Anisometropia is the difference in the magnitude of ametropia between the two eyes. This anomaly causes unpleasant ocular symptoms; can alter binocularity; and impair vision. Under-corrected anisometropia and lack of optical considerations in correction is a common cause of spectacle intolerance. This was to determine ...
Hu, Yuan Yuan; Wu, Jian Feng; Lu, Tai Liang; Wu, Hui; Sun, Wei; Guo, Da Dong; Jiang, Wen Jun; Wang, Xing Rong; Jonas, Jost B; Bi, Hong Sheng
To describe prevalence and associations of anisometropia in children. The cross-sectional school-based study included children aged 4 to 18 years. The study included 6025 (94.7%) of 6364 eligible children. Mean refractive anisometropia was 0.37 ± 0.57 diopters (median: 0.25 diopters; range: 0-7.88 diopters; prevalence [≥1 diopter]: 7.0% ± 0.3%). In multivariate analysis (regression coefficient r: 0.66), higher refractive anisometropia was associated with older age (P Refractive anisometropia showed a U-shaped correlation with refractive error. Higher anisomyopia was associated (r: 0.57) with older age (P = 0.001; β: 0.05; B: 0.006; 95% CI: 0.002-0.009), higher level of paternal education (P = 0.001; β: 0.01; B: 0.01; 95% CI: 0.01-0.02), more total time spent indoors reading or writing (P = 0.01; β: 0.03; B: 0.01; 95% CI: 0.00-0.01), larger intereye difference in axial length (P refractive error (P prevalence [≥1 diopter]: 3.7% ± 0.2%) increased with higher refractive anisometropia (P refractive error (P children, refractive anisometropia and anisomyopia increased with systemic parameters such as age, parental education level, and lifestyle of the children, for example, more time spent indoors reading or writing. In contrast, hyperopic anisometropia and cylindrical anisometropia were not related with lifestyle parameters.
Barrett, Brendan T; Bradley, Arthur; Candy, T Rowan
This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child's first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after the emergence of amblyopia secondary to either deprivation or strabismus, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of 'pure' anisometropic amblyopia. Although indirect, the therapeutic impact of refractive
Barrett, Brendan T.; Bradley, Arthur; Candy, T. Rowan
This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child’s first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after amblyopia secondary to either deprivation or strabismus has emerged, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of ‘pure’ anisometropic amblyopia. Although indirect, the therapeutic impact of refractive
Full Text Available OBJETIVO: Comparar as correlações dos componentes oculares (comprimento axial, comprimento do segmento anterior, poder médio da córnea, profundidade da câmara vítrea e poder refrativo equivalente com o erro refrativo total do olho portador da menor e da maior ametropia em anisométropes. MÉTODOS: Foi realizado um "survey" analítico conduzido em população de 68 anisométropes de duas ou mais dioptrias atendida no Ambulatório da Clinica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Os anisométropes foram submetidos à refração estática objetiva e subjetiva, ceratometria e biometria ultra-sônica. RESULTADOS: Não houve diferença significativa entre os valores dos componentes oculares medidos dos olhos portadores da menor e da maior ametropia. Os olhos portadores da menor ametropia apresentaram as mesmas correlações significantes observadas em olhos emétropes, ou seja, correlação da refração com comprimento do segmento anterior e comprimento axial, e correlação do comprimento axial com poder corneano e profundidade da câmara vítrea. Os olhos portadores da maior ametropia apresentaram correlação significante da refração com o comprimento axial e do comprimento axial com a profundidade da câmara vítrea. Ainda em ambos os olhos observou-se correlação significante do poder do cristalino com a profundidade da câmara anterior. CONCLUSÃO: Os olhos portadores da menor ametropia desenvolveram as correlações mais freqüentemente observadas nos olhos emétropes. Os olhos portadores da maior ametropia não desenvolveram as mesmas correlações dos emétropes.PURPOSE: To asses the correlation between ocular components (axial length, anterior segment length, corneal power, vitreous length and equivalent power of the eye and refractive error in eyes with higher and lower ametropia of subjects with anisometropia. METHODS: An analytical survey was carried out in 68 patients
Smith, Earl L; Hung, Li-Fang; Arumugam, Baskar; Wensveen, Janice M; Chino, Yuzo M; Harwerth, Ronald S
