Unilateral Amblyopia Research Articles

Add-on perceptual learning on refractive amblyopia in children.

To evaluate the visual outcomes of standard amblyopic treatment add-on training via perceptual learning in refractive amblyopic children and to identify the risk factors for treatment failure. Retrospective charts were reviewed in children with refractive amblyopia who received standard treatment and add-on Cambridge Visual Stimulator (CAM) training. The add-on CAM group that was enrolled had worn full-corrected glasses for at least 2mo before training. A control group received only the standard treatment. Treatment success was defined as best-corrected visual acuity (BCVA) ≥20/25. The age, sex, initial BCVA, refractive errors, sessions and duration of training, and final BCVA were recorded. A total of 209 children (129 children in add-on CAM group and 80 children in control group) were enrolled. Seventy-six percent of unilateral and 87% of bilateral amblyopic children achieved treatment success. In children with unilateral or bilateral moderate amblyopia, the duration to reach BCVA ≥20/25 was significantly shorter in add-on CAM group than in control group. Poor initial BCVA (P<0.001) and high astigmatism (P=0.007) were risk factors for treatment failure after add-on CAM training. Age, sex, and types of refractive error were not associated with treatment success. Add-on CAM training is an effective strategy for visual improvement and can shorten the treatment course when the effect of standard treatment is limited in amblyopic children.

Comparison of Three Clinical Stereoscopic Methods for Measuring Binocular Visual Function During Amblyopic Treatment in Unilateral Amblyopia.

This study aimed to compare the measuring stereopsis results of unilateral amblyopia during amblyopic treatment by employing some of the most widely used clinical tests. Thirty-four individuals with previously untreated unilateral amblyopia, aged 8.4 ± 2.7 years, were included in the study. Monocular (best corrected visual acuity [BCVA] at distance) and binocular (including Titmus, Random-dot, and Frisby stereopsis) visual functions were measured at baseline and 2-month and 6-month visits after synthetical treatment. We found that Titmus stereopsis was always significantly better than Random-dot stereopsis (p < 0.001). Frisby stereopsis was also always significantly better than Random-dot stereopsis (p < 0.001). However, there was no significant difference between Titmus stereopsis and Frisby stereopsis (p = 0.562). However, interestingly, there was no significant difference in the mean improvement of the three stereopsis methods from baseline to the 2-month visit, F = 1.158, p = 0.318. Similarly, a significant difference was also lacking in the mean improvement of the three stereopsis methods from baseline to the 6-month visit, F = 0.302, p = 0.740. We conclude that there will be different results obtained from different stereopsis measuring methods used to measure amblyopia in patients. We recommend performing at least two types of stereoscopic measurements to evaluate each case of amblyopia. However, for observing therapeutic effects, each measurement method has the same performance for clinical results during amblyopic treatment.

Assessment of stereopsis in unilateral amblyopia subjects using syntonic phototherapy

ABSTRACT Introduction Amblyopia is two Snellen line difference between both eyes. Red filter therapy is a treatment option for amblyopia based on principle of syntonic phototherapy. The purpose of this study is to assess the stereopsis in amblyopic patient using syntonic phototherapy. Methods A Qusai experimental study was conducted from August 2021 to December 2021 at Madina Teaching Hospital Faisalabad. A total 30 subjects of both gender and ages ranging between 8 to 18 years were included through a non-probability purposive sampling technique. The sample was considered of 15 anisometropic amblyopes and 15 strabismic amblyope. Data was collected using a Performa and pre assessments of stereopsis by Titmus fly chart were recorded without red filter. Red filter glasses were prescribed for 4 week, post assessment data was recorded after 4 weeks. Data was analyzed by using Paired sample T test and Independent Sample T test in SPSS 20 software. Results After syntonic phototherapy significant improvement was seen, mean stereopsis was 48.00000 (p = 0.002) in anisometropic amblyopes while mean improvement of stereopsis 1.670.93333 (p = 0.00) in strabismic amblyopes. Anisometropic amblyopic patients showed significantly better improvement in stereopsis (p = 0.00) by syntonic phototherapy as compared to strabismic amblyopes. Conclusion Significant improvement was seen in stereopsis, while improvement was more significant in anisometropic amblyopes as compared to strabismic amblyopes. Children were obsessed with the red filter glasses while their parents found syntonic therapy simple plus facile and gave good results. So, eye care professionals must be aware of this new therapy and they should keep syntonic phototherapy in mind whenever they are dealing with amblyopic patients.

