Treatment Of Amblyopia In Children Research Articles

Identifying Potential Themes for the Child Amblyopia Treatment Questionnaire

Patient-reported outcome (PRO) instruments are increasingly common in both clinical practice and research. The data obtained from these instruments can be used to help inform decision making and policy-making decisions. The methodological approaches undertaken in developing PROs is not frequently reported. Literature on the development of the descriptive systems for PROs is sparse in comparison with that on the assessment of the psychometric properties of such instruments. The purpose of this study is to describe the results of qualitative interviews conducted to identify potential themes for the Child Amblyopia Treatment Questionnaire (CAT-QoL), a pediatric disease-specific health-related quality of life instrument for amblyopia designed for children aged 4 to 7 years. Semistructured interviews were undertaken with 59 children (aged 3 years 9 months to 9 years 11 months; average, 6 years 3 months) with amblyopia. The interviews were transcribed verbatim and imported into QSR NVivo 8. Interview transcripts were analyzed to identify potential items to be included in the descriptive system. Thematic content analysis was undertaken using Framework. Eleven potential themes were identified for inclusion in the CAT-QoL instrument, namely, physical sensation of the treatment, pain, being able to play with other children, how other children have treated them, ability to undertake schoolwork, ability to undertake other tasks, sad or unhappy, cross, worried, frustrated, and feelings toward family members. Children are able to identify their thoughts and opinions of their own health and to describe what impact their amblyopia treatment has had on their daily lives. Themes for the draft descriptive system for a pediatric self-reported amblyopia QoL instrument have been identified. A draft version of the CAT-QoL instrument has been developed. Further research is required to refine and assess the psychometric properties of the instrument.

Efficacy of split hours part-time patching versus continuous hours part-time patching for treatment of anisometropic amblyopia in children: a pilot study

AimTo compare efficacy of ‘split hours part-time patching’ and ‘continuous hours part-time patching’ for the treatment of anisometropic amblyopia.MethodsWe designed a prospective, interventional, non-randomised, comparative pilot study involving children between...

Developing the draft descriptive system for the child amblyopia treatment questionnaire (CAT-Qol): a mixed methods study.

BackgroundAmblyopia is a visual condition that occurs in childhood. Screening programmes exist within the United Kingdom (UK) to detect amblyopia, and once detected treatment is given.Existing patient reported outcome (PRO) measures for amblyopia do not meet current recommendations for the methods adopted during their development, or the way in which the instruments are administered. The overall aim of this study was to produce a self-complete PRO instrument for amblyopia for children aged 4–7 years that uses children’s responses in the development phase. The study comprised a number of stages. This paper reports on the refinement of the descriptive system for the draft instrument (the Child Amblyopia Treatment Questionnaire, CAT-QoL) using qualitative and quantitative methods.MethodsThe study consisted of three components. Children were asked to read, and complete the draft questionnaire as independently as possible. They were then asked about the questionnaire, and its format, in a cognitive debriefing exercise. Observations were made as to the child’s ability to read the questionnaire, particular attention was made as to which individual words participants struggled to read. Children were also asked their opinion on the design layout of the questionnaire. Finally, some children were asked to complete a ranking task to help determine the order of the levels of the items as judged by the children. Mid-rank scoring and statistical level of agreement were calculated for the ranking exercise.ResultsThirty-two (n=32) participants completed a draft questionnaire; each of these underwent a cognitive de-briefing interview. Twenty-two (n=22) children completed the ranking exercise. Ten children did not understand the concept of ranking. The results of the qualitative phase (cognitive de-briefing interview) were used to modify the wording of items and layout of the instrument. Results of the ranking exercise were used to inform the order of the response levels for the items.ConclusionResponses of young children can be used in the development of PRO instruments. They are able to help inform the content, wording, and format of an instrument, ensuring good content and face validity. The results have been used to further refine the CAT-QoL, however further research is required to assess the psychometric properties of the instrument.