We investigated the potential causal relationships between anisometropia, amblyopia and strabismus, specifically to determine whether either amblyopia or strabismus interfered with emmetropization. We analyzed data from non-human primates that were relevant to the co-existence of anisometropia, amblyopia and strabismus in children. We relied on interocular comparisons of spatial vision and refractive development in animals reared with 1) monocular form deprivation; 2) anisometropia optically imposed by either contact lenses or spectacle lenses; 3) organic amblyopia produced by laser ablation of the fovea; and 4) strabismus that was either optically imposed with prisms or produced by either surgical or pharmacological manipulation of the extraocular muscles. Hyperopic anisometropia imposed early in life produced amblyopia in a dose-dependent manner. However, when potential methodological confounds were taken into account, there was no support for the hypothesis that the presence of amblyopia interferes with emmetropization or promotes hyperopia or that the degree of image degradation determines the direction of eye growth. To the contrary, there was strong evidence that amblyopic eyes were able to detect the presence of a refractive error and alter ocular growth to eliminate the ametropia. On the other hand, early onset strabismus, both optically and surgically imposed, disrupted the emmetropization process producing anisometropia. In surgical strabismus, the deviating eyes were typically more hyperopic than their fellow fixating eyes. The results show that early hyperopic anisometropia is a significant risk factor for amblyopia. Early esotropia can trigger the onset of both anisometropia and amblyopia. However, amblyopia, in isolation, does not pose a significant risk for the development of hyperopia or anisometropia. Copyright © 2017 Elsevier Ltd. All rights reserved.
Lee, Chong Eun; Lee, Young Chun; Lee, Se-Youp
To evaluate factors that can influence the prevalence of amblyopia in children with anisometropia. We retrospectively reviewed the records of 63 children 2 to 13 years of age who had anisometropic amblyopia with a difference in the refractive errors between the eyes of at least two diopters (D). The type of anisometropia (myopia, hyperopia, and astigmatism), degree of anisometropia (4 D), best corrected visual acuity (BCVA) of the amblyopic eye at the time of initial examination, BCVA differences between sound and amblyopic eyes, whether or not occlusion therapy was performed, compliance with occlusion therapy, and the patient's age when eyeglasses were first worn were investigated. There was an increase in the risk of amblyopia with increased magnitude of anisometropia (p=0.021). The prevalence of amblyopia was higher in the BCVA 4 lines between sound and amblyopic eyes (p=0.008 and p=0.045, respectively). There was no statistical relationship between the prevalence of amblyopia and the type of anisometropia or the age when eyeglasses were first worn. Poor compliance with occlusion therapy was less likely to achieve successful outcome (p=0.015). Eyes with poor initial visual acuities of 4 line difference in the BCVA between sound and amblyopic eyes at the initial visit may require active treatment.
Carlos Alexandre de Amorim Garcia
Full Text Available PURPOSE: To perform an epidemiologic study in students in Natal/Brazil, with relation to refractional anisometropia, evaluating criteria such as: gender, age, and association with strabismus and amblyopia. METHODS: A study of 1,024 students randomly selected from several districts of Natal/Brazil was undertaken by the Department of Ophthalmology of the Federal University of Rio Grande do Norte (UFRN, observing the following criteria of > 2 spherical or cylindrical diopter refractional anisometropia relating it to sex, age, association with strabismus, amblyopia and anisometropia classification. RESULTS: We found a prevalence of 2% (N=21 anisometropia in the students. The female gender predominated with 81% (N=17. In students with anisometropia, we observed an association with strabismus in 9.5% of cases (N=2, both with exotropia. The association of anisometropia with amblyopia occurred in 47.6% of the cases (N=10, with 8 cases of unilateral amblyopia and 2 cases of bilateral amblyopia. CONCLUSIONS: There was a predominance of anisometropia in females, and an increased prevalence of strabismus and amblyopia in students with anisometropia.OBJETIVO: Realizar um estudo epidemiológico em estudantes de Natal/Brasil, com relação à anisometropia refracional, avaliando os seguintes critérios: sexo, idade e associação com estrabismo e ambliopia. MÉTODOS: Foram estudados 1.024 estudantes, randomicamente selecionados, pertencentes aos diversos distritos da cidade de Natal/Brasil, pelo Departamento de Oftalmologia, da Universidade Federal do Rio Grande do Norte (UFRN, observando os seguintes aspectos, quanto à anisometropia > 2 dioptrias esférica ou cilíndrica, sexo, idade, associação com estrabismo e ambliopia, e os tipos de anisometropia. RESULTADOS: Encontrou-se prevalência de anisometropia de 2% (N=21 nos estudantes. O sexo feminino predominou com 81% (N=17. Nos estudantes com anisometropia, observou-se associação com estrabismo em 9
