Occlusion Therapy In Children Research Articles

Visual Outcome of Occlusion Therapy in Anisometropic Amblyopia

Background: Amblyopia is a common visual disorder in children, often treated with occlusion therapy. This study aimed to assess the visual outcomes following occlusion therapy in children with anisometropic amblyopia, focusing on improvements in best-corrected visual acuity (BCVA) over a six-month period. Methods: This cross-sectional study was conducted in Shaheed Monsur Ali Medical College Hospital, Dhaka, Bangladesh during the period from January 2015 to August 2015. Participants underwent occlusion therapy, where the better-seeing eye was covered for varying durations based on initial BCVA. Visual acuity was measured using the Snellen chart and converted to logMAR units at baseline, and after 1, 3, and 6 months of therapy. Statistical analysis was performed using Pearson’s correlation test. Results: The mean BCVA improved significantly from 0.88±0.28 at baseline to 0.55±0.21 after 1 month, 0.42±0.15 after 3 months, and 0.23±0.12 after 6 months (p < 0.001 for all comparisons). Among the participants, 68% had hypermetropia, 22% had astigmatism, and 10% had myopia. The majority of participants (68%) had anisometropic amblyopia in the right eye. The age distribution was 32% aged 5-7 years, 47% aged 8-9 years, and 21% aged 10-11 years, with a mean age of 8.64 years. Gender distribution was 64% male and 36% female. Conclusion: Occlusion therapy significantly improves visual acuity in children with anisometropic amblyopia, with early and consistent treatment yielding the best results. These findings support the continued use of occlusion therapy as an effective treatment modality, even when initiated later in childhood. Future research should explore long-term outcomes and complementary treatment approaches.

Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress

Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC). To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning. This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023. Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day). At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and χ2 tests were used to compare outcomes by amount of patching. Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points). Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.

Effectiveness of the smartphone application in increasing compliance with occlusion therapy in children with amblyopia: a randomized controlled trial

ABSTRACT Aim: To determine the effectiveness of the Amblyopia Treatment Chulalongkorn University (ATCU) application in improving compliance to occlusion therapy in amblyopic children. Methods: We developed a smartphone application called Amblyopia Treatment Chulalongkorn University (ATCU), which includes education, patching calendar, mini-games, and notifications, offering caregivers a comprehensive tool to enhance amblyopia treatment adherence through informative content, interactive features, and personalized reminders. Children aged 4–12 years with strabismic, anisometropic, deprivation, or mixed-type amblyopia were recruited and randomly assigned to either use ATCU application to facilitate eye patching (group A) or receive standard care (group B). Compliance with eye patching (primary outcome) was measured as a percentage of actual patching hours which were subjectively reported by caregivers, compared to prescribed patching hours, assessed at 1 and 3-month follow-up. Secondary outcomes include best corrected visual acuity (BCVA). Results: Between October 2018 and December 2019, 45 children were enrolled in our study, with all meeting eligibility criteria. One participant was lost to follow-up, and only one child was newly diagnosed with amblyopia, while the others had undergone patching as a prior treatment. At 1-month, compliance was significantly higher in group A (85%) than in group B (64%) [median difference 22% (95% CI, 3 to 48; p = .037)]. At 3-months, the compliance was also higher in group A (80%) than group B (55%), but not significantly [median difference 13% (95% CI, −6 to 30; p = .096)]. BCVA improvement in group A was higher than group B at both follow-up periods [mean difference 0.04 logMAR (95% CI, 0.01 to 0.07; p = .025) at 1-month and 0.04 logMAR (95% CI, 0.01 to 0.08; p = .022) at 3-month follow-up]. Conclusion: The ATCU application significantly improved compliance with occlusion therapy at 1-month. This application may be helpful as an adjunctive tool in the treatment of amblyopia.

Stereoacuity after Successful Occlusion Therapy in Children with Anisometropic Amblyopia

Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity.Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group.Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test.Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.

Amblyopia therapy in children with penetrating corneal injuries.

BACKGROUND:The role of part-time occlusion therapy in children with penetrating ocular injuries has not been studied. The aim of the study is to analyze the role of part-time occlusion therapy in children with penetrating ocular trauma following surgical intervention.MATERIALS AND METHODS:This is a retrospective case series with a median follow-up of 17 months (range: 3–105 months). The study was carried out at a tertiary referral center. Consecutive children with penetrating corneal tear injury who underwent surgical intervention were included in the study. These patients were subjected to part-time occlusion, and those with good compliance and follow-up were included in the study. The role of part-time occlusion therapy in children with ocular trauma is studied.RESULTS:There were 26 patients included in the study of which 23 were male and 3 were female, with a median age at presentation of 5 years (range: 1–11 years). The vision following surgical intervention at 6 weeks was 0.85 logMAR units (range: 0.3–2.8). Final median visual acuity was 0.48 logMAR units (range: 0–2). Paired t-test done for improvement in visual outcome before and after amblyopia therapy was statistically significant (P = 0.007).CONCLUSION:Amblyopia therapy shows promising results for patients following penetrating intraocular injury despite corneal scar in the visual axis in our group. A study on larger population is indicated.