Rééducation de la part fonctionnelle de l’amblyopie dans le glaucome primitif infantile opéré, recul de 11 ans

To evaluate the efficacy of functional amblyopia treatment in children having undergone surgery for primary infantile glaucoma. Parameters studied included: age at surgery, current age, visual acuity (VA) (initial and most recent acuity), refraction, alignment, adherence to amblyopia treatment, condition of the cornea (Haab striae, stromal scarring, pachymetry, cell count), condition of the optic disc (cupping, RNFL OCT) and intraocular pressure. Pearson's p-value was fixed at 5%. Retrospective study of 29 eyes; average age at surgery was four months, mean follow-up was 11.2 years. Initial VA averaged 4.5 over 10, most recent VA 7 over 10, i.e. a gain of 2.3 over 10. Refraction revealed 37.9% myopia, 10.3% emmetropia, 48.2% hyperopia and an average astigmatism of 2.14 D. A negative correlation was found between astigmatism and most recent VA (rho=-0.7; P<0.001). A positive correlation was found between the quality of the occlusion therapy and the recovery of VA with a gain of 3.2 over 10 (P=0.001). A strong positive correlation was found between the cylinder power and the number of Haab striae [rho0.702, P<0.0001]; final VA is best when the striae show no organized scar formation (P=0.04). This study underlines the necessity of prolonged treatment of functional amblyopia in primary infantile glaucoma for the best possible visual rehabilitation.

Two‐year follow‐up of a randomized trial of spectacles alone or combined with Bangerter filters for treating anisometropic amblyopia

To compare spectacle correction alone to spectacle correction with Bangerter filters as treatments for anisometropic amblyopia in children 1 year after completion of a 1-year randomized trial. In a randomized clinical trial, 80 children (mean age, 4.4 years) with anisometropic amblyopia and a best median visual acuity (VA) in the amblyopic eye of 0.4 logarithm of the minimum angle of resolution (logMAR) were assigned to treatment with either spectacles or spectacles in combination with a Bangerter filter for 1 year. After 1 year, treatment with spectacles continued. If the VA differed by ≥ 2 lines, treatment with Bangerter filters was continued if originally prescribed. The main outcome measure was the median change in VA of the amblyopic eye after 2 years. The median change in VA of the amblyopic eye did not differ significantly between the groups (0.4 log unit for both groups) at the 2-year visit. At that time, the VA in the amblyopic eyes and the fellow eyes was 0.0 median logMAR in both groups. Between years 1 and 2, the median VA improved in the amblyopic eyes; in the spectacles group (p = 0.0181) and in the Bangerter filter group (p = 0.0342). The median anisometropia decreased in both groups (p < 0.0001 for both comparisons). We found stability in the VA improvement in both groups. The magnitude of the VA change 2 years after treatment with spectacles alone did not differ significantly from that after treatment with spectacles and a Bangerter filter for anisometropic amblyopia.

Effect of Age on Response to Amblyopia Treatment in Children

To determine whether age at initiation of treatment for amblyopia influences the response among children 3 to less than 13 years of age with unilateral amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. A meta-analysis of individual subject data from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol. Age was categorized (3 to <5 years, 5 to <7 years, and 7 to <13 years) because there was a nonlinear relationship between age and improvement in amblyopic eye visual acuity. Children from 7 to less than 13 years of age were significantly less responsive to treatment than were younger age groups (children from 3 to <5 years of age or children from 5 to <7 years of age) for moderate and severe amblyopia (P < .04 for all 4 comparisons). There was no difference in treatment response between children 3 to less than 5 years of age and children 5 to less than 7 years of age for moderate amblyopia (P = .67), but there was a suggestion of greater responsiveness in children 3 to less than 5 years of age compared with children 5 to less than 7 years of age for severe amblyopia (P = .09). Amblyopia is more responsive to treatment among children younger than 7 years of age. Although the average treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to treatment.