Full Text Available OBJETIVO: Em anisométropes comparar os valores médios individuais dos componentes oculares de ambos os olhos, correlacionar as diferenças dos componentes com as diferenças de refração; e identificar o menor número de fatores que contenham o mesmo grau de informações expressas no conjunto de variáveis que influenciam a diferença refrativa. MÉTODOS: Realizou-se estudo transversal analítico em população de 77 anisométropes de 2 D ou mais, atendida no ambulatório de Oftalmologia do Hospital Universitário da Faculdade de Medicina Nilton Lins, Manaus. RESULTADOS: Os anisométropes foram submetidos à refração estática objetiva e subjetiva, ceratometria e biometria ultrassônica A-scan. A análise dos dados foi feita por meio dos seguintes modelos estatísticos: análise univariada, multivariada, de regressão múltipla e fatorial. CONCLUSÕES: Não houve diferenças significativas na comparação dos valores médios individuais dos componentes oculares entre os olhos. Houve correlação negativa média entre a diferença refrativa e a diferença de comprimento axial (r= -0,64 (pPURPOSE: To compare the individual means of ocular components of both eyes in patients with anisometropia; to correlate the differences of the components with refractive differences; and to identify the smallest number of factors that contain the same level of information expressed in the set of variables that influence refractive difference. METHODS: An analytical transversal study was carried out in 77 patients with anisometropia of two or more dioptres seen at the Ophthalmologic Clinic, University Hospital, Nilton Lins Medical School, Manaus. RESULTS: All participants were submitted to ophthalmologic examination which included objective and subjective cycloplegic refractometry, keratometry and ultrasound biometry. Data analysis comprised the following statistical models: univariate, multivariate, multiple and factorial regression analyses. CONCLUSIONS
Keane, Pearse A; Mitra, Arijit; Khan, Imran J; Quhill, Fahd; Elsherbiny, Samer M
The purpose of this article was to describe a patient with dome-shaped macula in the setting of mild myopic anisometropia and to speculate regarding the role of this feature as a compensatory mechanism in ocular development. The clinical records of a 49-year-old woman with this condition were reviewed. Spectral-domain optical coherence tomographic images revealed evidence of a dome-shaped macula. B-scan ultrasonography measured axial lengths of 23.8 mm in the right eye and 22.8 mm in the left eye. Spherical equivalents were -1.375 and +0.375 in the right and left eyes, respectively. Examination of the left eye was unremarkable. Dome-shaped macula has previously only been described in patients with high myopia. These findings support the hypothesis that myopic anisometropia, rather than absolute refractive status, is central to the development of dome-shaped macula and that this feature represents a protective mechanism aimed at reducing the effects of anisometropia. Copyright 2012, SLACK Incorporated.
Afsari, Sonia; Rose, Kathryn A; Gole, Glen A; Philip, Krupa; Leone, Jody F; French, Amanda; Mitchell, Paul
To determine the age and ethnicity-specific prevalence of anisometropia in Australian preschool-aged children and to assess in this population-based study the risk of anisometropia with increasing ametropia levels and risk of amblyopia with increasing anisometropia. A total 2090 children (aged 6-72 months) completed detailed eye examinations in the Sydney Paediatric Eye Disease Study, including cycloplegic refraction, and were included. Refraction was measured using a Canon RK-F1 autorefractor, streak retinoscopy and/or the Retinomax K-Plus 2 autorefractor. Anisometropia was defined by the spherical equivalent (SE) difference, and plus cylinder difference for any cylindrical axis between eyes. The overall prevalence of SE and cylindrical anisometropia ≥1.0 D were 2.7% and 3.0%, for the overall sample and in children of European-Caucasian ethnicity, 3.2%, 1.9%; East-Asian 1.7%, 5.2%; South-Asian 2.5%, 3.6%; Middle-Eastern ethnicities 2.2%, 3.3%, respectively. Anisometropia prevalence was lower or similar to that in the Baltimore Pediatric Eye Disease Study, Multi-Ethnic Pediatric Eye Disease Study and the Strabismus, Amblyopia and Refractive error in Singapore study. Risk (OR) of anisometropic amblyopia with ≥1.0 D of SE and cylindrical anisometropia was 12.4 (CI 4.0 to 38.4) and 6.5 (CI 2.3 to 18.7), respectively. We found an increasing risk of anisometropia with higher myopia ≥-1.0 D, OR 61.6 (CI 21.3 to 308), hyperopia > +2.0 D, OR 13.6 (CI 2.9 to 63.6) and astigmatism ≥1.5 D, OR 30.0 (CI 14.5 to 58.1). In this preschool-age population-based sample, anisometropia was uncommon with inter-ethnic differences in cylindrical anisometropia prevalence. We also quantified the rising risk of amblyopia with increasing SE and cylindrical anisometropia, and present the specific levels of refractive error and associated increasing risk of anisometropia.
