±0.07 conv. units, in the 2nd group was -0.1±0.19 conv. units (рm-u=0.03). The microfluctuation coefficient (CMF) of the amblyopic eye was increased, but the CMF of the paired leading eye in children after FS-LASIK approached the norm and amounted to 58.4±5.4 µF / min. In the conservative treatment group CMF remained high and was 60.8±4.44 µF / min (рm-u= 0.08). The objective accommodative response of the amblyopic eye in the 1st group increased by -1.13±0.03 diopters, in the 2nd group – by -0.82±0.48 diopters (рm-u=0.05). Conclusion. FS-LASIK helps to improve the accommodative ability in children with hyperopia, anisometropia and amblyopia. Key words: accommodation, hyperopia, anisometropia, amblyopia, FS-LASIK.

Clinical case of intraocular correction of high-degree anisometropia

The paper describes a clinical example of the intraocular correction of high-grade hyperopic anisometropia. Surgical treatment made it possible to restore binocular vision, obtain high visual functions without additional correction, preserve the accommodative ability of the eye, and achieve rapid visual rehabilitation.

Evaluation of Corneal Optic Quality in Amblyopia

Objective: To compare corneal aberrations and densitometry values in children with amblyopia due to anisometropic hyperopia with those of healthy children.&#x0D; Methods: This study included 173 children with amblyopia due to hyperopic anisometropia in one eye and 173 children with both healthy eyes. The amblyopic eye (Group 1) and the fellow normal eye (Group 2) of the amblyopic patients and the right eye of the healthy control group (Group 3) were evaluated. Of the corneal aberration and corneal densitometry (CD)measured using Scheimpflug corneal topography values were noted.&#x0D; Results: While there was a significant difference in total root mean square (RMS), higher-order aberration (HOA) RMS, coma horizontal, trefoil horizontal and spherical aberration values between the groups (p

Effects of Simulated Hyperopic Anisometropia on Reading Performance in Young Adults

Effects of Simulated Hyperopic Anisometropia on Reading Performance in Young Adults

The Effect of Myopia and Hyperopic Anisometropia to Binocular Accommodative Response

Purpose : The purpose of this study was to measure binocular accommodative response when hyperopic and myopic anisometropia were induced on non-dominatn eye.Methods : Twenty participants (mean age: 24.05±1.73) who had corrected visual acuity more than 0.0 logMAR and no eye disease or systemic disease were recruited. The contact lenses with +1.00, +2.00, -1.00, -2.00 D were monocularly worn on non-dominant eye. The accommodative responses were measured by a binocular open-field autorefractometer when participant fixates target (accommodative stimulus) at 300, 40, and 20 cm.Results : As the accommodative stimulus distance decreased, the amount of accommodative response increased in both eyes (p<0.050). There was significant difference of accommodative responses by different degree of anisometropia (p<0.050). When –2.00 D hyperopic anisometropia was induced, both eyes showed the highest accommodative responses at 40 cm (dominant eye 1.50±0.11 D, non dominant-eye 1.71±0.09 D). When comparing accommodative responses by the type of anisometropia, there was a significant differences in both the dominant and nondominant eyes at 20 cm when inducing 1.00 and 2.00 D in myopic and hyperopic anisometropia (p<0.050). At 40 cm, there was a significant differences in both the dominant and non-dominant eyes when inducing 1.00 in myopic and hyperopic anisometropia (p<0.050). In addition it showed that the higher the degree of myopia and hyperopia, the higher the difference in accommodative response on both eyes and the difference was significant between 40 and 20 cm (p<0.050).Conclusion : There is a difference in the amount of accommodative response between dominant and non-dominant eye when anisometropia was induced. Regardless of the type, the environment that causes the difference in the amount of accommodative response between both eyes causes eye fatigue, so to prevent such a situation, not only the examination on accommodative response of both eyes, but also regular and continuous management is necessary. Also, a prescription for glasses and addition considering the difference between the two eyes is required.