Detection and treatment of amblyopia in children

Refractive errors are a common cause of decreased visual acuity. They can be found in 2-4% of preschool children. If not discovered on time and not properly treated, they can lead to amblyopia and strabismus. The active participation of parents and paediatricians is of great importance in timely discovering and treatment of amblyopia. The most common causes of amblyopia are strabismus (50.1%) and refractive error (44.7%). The best treatment results are achieved in amblyopic children with strabismus. The cooperation of physicians of all specialties, above all paediatricians and ophthalmologists, as well as a good collaboration of parents based on their being well-informed, must exist in the process of timely diagnosing and treating of amblyopia.

Evaluating the burden of amblyopia treatment from the parent and child’s perspective

To evaluate the psychometric properties of the original Parent and new Child Amblyopia Treatment Index (ATI), questionnaires that assess the burden of amblyopia treatment in children and families, and to compare scores between children treated with atropine or patching. Parent ATI and Child ATI were administered to 233 children 7 to <13 years old and their parents as part of a randomized trial comparing patching and atropine for amblyopia treatment. For each ATI version, construct validity was assessed using factor analysis; internal consistency reliability was assessed using Cronbach's alpha. Data from the Parent ATI and Child ATI were correlated and scores for each version were compared between treatment groups. We analyzed the 3 subscales found in prior Parent ATI studies in younger children and confirmed subscales for adverse effects and treatment compliance, but not for social stigma, in both parent and child versions. Overall and subscale scores on the Parent ATI and Child ATI were moderately to well correlated except for the social stigma subscale. For both the Parent ATI and the Child ATI, children treated with atropine had better scores than those treated with patching, both overall and on treatment compliance and social stigma subscales (all p values ≤ 0.01). When used for children 7 to <13 years old, the Parent ATI and Child ATI have similar factor structures to each other and to the Parent ATI for children 3 to <7 years old. Atropine treatment was found to have less negative impact than patching.

Retrospective Clinical Review of Amblyopia Treatment in Children Under 5 Years of Age

Retrospective Clinical Review of Amblyopia Treatment in Children Under 5 Years of Age

Effectiveness of Telescopic Magnification in the Treatment of Amblyopia

To compare the effectiveness of patching plus telescopic magnification vs patching alone in treating refractory amblyopia. Children aged 4 to 17 years who failed previous amblyopia treatment were recruited into this prospective study. Subjects were randomly assigned to either 30 minutes per day of patching of the fellow eye only (n = 7) or 30 minutes per day of patching of the fellow eye plus concurrent use of a telescope in the amblyopic eye (n = 8). Best-corrected logMAR visual acuity score of the amblyopic eye after 17 weeks of treatment. Both treatment groups demonstrated significant improvement in visual acuity in the amblyopic eye after 17 weeks (P = .001). Improvements in the patching-only group were slightly greater over the course of treatment, but this difference was not statistically significant (P = .06). At 17 weeks, mean visual acuity improvement from baseline was 0.14 logMAR (SD, 0.13 logMAR) in the patching-only group and 0.06 logMAR (SD, 0.17 logMAR) in the patching plus telescope group (P = .11). The 17-week visual acuity was at least 0.2 logMAR and/or improved from baseline by at least 0.2 logMAR in 2 patients in the patching-only group and none in the patching plus telescope group (P = .08). Treatment of refractory amblyopia in children using telescopic magnification did not appear to confer any additional benefits over patching alone. Occlusion and penalization remain the standard of care for patients with amblyopia and should remain the benchmark against which other treatments are compared in clinical trials for amblyopia therapy. clinicaltrials.gov Identifier: NCT00970554.