Patrícia Ioschpe Gus
Full Text Available OBJETIVO: Avaliar a eficácia da técnica laser in situ keratomileusis (LASIK na redução de anisometropia em adultos, para os quais os tratamentos convencionais não tiveram sucesso. MÉTODOS: Série de casos de três olhos de três pacientes adultos, dois do sexo feminino e um do sexo masculino, com idade entre 28 e 49 anos (média de 38,3 anos, os quais foram submetidos à técnica de LASIK. Dois pacientes foram acompanhados por dezoito meses e um por seis meses após a cirurgia. RESULTADOS: Comparando a acuidade visual corrigida do pré-operatório com a acuidade visual não corrigida do pós-operatório, um olho ganhou duas linhas de visão, um olho manteve-se igual e um olho perdeu uma linha de visão. Todos os olhos se mantiveram sem ametropia esférica, e o astigmatismo não excedeu -0,75 D no pós-operatório. CONCLUSÃO: A técnica LASIK mostrou-se eficaz na correção de alta anisometropia em adultos, melhorando a acuidade visual e as queixas astenopéicas, e diminuindo a anisometropia.PURPOSE: To evaluate the efficacy of the laser in situ keratomileusis (LASIK technique in the reduction of anisometropy in adults, for whom conventional treatment was not successful. METHODS: A sequence of cases of three eyes of three adult patients, two females and one male, age ranging from 28 and 49 years (average 38.3 years, who underwent LASIK. Two patients were followed up for eighteen months and one for six months. RESULTS: Comparing the corrected visual acuity before surgery with the non-corrected visual acuity after surgery, one eye gained two lines of vision, one eye remained the same and one eye lost one line of vision. All eyes remained without spheric refraction, and astigmatism did not exceed - 0.75 D after surgery. There has been an improvement in the symptoms of asthenopia in the three patients. CONCLUSION: The LASIK technique proved to be efficient in the correction of anisometropy in adults, improving visual accuity and asthenopia
Discussion: The results show that the prevalence of anisometropia was higher than shown in previous studies but prevalence of convergence insufficiency, esotropia and exotropia was lower than previous studies.