Choroidal vessel density in unilateral hyperopic amblyopia using en-face optical coherence tomography

BackgroundStructural changes of the choroid, such as choroidal thickening, have been indicated in amblyopic eyes with hyperopic anisometropia as compared to fellow or healthy eyes. The purpose of the present study was to investigate choroidal vascular density (CVD) in children with unilateral hyperopic amblyopia.MethodsThis study included 88 eyes of 44 patients with unilateral amblyopia due to hyperopic anisometropia with or without strabismus and 29 eyes of 29 age-matched normal controls. The CVD of Haller’s layer was quantified from en-face images constructed by 3-dimensional swept-source optical coherence tomography images flattened relative to Bruch’s membrane. The analysis area was a 3 × 3-mm square of macula after magnification correction. Relationships between CVD and other parameters [best-corrected visual acuity (BCVA), refractive error and subfoveal choroidal thickness (SFCT)] were investigated, and CVDs were compared between amblyopic, fellow, and normal control eyes.ResultsMean CVD was 59.11 ± 0.66% in amblyopic eyes, 59.23 ± 0.81% in fellow eyes, and 59.29 ± 0.74% in normal control eyes. CVD showed a significant positive relationship with SFCT (p = 0.004), but no relationships with other parameters. No significant differences in CVD were evident among amblyopic, fellow, and normal control eyes after adjusting for SFCT (p = 0.502).ConclusionsCVD was unrelated to BCVA, and CVD did not differ significantly among amblyopic, fellow and normal control eyes. These results suggest that the local CVD of Haller’s layer is unaffected in unilateral hyperopic amblyopic eyes.

Does anisometropia affect the ciliary muscle thickness? An ultrasound biomicroscopy study.

To compare the ciliary muscle thickness (CMT) of the normal fellow eye to that of the amblyopic eye using ultrasound biomicroscopy (UBM) in patients with unilateral anisometropic amblyopia. Thirty patients with unilateral anisometropic amblyopia were involved. The patients were divided into two groups: 19 hyperopic and 11 myopic. Axial length (AL) was measured with optic biometry and anterior chamber depth (ACD), iris area, and CMT were measured with UBM. The mean age was 34.10 ± 6.61years. The mean spherical difference between two eyes was 2.59 diopter (D) in hyperopic patients and 3.77D in myopic patients. In the hyperopic patients, nasal CMT1(nCMT), temporal CMT1(tCMT), tCMT2, and tCMT3 values were statistically thinner in amblyopic eyes than healthy eyes (p = 0.036, p = 0.003, p = 0.023, p = 0.005, respectively). ACD values were statistically lower in amblyopic eyes (2.78 ± 0.26mm) than healthy eyes (2.90 ± 0.21mm) (p < 0.001). In the myopic patients, nCMT1, nCMT2, nCMT3, tCMT1, tCMT2, and tCMT3 values were statistically thicker in amblyopic eyes than healthy eyes (p = 0.003, p = 0.003, p = 0.005, p = 0.003, p = 0.003, p = 0.019, respectively). ACD values were statistically higher in amblyopic eyes (3.20 ± 0.30mm) than healthy eyes (3.06 ± 0.29mm) (p = 0.004). Also, there was no significant difference in the iris area between the amblyopic and normal eyes of the myopic and hyperopic patients (p > 0.05). Amblyopic eyes in patients with unilateral myopic anisometropia have thicker CMT and deeper ACD than healthy eyes. Conversely, amblyopic eyes in patients with unilateral hyperopic anisometropia have thinner CMT and shorter ACD than healthy eyes. There is a positive correlation between AL and CMT.

Pediatric Anisometropia: Case Series and Review

Background: The etiology and natural course and history of pediatric anisometropia are incompletely understood. This article reviews the literature regarding pediatric anisometropia with much of the review integrated into a case series. The review and case reports are intended to elevate clinical understanding of pediatric anisometropia including and especially treatment outcomes. Case Reports: Case one is anisomyopia with amblyopia that resulted in a poor treatment outcome despite outstanding compliance with prescribed spectacles, vision therapy, and occlusion. Case two is anisometropia caused by organic vision loss from optic neuritis early in life. Case three is an infant with hyperopic anisometropia and esotropia. The esotropia did not respond to spectacles and home based vision therapy. Neonatal high bilateral hyperopia that converted to anisometropia because of early onset cosmetically invisible unilateral esotropia is speculated. Case four describes a boy diagnosed with hyperopic anisometropia at age 11 months coincident with a diagnosis of pseudoesotropia. His compliance with prescribed spectacles was spotty until age three years. An outstanding visual outcome was achieved by age five years with spectacles only (no occlusion therapy). Case five concerns a boy who acquired hyperopic anisometropia because one eye experienced increasing hyperopia during his toddler years. His response to treatment, spectacles and part time occlusion with home vision therapy, was outstanding. Case six is an infant diagnosed with 2.50 diopters of hyperopic anisometropia at age six months. Monocular home based vison developmental activities, not glasses, were prescribed. Her anisometropia vanished three months later. Conclusions: Pediatric anisometropia presents and responds to treatment in a variety of ways that challenge clinical care. Etiology and age of onset, which usually elude clinicians, can explain this variety. Additional research is required to improve clinical outcomes.