Quality of life and mental health in amblyopic children treated with and without occlusion therapy

To assess the long-term (≥1year) psychosocial effects of occlusion therapy in children with refractive amblyopia and their caregivers. Multiple self-reported questionnaires were used to investigate HRQoL, anxiety, depression, and stress in a cross-sectional study of children with refractive amblyopia and their caregivers. Children were divided into two subgroups: those treated with glasses only and those treated with both glasses and occlusion therapy who had stopped wearing a patch at least 1year earlier. A total of 79 children were included: 32 in the refraction-only group and 47 in the glasses+occlusion group. Median age of subjects was 12years (IQR=3.0). Mean age of the 79 caregivers was 41.9±5.0years. No significant differences were found for any of the psychosocial outcomes analyzed between children treated with glasses and patching and those treated with glasses only. The differences remained insignificant between children according to age of first occlusion (<6 vs≥6years). The only significant (but not clinically relevant) difference observed for caregivers was a higher score in the depression dimension of the Hospital Anxiety and Depression Scale for caregivers of children treated with glasses only (P=0.036; effect size=0.23). In our study cohort, patching was not associated with long-term negative psychosocial outcomes in children with refractive amblyopia treated with occlusion therapy.

Comparative evaluation of binocular visual stimulation versus occlusion therapy in children with anisometropic amblyopia

Comparative evaluation of binocular visual stimulation versus occlusion therapy in children with anisometropic amblyopia

Monitoring occlusion therapy in amblyopic children using pattern visual evoked potential

Background Amblyopia is a unilateral or bilateral reduction of best-corrected vision that cannot be attributed only to a structural abnormality of the eye. It is a common childhood problem, and can be reversed if treated while the visual system is still maturing. Objective The aim of the present study was to investigate the role of pattern visual evoked potential (PVEP) in the assessment of visual function after occlusion therapy for children with unilateral strabismic amblyopia. Patients and methods Visual function was assessed clinically and using monocular PVEP, elicited by high-contrast checkerboard-patterned stimuli, before and after occlusion of the healthy eye for 1 week for every year of life in 20 children presenting with unilateral strabismic amblyopia. Results PVEP responses were significantly prolonged in latency in amblyopic eyes after the first assessment compared with nonamblyopic eyes. There was no significant difference in the interside amplitude. Assessment after occlusion showed a statistically significant reduction in the latency of the amblyopic eye and statistically significant improvement in the visual acuity. Conclusion PVEP can be used as a method of assessment of visual function after the occlusion therapy for children with unilateral strabismic amblyopia.

Randomised comparison of three tools for improving compliance with occlusion therapy: an educational cartoon story, a reward calendar, and an information leaflet for parents

We previously demonstrated that compliance with occlusion therapy for amblyopia was improved by the use of an educational programme, especially in children of parents of foreign origin and who spoke Dutch poorly. The programme consisted of: (i) a cartoon story for amblyopic children that explained without words why they should patch, (ii) a calendar with reward stickers, and (iii) an information leaflet for parents. In the current study, we assessed the individual effect of each component on compliance. We recruited 120 3- to 6-year-old children who lived in a low socio-economic status (SES) area in The Hague and were starting occlusion therapy for the first time. They were randomised to receive one of the components (three intervention groups), or a picture to colour (control group). The randomisation was blinded for treating orthoptist and researcher. Compliance was measured electronically using the Occlusion Dose Monitor (ODM). Primary outcome was percentage of compliance (actual/prescribed occlusion time). Secondary outcome was absolute occlusion hours per day. Parental fluency in Dutch was rated on a five-point scale. Compliance could be measured electronically in 88 of the 120 children; in 32 others, it failed for various reasons. Parental fluency in Dutch was moderate or worse in 36.4 % (p = 0.327). Average compliance was 55 % standard deviation (SD) 40 (n = 18) in the control group, 89 % SD 25 in the group receiving the educational cartoon (n = 25, P = 0.002 compared with control group), 67 % SD 33 (n = 24, P = 0.301) in the reward-calendar group and 73 % SD 40 (n = 21, P = 0.119) in the parent-information-leaflet group. On average, children in the control group occluded 1:46 SD1:19 hours/day, 2:33 SD 1:18 hours/day in the group receiving the educational cartoon, 1:59 SD 1:13 hours/day in the reward-calendar group and 2:18 SD 1:13 hours/day in the parent-information-leaflet group. No child who received the cartoon story occluded less than 1 hour per day, against seven in the reward-calendar group, five in the parent-information-leaflet group and five in the control group. Although all three components of the programme improved compliance with occlusion therapy in children in low-SES areas, the educational cartoon had the strongest effect, as it explained without words to a 4- to 5-year-old child why it should wear the eye patch.