Ying, Gui-shuang; Huang, Jiayan; Maguire, Maureen; Quinn, Graham; Kulp, Marjean Taylor; Ciner, Elise; Cyert, Lynn; Orel-Bixler, Deborah
Purpose To evaluate the relation of anisometropia with unilateral amblyopia, interocular acuity difference (IAD) and stereoacuity, among Head Start preschoolers, using both clinical notation and vector notation analyses. Design Multicenter, cross-sectional study. Participants 3- to 5-year-old participants in the Vision In Preschoolers (VIP) Study (N=4040). Methods Secondary analysis of VIP data from participants who had comprehensive eye examinations including monocular visual acuity (VA) testing, stereoacuity testing, and cycloplegic refraction. VA was retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as IAD ≥2 lines in logarithm of the Minimum Angle of Resolution (logMAR). Anisometropia was defined as ≥0.25 D (diopter) difference in spherical equivalent (SE) or in cylinder power, and also two approaches using power vector notation. The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity were compared between anisometropic and isometropic children. Main Outcomes Measures The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity. Results Compared with isometropic children, anisometropic children had a higher percentage of unilateral amblyopia (8% vs. 2%), larger mean IAD (0.07 vs. 0.05 logMAR) and worse mean stereoacuity (145 vs.117 arc sec) (all pamblyopia, larger IAD, and worse stereoacuity (trend pamblyopia was significantly increased with spherical equivalent (SE) anisometropia >0.5 D, cylindrical anisometropia >0.25 D, the vertical/horizontal meridian (J0) or oblique meridian (J45) >0.125 D, or vector dioptric distance (VDD) >0.35 D (all pamblyopia than cylinder, SE, J0 and J45 (pamblyopia, larger IAD and worse stereoacuity. The threshold level of anisometropia at which unilateral amblyopia becomes significant was lower than current guidelines. VDD is more accurate than spherical equivalent anisometropia or cylindrical anisometropia in identifying preschoolers with
Jeon, Hyun Sun; Choi, Dong Gyu
To evaluate the level of stereopsis and fusion in patients with anisometropia according to the presence of amblyopia. We included 107 children with anisometropia, divided into groups with non-amblyopic anisometropia (NA, n = 72) and amblyopic anisometropia (AA, n = 35). Normal subjects without anisometropia were enrolled in the control group (n = 73). Main outcome measures were the level of stereopsis and sensory fusion as evaluated by Titmus stereotest and Worth 4-dot test, respectively, using anisometropic glasses. The degree of anisometropia in the NA, AA, and control groups was 2.54 diopters (D), 4.29 D, and 0.30 D, respectively (P = 0.014). Stereopsis (arcsec) was significantly worse in the AA group than the NA and control groups (641.71, 76.25, 54.52, respectively, P < 0.001), while no significant difference was found between the NA and control groups. The rate of fusion was significantly lower in the AA than the NA group (14.3% vs. 65.3%, P < 0.001), and was significantly lower in the NA than the control group (65.3% vs. 80.6%, P = 0.001). The levels of stereopsis and sensory fusion with anisometropic glasses were significantly worse in the AA than in the NA group. The level of stereopsis in the NA group, however, did not differ significantly from that in the isometropic control, while the rate of fusion was significantly lower. Early prescription of anisometropic glasses is needed to improve visual acuity and binocularity in children with possible amblyopic anisometropia.
Bilgihan, K; Ozdek, S C; Gürelik, G; Adigüzel, U; Onol, M; Hasanreisoglu, B
To evaluate the efficacy of unilateral photorefractive keratectomy to correct anisometropia induced by retinal detachment surgery. Photorefractive keratectomy was performed in 10 eyes of 10 patients with anisometropia induced by previous retinal detachment surgery. The Aesculap Meditec MEL 60 excimer laser was used. Preoperative mean spherical equivalent refraction was -5.20 D. Mean postoperative spherical equivalent refraction was -0.25 D after a mean follow-up of 12.9 months. Mean preoperative spherical equivalent refraction difference between two eyes of 4.87 D was decreased to a mean 0.60 D postoperatively (t-test, P < .0001). All patients were free of anisometropic symptoms after laser surgery. Unilateral photorefractive keratectomy seems to be an effective method to correct anisometropia induced by conventional retinal detachment surgery, especially for patients with spectacle and contact lens intolerance.
Ardagil, Aylin; Yaylali, Sevil; Erbil, Hasan; Olgun, Ali; Aslan, Zeki; Dolar, Ayse
The purpose of this study was to document the prevalence of anisometropia, anisoastigmatism, and anisometropic amblyopia in patients with neurofibromatosis-1 (NF1) and to compare it with that in age- and sex-matched controls. Fifty patients with NF1 and 150 age- and sex-matched controls were examined in this study. Cycloplegic autorefraction was attempted on all patients 16 years old. Anisometropia was defined as absolute interocular difference of spherical equivalent more than or equal to 1 D. Aniso-astigmatism was defined as interocular difference of refractive astigmatism of more than or equal to 1 D. Amblyopia was defined as two-line decrease in Snellen acuity between the two eyes. The overall prevalence of anisometropia, aniso-astigmatism, and amblyopia in patients with NF1 was 16%, 20%, and 10%, respectively, and they were all significantly higher than in the controls. The amblyopia was either moderate or severe in nature and all affected patients had significant astigmatism (>2.5 D) in the amblyopic eye. NF1 is a risk factor for anisometropia, aniso-astigmatism, and aniso-astigmatic amblyopia and screening patients with NF1 for refractive errors before age 3 will help to detect patients at risk of amblyopia and give them proper treatment.