Spontaneous recovery from amblyopia following fellow eye vision loss: a systematic review and narrative synthesis

BackgroundThe effectiveness of traditional amblyopia therapies is largely restricted to childhood. However, spontaneous recovery in adulthood is possible following vision loss in the fellow eye due to enucleation, injury, or disease. The twofold purpose of this study was (1) to define the incidence of recovery and (2) to elucidate the clinical features associated with greater amblyopic eye gains. MethodsA systematic review of three databases yielded 24 reports containing 110 cases of patients ≥18 years old with unilateral amblyopia and vision-limiting fellow eye pathology. ResultsOur analysis revealed that 25 of 42 of adult patients (59.5%) gained ≥2 logMAR lines in the amblyopic eye after fellow eye vision loss. The degree of improvement is clinically meaningful (median, 2.6 logMAR lines). Recovery occurs within 12 months of initial loss of fellow eye vision. Regression analysis demonstrated that younger age, worse baseline visual acuity in the amblyopic eye, and worse vision in the fellow eye independently conferred greater gains in amblyopic eye visual acuity. Recovery occurs across amblyopia types and fellow eye pathologies, although disease entities affecting fellow eye retinal ganglion cells demonstrate shorter latencies to recovery. ConclusionsAmblyopia recovery after fellow eye injury demonstrates that the adult brain harbors the neuroplastic capacity for clinically meaningful recovery, which could potentially be harnessed by novel approaches to treat adults with amblyopia.

Comparison of Cambridge vision stimulator (CAM) therapy with passive occlusion therapy in the management of unilateral amblyopia; a randomized clinical trial

ABSTRACT Introduction There are limited studies on the effectiveness of Cambridge vision stimulator (CAM) therapy as a management strategy in amblyopic patients. In addition, all these studies have a low sample size. The main purpose of this study was to compare the effect of CAM therapy with passive occlusion therapy in the management of unilateral amblyopia. Methods In this randomized clinical trial study, 110 cooperative amblyopic children, who had not been managed previously, were randomly divided into two groups of CAM therapy (n = 55) and passive occlusion therapy (n = 55). In the CAM procedure, five discs with different spatial frequencies (SF) (2, 6, 15, 20, 30 cycles/degree) were presented to the patient (30 minutes a day, twice a week). Plates with SF equal to the two lines better than the measured corrected distance visual acuity (CDVA) were chosen. During the training, the non-amblyopic eye was occluded. The standard occlusion therapy protocols were performed in the occlusion therapy group. The CDVA for all patients was measured at baseline and then at one, two, and three months after the treatment. Results The mean age of patients in CAM and occlusion therapy groups was 7.0 ± 2.1 and 6.9 ± 1.9 years, respectively (p = .721). There was no significant difference in the mean CDVA between CAM and occlusion therapy groups after one (0.30 ± 0.16 vs. 0.25 ± 0.14, p = .079), two (0.15 ± 0.10 vs. 0.15 ± 0.11, p = .732) and three months (0.05 ± 0.08 and 0.05 ± 0.06, p = .919) from baseline. However, the mean amount of CDVA increased significantly in each follow-up in both groups (all p < .001). Regarding the amblyopia type and severity, the mean improvement of CDVA from baseline in the anisometropic patients and in moderate amblyopia was significantly higher in the CAM group than the occlusion group after two and three months (p < .05). Discussion CAM and conventional occlusion therapies significantly improved CDVA in children with amblyopia, and the difference was not significant; therefore, they could be used as alternatives. CAM therapy requires cost and time for the amblyopic patient and parents. Thus, it can be considered as a second treatment option in amblyopic patients, especially anisometropic type and moderate amblyopia, with poor compliance to patching.

Feasibility of a new ‘balanced binocular viewing’ treatment for unilateral amblyopia in children aged 3–8 years (BALANCE): results of a phase 2a randomised controlled feasibility trial

ObjectivesThis study aimed to evaluate the safety of dichoptic balanced binocular viewing (BBV) for amblyopia in children, plus feasibility, adherence, acceptability, trial methodology and clinical measures of visual function.DesignWe carried...