A Pilot Study of levodopa as treatment for residual amblyopia in children 8 to 17 years old

Michael X. Repka, M.D.1, Raymond T. Kraker, M.S.P.H.2, Roy W. Beck, M.D., Ph.D.2, Scott C. Atkinson, M.D.3, Darron A. Bacal, M.D.4, Don L. Bremer, M.D.5, Patricia L. Davis, M.D.6, Matthew D. Gearinger, M.D.7, Stephen R. Glaser, M.D.8, Darren L. Hoover, M.D.9, Daniel M. Laby, M.D.10, David G. Morrison, M.D.11, David L. Rogers, M.D.5, Nicholas A. Sala, D.O.12, Donny W. Suh, M.D.13, and Maynard B. Wheeler, M.D.14 for the Pediatric Eye Disease Investigator Group (PEDIG)* 1 Johns Hopkins University School of Medicine, Baltimore, MD 2 Jaeb Center for Health Research, Tampa, FL 3 St. John’s Clinic, Eye Specialists, Springfield, MO 4 Eye Physicians & Surgeons, PC, Milford CT 5 Pediatric Ophthalmology Associates, Inc., Columbus, OH 6 Progressive Eye Care, Lisle, IL 7 University of Rochester Eye Institute, Rochester, NY 8 Stephen R. Glaser, M.D., P.C., Rockville, MD 9 Everett and Hurite Ophthalmic Association, Cranberry TWP, PA 10 Daniel M. Laby, M.D., Sharon, MA 11 Vanderbilt Eye Center, Nashville, TN 12 Pediatric Ophthalmology of Erie, Erie, PA 13 Wolfe Clinic, West Des Moines, IA 14 Concord Eye Care P.C., Concord, NH

Refractory reverse amblyopia with atropine penalization

Pharmacological penalization with atropine has been shown to be equally effective as conventional occlusion therapy in the treatment of amblyopia in children. Reverse amblyopia of the sound eye with atropine penalization has been reported before, but is more common in cases where the effect is augmented with optical penalization and is mostly reversible. We report a case of reverse amblyopia with atropine penalization, in a 4-year-old girl, which was refractory to treatment. This report highlights the need for strict monitoring of the vision in the sound eye and regular follow-up in children undergoing amblyopia treatment.

Contact Lens and Amblyopia Treatment in Children With Unilateral High Myopic Anisometropia

Purpose: To report the clinical outcome of children with unilateral high myopic anisometropic amblyopia who were treated with contact lenses (CL). Methods: Patients who had myopic anisometropia greater than -7 diopters and was treated with contact lenses combined with occlusion therapy during the period between 1998 and 2007 were retrospectively reviewed. Twenty-seven patients who were followed up for more than 1 year after treatment were included in the study. Initial and final best corrected visual acuities (BCVA) were compared and factors which influence the visual outcome were analyzed. Results: A total of 10 out of 27 patients (37%) acquired visual improvement of more than 2 lines. At the final examination, 6 patients (22.2%) had BCVA better than logMAR 0.3 and 10 patients (37.0%) had BCVA better than logMAR 0.7. Medullated nerve fiber and strabismus were the most commonly associated ocular pathologies among the patients. Patients without strabismus or medullated nerve fiber acquired greater visual improvement than patients with these comorbidities. Patients with lower initial refractive error (spherical equivalent) in the amblyopic eye acquired a better final vision. Poor compliance to CL wearing or occlusion therapy adversely affected the final vision. Conclusions: In the present study of children with unilateral severe myopic anisometropic amblyopia treated with CL combined with occlusion therapy, a third of the patients acquired visual improvement of more than 2 lines. The absence of medullated nerve fiber or strabismus was determined to be a good prognostic factor.