Donahue, Sean P
Purpose Anisometropia is a common cause of amblyopia. The relationship between anisometropia, patient age, and the development of amblyopia is unknown. Photoscreening identifies children with anisometropia in a manner that is not biased by visual acuity and allows a unique opportunity to evaluate how patient age influences the prevalence and depth of anisometropic amblyopia. Methods A statewide preschool photoscreening program screened 120,000 children and identified 792 with anisometropia greater than 1.0 diopter. Age was correlated with visual acuity and amblyopia depth. Data were compared with those from 562 strabismic children similarly identified. Results Only 14% (6/44) of anisometropic children aged 1 year or less had amblyopia. Prevalence was 40% (32/80) for 2-year-olds, 65% (119/182) for 3-year-olds, and peaked at 76% (age 5). Amblyopia depth also increased with age. Moderate amblyopia prevalence was 2% (ages 0 to 1), 17% (age 2), and rose steadily to 45% (ages 6 to 7). Severe amblyopia was rare prior to age 4, 9% at age 4, 14% at age 5, and 9% at ages 6 to 7. In contrast, children with strabismus had a stable prevalence of amblyopia (30% at ages 0 to 2, 42% at ages 3 to 4, 44% at ages 5 to 7). Conclusions Younger children with anisometropic refractive error have a lower prevalence and depth of amblyopia than do older children. By age 4, when most children undergo traditional screening, amblyopia has usually already developed. New vision screening technologies that allow early detection of anisometropia provide ophthalmologists an opportunity to intervene early, perhaps retarding, or even preventing, the development of amblyopia. PMID:17057809
Mohsen Akhgary; Mohammad Ghassemi-Broumand; Mohammad Aghazadeh Amiri; Mehdi Tabatabaee Seyed
Purpose: Manifest strabismus such as constant and alternative esotropia and exotropia, not only cause cosmetic problem in patients but also induce disorders such as amblyopia. These anomalies can lead to academic failure in students and reduce efficiency in other jobs. Therefore, determining the prevalence of binocular anomalies is important. The purpose of this study is to determine the prevalence of strabismic binocular anomalies, amblyopia and anisometropia in patients examined in optometr...
Yekta, AbbasAli; Fotouhi, Akbar; Hashemi, Hassan; Dehghani, Cirous; Ostadimoghaddam, Hadi; Heravian, Javad; Derakhshan, Akbar; Yekta, Reihaneh; Rezvan, Farhad; Behnia, Mehdi; Khabazkhoob, Mehdi
To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran. A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus. Mean age of 2638 schoolchildren was 12.5 years (response rate = 86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p = 0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively. Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.
Dobson, Velma; Miller, Joseph M; Clifford-Donaldson, Candice E; Harvey, Erin M
To describe the relation between magnitude of anisometropia and interocular acuity difference (IAD), stereoacuity (SA), and the presence of amblyopia in school-aged members of a Native American tribe with a high prevalence of astigmatism. Refractive error (cycloplegic autorefraction confirmed by retinoscopy), best corrected monocular visual acuity (VA; Early Treatment Diabetic Retinopathy Study logMAR charts), and best corrected SA (Randot Preschool Stereoacuity Test) were measured in 4- to 13-year-old Tohono O'odham children (N = 972). Anisometropia was calculated in clinical notation (spherical equivalent and cylinder) and in two forms of vector notation that take into account interocular differences in both axis and cylinder magnitude. Astigmatism >or= 1.00 D was present in one or both eyes of 415 children (42.7%). Significant increases in IAD and presence of amblyopia (IAD >or= 2 logMAR lines) occurred, with >or=1 D of hyperopic anisometropia and >or=2 to 3 D of cylinder anisometropia. Significant decreases in SA occurred with >or=0.5 D of hyperopic, myopic, or cylinder anisometropia. Results for vector notation depended on the analysis used, but also showed disruption of SA at lower values of anisometropia than were associated with increases in IAD and presence of amblyopia. Best corrected IAD and presence of amblyopia are related to amount and type of refractive error difference (hyperopic, myopic, or cylindrical) between eyes. Disruption of best corrected random dot SA occurs with smaller interocular differences than those producing an increase in IAD, suggesting that the development of SA is particularly dependent on similarity of the refractive error between eyes.