Part-Time Occlusion Therapy for Anisometropic Amblyopia Detected in Children Eight Years of Age and Older

PurposeTo determine the outcome of part-time occlusion therapy in children with anisometropic amblyopia detected after they were 8 years of age.MethodsWe analyzed 29 eyes with anisometropic amblyopia in children 8 years of age and older. The mean age was 8.79±0.98 (range 8~12) years old. The subjects whose best-corrected visual acuity (BCVA) did not improve by two lines or better within 2 weeks of wearing glasses full-time were prescribed occlusion therapy for 6 hours a day outside of school hours, along with the instruction to wear glasses full-time. Subjects who complied with occlusion for more than 3 hours a day were considered to comply well.ResultsThe major component of the anisometropia was hyperopia in 51.7% of the subjects, and hyperopia plus astigmatism was found in 24.1%. The mean pretreatment BCVA score was 0.51±0.23 (LogMAR). Compliance was 89.66%. The mean posttreatment BCVA was 0.03±0.01 (LogMAR), and the success rate, based on a posttreatment BCVA of 0.1 (LogMAR) and better, was 96.43%. It took an average of 4.79±3.35 months to reach the desired posttreatment BCVA. The mean posttreatment stereopsis was 79.78±37.61 seconds of arc. The recurrence rate was 8%. The visual improvement was related to the degree of compliance (p=0.000). The time taken to reach the posttreatment BCVA was shorter in subjects with a better pretreatment BCVA (p=0.019), but it did not relate to the compliance (p=0.366).ConclusionsThe most common component of anisometropia detected after 8 years of age was hyperopia. The part-time occlusion therapy, which had been carried out after school hours, was successful in most cases.

Intermediate spatial frequency letter contrast sensitivity: its relation to visual resolution before and during amblyopia treatment

We examined the loss of letter contrast sensitivity (LCS) measured using the Pelli-Robson chart, and the extent to which any such loss was modulated by spectacle wear and occlusion therapy in children participating in an amblyopia treatment trial. Their initial mean interocular difference in logMAR acuity was approximately three times that of their LCS (0.45 vs 0.14 log units). Log LCS was weakly though significantly correlated with logMAR visual acuity (VA) for all VAs better than 0.90 (r = -0.19, 95% CI: -0.28 to -0.10) whereas for all VAs of 0.90 or poorer, log LCS was markedly and significantly correlated with VA (r = -0.72, 95% CI: -0.83 to -0.53). LCS in those children with a > or =0.1 log unit interocular difference on this test improved commensurately with VA during treatment. We conjecture that the spatial visual loss in all but the most severe amblyopes occurs in an area of resolution and contrast space that lies beyond that sampled by the Pelli-Robson chart.

The effect of increasing doses of levodopa on children with strabismic amblyopia

Purpose: The purpose of this study was to determine the efficacy and tolerance of a levodopa/carbidopa combination and to test its dose-effect response when combined with occlusion therapy for children with amblyopia. Methods: A 1-week randomized, double-blind, parallel, and placebo-controlled study was performed with 78 children with amblyopia aged between 7 and 17 years. Children who weighed less than 40 kg were randomly assigned to receive 5, 10, or 20 mg of levodopa or placebo (3 times a day), and those who weighed 40 kg or more were randomly assigned to receive 10, 20, or 40 mg of levodopa or placebo. Subjects were instructed to occlude the dominant eye (3 h/d). Snellen visual acuity was measured at baseline and at 2 hours after ingestion of the last capsule. Compliance with occlusion and capsule consumption was verified by a questionnaire and counting capsules. Adverse effects were checked with a physical examination and a questionnaire. Results: From baseline to the follow-up test trial, the improvement in the logarithm of the Snellen fraction was 0.05 ± 0.11 in the placebo group, 0.18 ± 0.21 in group I, 0.08 ± 0.11 in group II, and 0.16 ± 0.15 in group III ( P = .031). Visual acuity improved from 0.59 to 0.45 in the levodopa/carbidopa group and from 0.69 to 0.63 in the control group ( P = .023). The compliance with occlusion was similar in all groups. No one complained of adverse side effects. Conclusion: Levodopa, at an average dose of 0.51 mg/kg per day, is well tolerated and produces a clinical and statistically significant short-term improvement of visual acuity in children with amblyopia. (J AAPOS 1999; 3:337-40)

Effect Of Prolonged Monocular Occlusion On Latent Nystagmus

The authors recorded nystagmus during seeing with one eye in eight patients with latent nystagmus (LN) before and after two or three days of prolonged occlusion of the better eye (POBE). Before POBE, the slow-phase speed of the nystagmus (SPS) was usually higher when the better eye was covered. After POBE, the SPS during cover of the better eye had decreased and the SPS during cover of the poorer eye had increased (please note the time difference between ‘prolonged occlusion’ and ‘cover'). However, the sum of the two speeds (absolute values, for they were opposite in direction) remained the same in all cases. This indicates that the principal component of the LN, the difference between LN with right-and LN with left-eye cover, remained the same, but a drift towards the poorer eye had been added that decreased the SPS during cover of the better eye and increased the SPS during cover of the poorer eye. In three patients who had oscillopsia during POBE, the oscillopsia gradually decreased over days during POBE, indicating that the drift changes slowly, over a period of days. As regards occlusion therapy in children with amblyopia and latent nystagmus, based on these findings, it seems advisable to occlude the better eye during days per week, rather than during hours per day: Then there is more time for the nystagmus to decrease, so that amblyopia therapy can be more effective.