Amblyopia Therapy in Children Identified by Photoscreening

To determine the efficacy of amblyopia treatment in children identified through a community photoscreening program. Case series. We included 125 children diagnosed with amblyopia after referral from a photoscreening program. Retrospective chart review of 125 amblyopic children identified by photoscreening and treated in a single academic pediatric ophthalmology group practice. Treatment regimens included spectacles, patching, and/or atropine penalization. Successful treatment was defined as > or =3 Snellen line equivalent improvement in visual acuity and/or 20/30 visual acuity in the amblyopic eye in literate children. Successful treatment in initially preliterate children was defined as 20/30 or better visual acuity in the amblyopic eye. Percentage of successfully treated amblyopic children. Of 901 children evaluated after being referred from photoscreening, 551 had amblyopiogenic risk factors without amblyopia, 185 were diagnosed with amblyopia, and 165 were false positives. Of 185 children with amblyopia, 125 met inclusion criteria for analysis and 78% (97 of 125) were successfully treated. The success rate of amblyopia treatment in children identified through our photoscreening program is high. This study supports the role of photoscreening programs in the prevention of amblyopia-related vision loss. Such early screening may translate to true visual acuity improvement. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Contrast Sensitivity Following Amblyopia Treatment in Children

Contrast Sensitivity Following Amblyopia Treatment in Children

Monocular Oral Reading Performance After Amblyopia Treatment in Children

To evaluate the monocular oral reading rate, accuracy, fluency, and comprehension in 10-year-old children previously treated for amblyopia. Prospective, observational case series. Seventy-nine children (mean age, 10.3 years) previously treated in a multicenter randomized trial comparing patching and atropine were tested at seven sites using a modification of the Gray Oral Reading Test, Fourth Edition (GORT-4). The mean visual acuities (VA) in the amblyopic and fellow eyes at the time of the reading assessment were 0.17 logarithm of the minimum angle of resolution (logMAR) units (approximately 20/32) and -0.03 logMAR units (approximately 20/20), respectively. Compared with the sound eye, amblyopic eye performance was worse when reading orally with respect to rate (P < .001), accuracy (P = .03), and fluency (P < .001). Reading comprehension scores were similar with the amblyopic and fellow eyes (P = .45). Similar results were found with respect to original treatment group assignment (atropine or patching). There was a modest correlation between interocular difference (IOD) of VA at age 10 years and IOD in reading rate (r = 0.37; 95% confidence interval [CI], 0.18 to 0.56) and fluency (r = 0.28; 95% CI, 0.08 to 0.49). There was no correlation between the IOD in VA and IOD in accuracy (r = 0.08; 95% CI, -0.14 to 0.30) or comprehension (r = 0.16; 95% CI, -0.05 to 0.37). The monocular oral reading ability when measured with the GORT-4 was slightly worse when reading with previously treated amblyopic eyes compared with fellow eyes in terms of rate, accuracy, and fluency, but reading comprehension testing was similar.

Treatment of Bilateral Refractive Amblyopia in Children Three to Less Than 10 Years of Age

To determine the amount and time course of binocular visual acuity improvement during treatment of bilateral refractive amblyopia in children three to less than 10 years of age. Prospective, multicenter, noncomparative intervention. One hundred and thirteen children (mean age, 5.1 years) with previously untreated bilateral refractive amblyopia were enrolled at 27 community- and university-based sites and were provided with optimal spectacle correction. Bilateral refractive amblyopia was defined as 20/40 to 20/400 best-corrected binocular visual acuity in the presence of 4.00 diopters (D) or more of hypermetropia by spherical equivalent, 2.00 D or more of astigmatism, or both in each eye. Best-corrected binocular and monocular visual acuities were measured at baseline and at five, 13, 26, and 52 weeks. The primary study outcome was binocular acuity at one year. Mean binocular visual acuity improved from 0.50 logarithm of the minimum angle of resolution (logMAR) units (20/63) at baseline to 0.11 logMAR units (20/25) at one year (mean improvement, 3.9 lines; 95% confidence interval [CI], 3.5 to 4.2). Mean improvement at one year for the 84 children with baseline binocular acuity of 20/40 to 20/80 was 3.4 lines (95% CI, 3.2 to 3.7) and for the 16 children with baseline binocular acuity of 20/100 to 20/320 was 6.3 lines (95% CI, 5.1 to 7.5). The cumulative probability of binocular visual acuity of 20/25 or better was 21% at five weeks, 46% at 13 weeks, 59% at 26 weeks, and 74% at 52 weeks. Treatment of bilateral refractive amblyopia with spectacle correction improves binocular visual acuity in children three to less than 10 years of age, with most improving to 20/25 or better within one year.