Lee, Chia-Wei; Fang, Shao-You; Tsai, Der-Chong; Huang, Nicole; Hsu, Chih-Chien; Chen, Shing-Yi; Chiu, Allen Wen-Hsiang; Liu, Catherine Jui-Ling
Lifestyle behaviour may play a role in refractive error among children, but the association between near work habits and refractive anisometropia remains unclear. We estimated the prevalence of refractive anisometropia and examined its association with near work activities among 23,114 children in the Myopia Investigation Study in Taipei who were grade 2 elementary school students at baseline in 2013 and 2014. Baseline data on demographics, medical history, parental history and near work habits were collected by parent-administered questionnaire survey. Refractive status was determined by cycloplegic autorefraction. Refractive anisometropia was defined as the spherical equivalent difference ≥ 1.0 diopter between eyes. The prevalence of refractive anisometropia was 5.3% (95% confidence interval [CI], 5.0% to 5.6%). The prevalence and severity of refractive anisometropia increased with both myopic and hyperopic refractive error. Multivariate logistic regression analysis revealed that refractive anisometropia was significantly associated with myopia (odds ratio [OR], 2.98; 95% CI, 2.53-3.51), hyperopia (OR, 2.37; 95% CI, 1.98-2.83), degree of astigmatism (OR, 1.005; 95% CI, 1.005-1.006), amblyopia (OR, 2.54; 95% CI, 2.06-3.12), male gender (OR, 0.88; 95% CI, 0.78-0.99) and senior high school level of maternal education (OR, 0.69; 95% CI, 0.52-0.92). Though anisometropic children were more likely to spend more time on near work (crude OR, 1.15; 95% CI, 1.02-1.29) and to have less eye-to-object distance in doing near work (crude OR, 1.15; 95% CI, 1.01-1.30), these associations became insignificant after additional adjustment for ocular, demographic and parental factors. The present study provides large-scale, population-based evidence showing no independent association between refractive anisometropia and near work habits, though myopia is associated with refractive anisometropia.
Amitava, Abadan Khan; Kewlani, D.; Khan, Z.; Razzak, A.
Background : Current amblyopia screening methods are not cost effective. Aim : To evaluate the diagnostic capability of a modified Brückner test (MBT) for amblyopiogenic risk factors. Materials and Methods : We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. Statisitics : D...
Full Text Available AIM:To analyze the clinical significance of axial length, diopter and retinal nerve fiber layer thickness in hyperopia children with anisometropia amblyopia. METHODS: From January 2015 to January 2017 in our hospital for treatment, 103 cases, all unilateral, were diagnosed as hyperopia anisometropia amblyopia. The eyes with amblyopia were as experimental group(103 eyes, another normal eye as control group(103 eyes. We took the detection with axial length, refraction, foveal thickness, corrected visual acuity, diopter and the average thickness of retinal nerve fiber layer. RESULTS: Differences in axial length and diopter and corrected visual acuity were statistically significant between the two groups(PP>0.05. There was statistical significance difference on the foveal thickness(PP>0.05. The positive correlation between diopter with nerve fiber layer thickness of foveal and around the optic disc were no statistically significant difference(P>0.05. CONCLUSION: Retinal thickness of the fovea in the eye with hyperopic anisometropia amblyopia were thicker than those in normal eyes; the nerve fiber layer of around the optic disc was not significantly different between the amblyopic eyes and contralateral eyes. The refraction and axial length had no significant correlation with optic nerve fiber layer and macular foveal thickness.
Abadan Khan Amitava
Full Text Available Background : Current amblyopia screening methods are not cost effective. Aim : To evaluate the diagnostic capability of a modified Brückner test (MBT for amblyopiogenic risk factors. Materials and Methods : We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. Statisitics : Data were analyzed by 2 Χ 2 tables for diagnostic test parameters (95% CI. Results : From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ≥ 90% (95%CI 89% to 97% over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 (0.48, 0.64, 0.97 (0.95, 0.98, 0.92 (0.90, 0.93 and 18 (9.7, 35; for 1D: 0.74(0.60, 0.82, 0.95 (0.94, 0.97, 0.97 (0.95, 0.98 and 16 (9.3, 28; and for strabismus: 0.5 (0.32, 0.66, 0.98 (0.97, 0.98, 0.97 (0.96, 0.98 and 20 (9.1, 42. Conclusion : Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice.