Prevalence and characteristics of amblyopia, strabismus, and refractive errors among patients aged 3–16 years in Shanghai, China: a hospital-based population study

BackgroundFunctional visual impairments in children are primarily caused by amblyopia or strabismus. This study aimed to determine the prevalence and clinical profile of amblyopia and strabismus among individuals aged 3–16 years in Shanghai, China.MethodsFrom February 2023 to February 2024, this hospital-based, cross-sectional study included data of children who visited the Ophthalmology Department of Shanghai General Hospital. Comprehensive ocular examinations included visual acuity measurement after cycloplegic refraction, slit lamp examination, cover test, and dilated fundus examination. Descriptive statistics were performed to estimate the proportion and clinical characteristics of amblyopia and strabismus.ResultsA total of 920 children were enrolled in our study. Among them, 223 (24.24%) children were identified as amblyopia. Unilateral amblyopia occupied 57.85%, and bilateral amblyopia occupied 42.15%. Most participants were within the age range of 5–10 years (75.97% for unilateral amblyopia, and 70.21% for bilateral amblyopia). Anisometropia was the primary cause of unilateral amblyopia (68.99%). Most amblyopic children have high hyperopia (38.76% for unilateral amblyopia, and 39.89% for bilateral amblyopia). 30 (3.26%) children were diagnosed with strabismus, and 19 (63.3%) of them were aged 5–10 years. Seven of the children had both strabismus and amblyopia.ConclusionThe proportion of patients with amblyopia and strabismus was determined as 24.24% and 3.26% in our study. Anisometropia was the leading cause of unilateral amblyopia, whereas high hyperopia was a crucial refractive error in the amblyopic population. These findings shed light on further longitudinal studies targeting the age-related changes in amblyopia, strabismus and refraction errors. Therefore, efforts should be made to manage uncorrected refractive errors, amblyopia, and strabismus among children in Shanghai.

Analysis of choroidal thickness, macular thickness, peripapillary retinal nerve fiber layer thickness, and macular vascular density in children with unilateral amblyopia using swept-source optical coherence tomography and their changes following occlusion therapy

Analysis of choroidal thickness, macular thickness, peripapillary retinal nerve fiber layer thickness, and macular vascular density in children with unilateral amblyopia using swept-source optical coherence tomography and their changes following occlusion therapy

Longitudinal evaluation of macular vascular density alterations in unilateral amblyopic children undergoing therapy: An optical coherence tomographic angiography study

ImportanceUnderstanding the pathophysiology of the macula in amblyopic eyes is an active research area. ObjectiveTo correlate macular retinal vascular density changes with best-corrected visual acuity changes following occlusion therapy for amblyopia in children. DesignA prospective cohort study of children visiting the Pediatric Ophthalmology Division of our institution between January 2020 and January 2022 was conducted. SettingA specialist eye hospital in Saudi Arabia. ParticipantsThirty children with unilateral amblyopia. ExposureOcclusion therapy for amblyopia.Main Outcome and Measures: Best corrected visual acuity (logMAR) before and at each of the four optical coherence tomographic angiographies was compared in amblyopic and fellow eyes. The effect of pretreatment determinants on the correlation between best-corrected visual acuity and retinal vascular density changes was reviewed. ResultsIn this cohort of 30 amblyopic and 30 fellow eyes from 30 children (mean age 8.7 ± 1.4 years; male: female 18:12. The best-corrected visual acuity improved from a median of 0.6 (interquartile range 0.5; 1.1) pretreatment to a median of 0.4 (interquartile range 0.2; 0.6) posttreatment in amblyopic eyes, and from a median of 0.1 to 0.05 in the fellow eyes. The total percentage change in retinal vascular density in the amblyopic eye was significantly higher than that in the fellow eye (Z = −1.92, P = 0.05). The change in best-corrected visual acuity in the amblyopic eye after a median of 98 months (interquartile range, 69–126 months) of intervention was significantly correlated with the refraction-adjusted change in retinal vascular density (B = −0.03, 95 % confidence interval −0.04, −0.02, P < 0.001) and was influenced by strabismus (B = −0.46, 95 % confidence interval −0.59, −0.34, P < 0.001), type of amblyopia (B = 0.24, 95 % confidence interval 0.12, 0.36, P < 0.001), duration of occlusion (B = −0.43, 95 % confidence interval −0.65, −0.22, P < 0.001), and occlusion compliance (B = 0.24, 95 % confidence interval 0.11, 0.36, P < 0.001). Conclusionsand Relevance: The RVD in amblyopic eyes in the first six months of therapy was significantly lower than that in fellow eyes, but not in subsequent assessments.