Effect of oral CDP-choline on visual function in young amblyopic patients

The purpose of the study was to evaluate the effect on visual function of orally administered CDP-choline in addition to patching for the treatment of amblyopia in children. This was an open label parallel group study comparing patching plus oral CDP-choline with patching alone. Sixty-one participants (aged between 5 and 10 years) suffering from anisometropic or strabismic amblyopia were divided at random into two groups: Group A, 800 or 1,200 mg (according to the body weight) of orally administered CDP-choline and 2-h patching a day; Group B, 2-h patching a day. Both groups were treated for 30 consecutive days. A follow-up visit was set 60 days after the treatment was discontinued. The main outcome measure was the change in visual acuity of amblyopic eyes as measured by Snellen's E charts. The secondary outcome measures were changes in the visual acuity of amblyopic eye as measured by isolated letters (Snellen's E) and changes in the contrast sensitivity of amblyopic eyes. The addition of CDP-choline to patching therapy was not found to be more effective than patching alone after 30-day treatment. The present results showed that adding CDP-choline to patching stabilised the effects obtained during the treatment period. In fact, whereas the participants treated only with patching showed a decrease in visual acuity at 90 days, these receiving CDP-choline and patching combined appeared to maintain the results obtained (two-way ANOVA: P = 0.0042). Similar results were obtained when measuring visual acuity by isolated Snellen's E letters. In amblyopic patients, CDP-choline combined with patching contributes to obtaining more stable effects than patching alone.

The effect of the randomized trial of patching regimens for treatment of moderate amblyopia on pediatric ophthalmologists: 3-year outcome

To investigate whether the recommendations of the randomized trial of patching regimens for treatment of moderate amblyopia in children have been adopted by pediatric ophthalmologists 3 years after publication. An identical questionnaire to that emailed 3 years ago (6 months after publication of the randomized trial) was emailed to 560 members of the American Association for Pediatric Ophthalmology and Strabismus. One hundred seven (20%) responses were received. Fifty-five percent of respondents had decreased their prescribed patching regimens at least sometimes as compared with 28% (p = 0.0005) in 2003. There was no significant increase in the prescription of near visual tasks or only 2 hour patching regimens. Our study suggests that pediatric ophthalmologists may be prescribing fewer patching hours in 2006 in comparison to 2003. However, the majority of ophthalmologists are still reluctant to patch for only 2 hours, and there has not been a significant increase in prescribing near visual tasks during patching.

Amblyopic children identified by photoscreening respond well to treatment

Introduction: Photoscreening programs have been shown to identify children with amblyopia or amblyogenic risk factors. This study serves to evaluate the effect of therapy on amblyopic children identified through a community outreach photoscreening program. Methods: Retrospective chart review of 510 children referred to one academic pediatric ophthalmology group from a photoscreening program. Children diagnosed with amblyopia were treated with standard therapy, including spectacles, patching, and/or atropine penalization. Successful treatment of amblyopia was defined as two lines or greater of improvement in visual acuity, equal visual acuity among both eyes, or equal fixation preference in preverbal children. Results: Of the 510 photoscreen-positive children, 110 were diagnosed with amblyopia, 288 had AAPOS-defined risk factors without amblyopia, 82 were false-positives without amblyopia or amblyogenic risk, and 30 were excluded. Of the 110 with amblyopia, 84 (76%) were successfully treated, with a mean follow-up time of 34 ± 23 months. Of the remaining 26 patients, 75% are still being actively treated. Additional follow-up will be updated prior to presentation. Discussion: The treatment of amblyopia in children identified through photoscreening is successful in a majority of cases. Conclusions: Photoscreening programs are not only capable of identifying at-risk children; in addition, those children with amblyopia can be successfully treated. Implementation of such vision screening programs can be a useful adjunct in the prevention of amblyopia-related vision loss.