Reduced Retinal Vascular Density and Skeleton Length in Amblyopia.

This study aimed to investigate the possible relationship between retinal vascular abnormalities and amblyopia by analyzing vascular structures of fundus images. In this observational study, retinal fundus images were collected from 36 patients with unilateral amblyopia, 33 patients with bilateral amblyopia, and 36 healthy control volunteers. We developed a customized training algorithm based on U-Net to digitalize the vasculature in the fundus images to quantify vascular density (area and fractal dimension), skeleton length, and number of bifurcation points. For statistical comparisons, this study divided participants into two groups. The amblyopic eyes and the fellow eyes of patients with unilateral amblyopia formed the paired group, while bilateral amblyopic patients and healthy controls formed the independent group. In the paired group, the vascular area (P = 0.007), vascular fractal dimension (P = 0.007), and vascular skeleton length (P = 0.002) of the amblyopic eyes were significantly smaller than those of the fellow eyes. In the independent group, significant decreases in the vascular fractal dimension (P = 0.006) and skeleton length (P = 0.048) were observed in bilateral amblyopia compared to control. The vascular area was also significantly correlated with best-corrected visual acuity in amblyopic eyes. This study demonstrated that retinal vascular density and skeleton length in amblyopic eyes were significantly smaller compared to control, indicating an association between the changes in retinal vascular features and the state of amblyopia. Our algorithm presents amblyopic retinal vascular changes that are more biologically interpretable for both clinicians and researchers.

Assessing Choroidal Thickness in Pediatric Patients With Unilateral Strabismic Amblyopia by Using Spectral Domain-Enhanced Depth Imaging-Optical Coherence Tomography.

Objective In this study, we aimed to evaluate the choroidal thickness in patients with unilateral strabismic amblyopia by usingspectral domain-enhanced depth imaging-optical coherence tomography (SD-EDI-OCT) (Heidelberg EngineeringGmbH, Heidelberg, Germany). Methods Twenty-five children with strabismic amblyopia and 20 age- and sex-matched healthy controls were included in this study. Seven sections were obtained, each comprising 25 repetitive images from each section at 200-micron intervals, and measurements were taken from nine different points at vertical and horizontal lines (1 and 3 mm from the subfoveal, superior, inferior, temporal, and nasal regions), centered on the fovea, using SD-EDI-OCT. Choroidal thickness values were obtained by measuring the distance between the basal border of the retinal pigment epithelium and the choroidoscleral border. The Mann-Whitney U test was used to compare choroidal thickness between the amblyopic and the control groups. Results The mean ageof children with amblyopia and that of controls were 8.4 ±2.7 and 9.9 ±3.3 years, respectively (p=0.120). The mean subfoveal choroidal thickness was 372.8 ±78.9 μm in amblyopic eyes and 372.4 ±79.3 μm in the fellow eyes, both of which were thicker than the control eyes (310.9 ±76.3 μm;p<0.05 for each). Similarly, the mean values for the choroidal thickness of the amblyopic children at 1 mm nasal (320 ±86 μm), 1 mm superior (363 ±70 μm), and 3 mm superior (336 ±62 μm) were also significantly thicker than those of the corresponding control eyes (p<0.05 for each). There was a negative correlation between the subfoveal choroidal thickness and axial length (r=-0.332, p=0.005). There were no correlations between the choroidal thickness, age, and visual acuity. Conclusions The choroidal thicknesses of strabismic and fellow eyes were similar in patients with strabismic amblyopia. However, the choroidal thickness of both eyes in strabismic children was significantly thicker than those of the healthy controls. Emmetropization may be defective in both eyes of strabismic amblyopic patients.

Impact of patching treatment on quality of life among children with amblyopia in Gaza Strip, Palestine

Background: Eye patching treatment affects the health-related quality of life of children with amblyopia. However, the extent of this effect in Gazan children with amblyopia remains unknown. This study evaluated the effect of patching on the health-related quality of life in Gazan children with unilateral or bilateral refractive amblyopia. Methods: This cross-sectional study was conducted at Gaza Ophthalmic Hospital, Gaza Strip, Palestine, from September 2019 to October 2020 with adherence to the standard operating procedures of the coronavirus pandemic. Children with refractive amblyopia who completed patching therapy with a successful outcome were recruited. After patching therapy was completed, the parents completed an 18-item parental Amblyopia Treatment Index (ATI) questionnaire via telephone. Results: Twenty-four children having 36 eyes with refractive amblyopia and a mean (standard deviation) age of 7.6 (1.8) years were included. Children underwent 2 h or 2–6 h of daily patching for 12 or 17 weeks. The mean values for total ATI score, adverse effects subscale, difficulty with compliance subscale, and social stigma subscale were 2.6, 2.6, 2.7, and 2.9, respectively, indicating that part-time patching was mostly accepted and had less impact on health-related quality of life. Treatment compliance was high; children complained at the time of patch application but did not pay attention to the patch once it was in place. In most children, the patch caused no adverse effects related to physical activities such as fun activities, learning, writing or drawing, visualizing, or playing with toys. Social stigma due to patch complications or different perceptions was not a concern. However, the perceptions of others were a major concern (n = 19, 79.2%). No significant association was found between the overall ATI score or the score of any of the subscales (adverse effects, difficulty with compliance subscale, or social stigma) and the child’s age, sex, number of lines improved in visual acuity of the amblyopic eye, severity of amblyopia, laterality, or treatment period (all P &gt; 0.05). Conclusions: The ATI questionnaire score and its three subscales revealed that the quality of life among Gazan children with refractive amblyopia was less affected by the part-time patching treatment. In the future, the ATI questionnaire could be used with various treatment modalities and types of amblyopia in the same setting to provide more practical guidelines on the management of amblyopia.

Preschool Vision Screening: Prevalence and Associated Factors of Amblyopia among School Going Children in Dhaka City

Background: Amblyopia is a decrease in best-corrected visual acuity in one or both eyes due to form deficiency or abnormal binocular interaction. It affects infancy and adulthood for the individual and society as a whole. Amblyopia affects academic success, career choice, visuomotor skills, social interaction, psychological development, and economic participation. Unilateral amblyopia increases the likelihood of bilateral vision loss. Ocular media opacity, strabismus, anisometropia, hypermetropia, astigmatism, myopia, and blepharoptosis are risk factors for amblyopia. Ocular screening programs in young children, primarily preschoolers, may detect amblyopia and amblyogenic risk factors like as strabismus, refractive errors, and media opacities early. It prevents and treats amblyopia. It helps children's emotional growth. Diagnosis and treatment of amblyopia at a younger age may result in a better and more stable final VA because to shorter treatment durations, faster VA improvement, and greater treatment adherence. Objective: The purpose of this study was to determine Preschool vision screening, prevalence and associated factors of amblyopia among school going children in Dhaka city. Methods and Material: Between January 1 and June 30, 2022, a cross-sectional survey of a community of Dhaka city residents in the school age range was carried out. Through interviews and physical exams, data were gathered using a pretested structured questionnaire and checklist. Using SPSS 23, descriptive and inferential analysis was performed, and variables with a p value of less than 0.2 were included into multivariate logistic regression. In the multivariable binary logistic regression, significant predictors were defined as variables with a p value of &lt; 0.05. Result: Majority of the student are of 4-5 years age, among the participant 50.8% were male and 45.8% were female. Study showed that majority of the family has 1-2 (49.5%) and 3-4 (45.3%) children. Majority of the mother .......

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.

Evaluation of the macular sensitivity and retinal ganglion cell layer in unilateral amblyopia.

To assess macular sensitivity and fixation pattern obtained by microperimetry and ganglion cell complex (GCC) obtained by optical coherence tomography (OCT) in cases with unilateral amblyopia and to compare with control. The study was conducted with 30 patients with amblyopia, aged 5-18 years, and 30 control eyes of healthy children in the same age group. Participants underwent full ophthalmological examination. Macular sensitivity, stabilization, and location of fixation values were measured using microperimetry. The GCC values were obtained by OCT. Measurements were compared between amblyopic eyes, fellow eyes, and controls. Any correlation between GCC, macular sensitivity, and fixation was investigated. P < 0.05 was considered statistically significant. The mean age was 10.13 ± 3.49 years in the amblyopia group and 11.53 ± 2.7 years in the control group. Three groups were formed: amblyopic eyes (Group 1, n = 30), fellow eyes (Group 2, n = 30), and control eyes (Group 3, n = 30). The macular sensitivity values were found highest in the control group (P = 0.007). Bivariate contour ellipse area 1, which is the numerical value of fixation stabilization, was measured to be the lowest in the control group (P < 0.0001). In the analysis among the three groups, no significant difference was observed in terms of the GCC (P = 0.229). In the correlation analyses, a significant correlation was detected between macular sensitivity and GCC values in amblyopic eyes. In amblyopic eyes, the macular sensitivity was significantly lower and the GCC thickness was found to be in a positive correlation with macular sensitivity.

The prevalence of functional amblyopia and its related risk factors in preschool children in North-Eastern Iran.

Purpose was to determine the prevalence of amblyopia and its related risk factors in children aged 3-6 years in Bojnurd, north-eastern Iran. In this cross-sectional study, from 12,331 children aged 3-6 in Bojnurd, 6600 children participated in annual amblyopic screening program and among them, around 1100 suspected cases were referred for full ophthalmic examinations. Measurement of visual acuity, cycloplegic refraction, subjective refraction, and cover test were performed for all participants. Amblyopia was defined as CDVA of 0.2 LogMar or less in each eye or 2-line difference or more in best-corrected visual acuity between two eyes. The prevalence of amblyopia was estimated 0.95% (95% confidence interval [CI]: 0.73%-1.2%). There was no relationship between amblyopia with age and genders. Most amblyopic children were hyperopic (61.9%; 95% CI: 48.7-73.8). Strabismus was found in 17.4% of amblyopic patients (95% CI: 9.05%-29.09%). Approximately half of the amblyopic children were anisometropic (55.5%; 95% CI: 42.40%-68.08%). The most common type of amblyopia was anisohyperopic (55.56%; 95% CI: 42.5%-67.5%). The prevalence of bilateral amblyopia was more than unilateral amblyopia. The assessment of data showed that hyperopia, astigmatism, and anisometropia were the most common causes of amblyopia in this study. The prevalence of amblyopia was estimated about 1% in north-eastern Iran. Our study indicated a valuable information around the effect of refractive error and anisometropia on amblyopia which could be helpful in designing a comprehensive vision screening program for preschool children.

Impact of active vision therapy compared to conventional patching therapy on visual acuity and stereoacuity in children with amblyopia

PurposeTo compare improvements in visual acuity (VA) and stereoacuity between active vision therapy (AVT) and conventional patching therapy in children with amblyopia. MethodsThis study included 65 children aged 5 to 16 years (mean age±SD, 11.00±3.29 years) with unilateral amblyopia. Among them, 31 children underwent active vision therapy (AVT group), and 34 children underwent conventional patching therapy (patching group). AVT group underwent three sequential phases of AVT: Monocular phase (pursuit, saccades, fixation, visuomotor, eye-hand coordination, and central peripheral activities), biocular phase (diplopia awareness, antisuppression, monocular fixation in a binocular field, accommodative activities, bilateral integration, and fine motor activities) and binocular phase (fusion and stereopsis). Patching group patched their fellow eyes as per guidelines by Pediatric Eye Disease Investigator Group. Best-corrected monocular VA and stereoacuity were measured at baseline and after three months of therapy in both groups. ResultsThere were significant improvements in the mean acuities in amblyopic eye (AE) in both AVT (0.32±0.11 logMAR, p <0.001) and patching groups (0.27±0.19 logMAR, p ˂ 0.001). However, there was no significant difference in mean acuity gains in AE between AVT and patching groups (p = 0.059). Mean gains in stereoacuities (log seconds of arc) were statistically significant in both AVT (0.81±0.34, p < 0.001) and patching groups (0.32±0.34, p < 0.001). The stereoacuity gain in the AVT group was significantly higher compared to patching group (p < 0.001). ConclusionActive vision therapy had a better impact than conventional patching therapy in terms of improvement of stereoacuity but not in terms of VA when used for treating children with amblyopia.

Case report of uniocular diplopia in a 26-year-old female: A diagnostic dilemma

A 26-year-old female had complaints of left eye monocular diplopia, blurred, wavy vision for 4 months and was diagnosed and managed as Dry eye syndrome outside. She did not improve clinically and presented to us. Routine ophthalmologic evaluations, including keratometry, slit lamp biomicroscopy, and fundoscopy, were done to rule out anterior and posterior segment etiologies. MRI brain and visual fields were done to rule out neurological causes. Provisional diagnosis of unilateral anisometropic amblyopia was made. On LASIK evaluation, she was found to have keratoconus suspect in corneal topography, and diagnosis of posterior keratoconus was confirmed with higher diagnostic tests like optical coherence tomography anterior segment and corneal tomography. She was managed with Cretan plus protocol. One must have a higher index of suspicion toward corneal ectatic disorders in this particular type of symptomatology of young patients.

OCT-Angiography Findings in Children with Anisometropic Amblyopia.

The purpose of this prospective study is to show findings of OCT angiography in children with anisometropic amblyopia with a statistically significant difference, regardless of the type of refractive disorder, between the amblyopic and the fellow eye. This research aimed to establish whether there is a difference in vascular density [VD] and size of the foveal avascular zone [FAZ] in the superficial capillary plexus [SCP]. All children between 9 and 18 years of age who were treated at the Outpatient Clinic for Orthoptics and Pleoptics of the Department of Ophthalmology, University Medical Centre Maribor from January 2020 to December 2022 due to unilateral anisometric amblyopia were enrolled in our study. Fourteen children met the criteria. Cirrus 5000 high-resolution OCT with AngioPlex OCT angiography was used to analyze the size of the FAZ and VD in the SCP and TCS. The paired t-test or Wilcox signed-rank test [p < 0.05] was used for statistical analysis of each parameter between the amblyopic and fellow eye. Mean child age was 13 years ± 2.9 and ranged from 9 to 18 years. Most of the children [85.7%] were boys. The VD of the SCP did not show statistically significant differences between the visually impaired and control eyes [p = 0.328]. The comparison of the FAZ area between the two eyes was also not statistically significant [p < 0.808]. There was also no statistically significant difference in central macular thickness [TCS] [p < 0.291]. Our research results show no statistically significant differences in the VD and the FAZ of the SCP, and in the TCS between the amblyopic and fellow eye in children with unilateral anisometropic amblyopia. Our research did not confirm the results of certain previous studies in which a lower density of the capillary network was present in the visually impaired eye. Further studies with more children are necessary to confirm our results.

Retinal microvascular changes in unilateral functional amblyopia detected by oct-angiography and follow-up during treatment.

To evaluate the macular microvascular changes using optical coherence tomographic angiography (OCT-A) in children with unilateral amblyopia and their reversibility during treatment. Patients with unilateral strabismic or anisometropic amblyopia or residual amblyopia from early congenital cataract surgery, examined between October 2019 and March 2021, were included. Vessel density and perfusion density in the superficial capillary plexus and area, perimeter and circularity of the foveal avascular zone (FAZ) were analysed using OCT-A in amblyopic eyes, contralateral eyes and control group healthy eyes. Correlation analyses between the microvascular parameters and the visual acuity were performed. In a pilot study on a few patients from the amblyopic cohort, longitudinal follow-up during treatment was also performed. A total of 128 eyes of 64 patients were included: 32 amblyopic eyes compared with 32 contralateral eyes and 64 control eyes. Vessel density and perfusion density in the superficial capillary plexus were significantly lower in amblyopic eyes compared to control eyes in 6 × 6 mm (p < 0.02) and 3 × 3 mm (p < 0.01) scans. Correlation analyses showed a linear decrease in vessel density and perfusion density with decreasing visual acuity. The microvascular changes observed were reversible with the occlusion treatment of amblyopia (p < 0.001). The study found a decrease in vessel density and perfusion density in the macula of children with unilateral functional amblyopia. These microvascular changes were correlated with visual acuity and appeared to be reversible with treatment of amblyopia. On the whole, OCT-A appears to be a relevant complementary examination when it comes to diagnosing and monitoring functional amblyopia.