Autrata, R; Krejčířová, I; Griščíková, L; Doležel, Z
Our study evaluated the visual and refractive results of LASEK and anterior chamber phakic intraocular lens (pIOL) implantation performed for high myopic anisometropia with amblyopia and contact lens intolerance in children compared with conventional treatment by contact lenses.Fourty-three patients (Group A) aged 3 to 7 years (mean, 5,6 years) with high myopic anisometropia and amblyopia had performed multizonal LASEK (27 eyes) or pIOL Verisyse implantation (16 eyes) on the more myopic eye in general anesthesia. Surgery was followed by patching of the dominant eye. Postoperative visual and refractive outcomes were analyzed and all children had minimally two years follow-up after procedure. Refractive surgical data were reported in standard format to describe safety, efficacy, predictability and stability of the procedure. This Group A of 43 children was compared with control Group B of 37 children (mean age 5,4 years), in whom myopic anisometropia and amblyopia were treated conventionally by contact lenses (CL) and patching of the dominant eye. Visual acuity (VA) and binocular vision (BV) outcome were analyzed and compared in both groups.The mean preoperative spherical equivalent (SE) cycloplegic refraction in Group A was - 9,45 ± 2,47 diopters (D) (range -6.0 to -18.25 D) and the mean postoperative SE -1,48 ± 1,13 D (range + 0,75 to - 2,25 D). The mean preop. decimal uncorrected visual acuity (UCVA) 0,023 ± 0,017 increased to 0,46 ± 0,18. The mean preop.decimal best-corrected visual acuity (BCVA) in Group A was 0,28 ± 0.22 and changed to 0,78± 0,19 by 2 years after surgery. The mean BCVA in Group B was 0,23 ± 0,19, at start of CL correction and amblyopia therapy, and improved to 0,42 ± 0,15 after two years. The mean BCVA at final examination was significantly better in Group A (P amblyopia in children when contact lens intolerance. Visual acuity and binocular vision outcomes were better in children who received permanent surgical correction of
Full Text Available The term amblyopia is used to describe reduced visual function in one eye (or both eyes, though not so often which cannot be fully improved by refractive correction and explained by the organic cause observed during regular eye examination. This developmental disorder of spatial vision affects about 2-5% of the population and is associated with abnormal visual experience (e.g. anisometropia, strabismus during infancy or early childhood. Several studies have shown prolongation of saccadic latency time in amblyopic eye. In our opinion, study of saccadic latency in the context of central vision deficits assessment, should be based on central retina stimulation. For this reason, we proposed saccade delayed task. It requires inhibitory processing for maintaining fixation on the central target until it disappears – what constitutes the GO signal for saccade. The experiment consisted of 100 trials for each eye and was performed under two viewing conditions: monocular amblyopic / non-dominant eye and monocular dominant eye. We examined saccadic latency in 16 subjects (mean age 30±11 years with anisometropic amblyopia (two subjects had also microtropia and in 17 control subjects (mean age 28±8 years. Participants were instructed to look at central (fixation target and when it disappears, to make the saccade toward the periphery (10 deg as fast as possible, either left or the right target. The study results have proved the significant difference in saccadic latency between the amblyopic (mean 262±48 ms and dominant (mean 237±45 ms eye, in anisometropic group. In the control group, the saccadic latency for dominant (mean 226±32ms and non-dominant (mean 230±29 ms eye was not significantly different.By the use of LATER (Linear Approach to the Threshold with Ergodic Rate decision model we interpret our findings as a decrease in accumulation of visual information acquired by means of central (affected retina in subjects with anisometropic amblyopia.
Full Text Available Lifestyle behaviour may play a role in refractive error among children, but the association between near work habits and refractive anisometropia remains unclear.We estimated the prevalence of refractive anisometropia and examined its association with near work activities among 23,114 children in the Myopia Investigation Study in Taipei who were grade 2 elementary school students at baseline in 2013 and 2014. Baseline data on demographics, medical history, parental history and near work habits were collected by parent-administered questionnaire survey. Refractive status was determined by cycloplegic autorefraction. Refractive anisometropia was defined as the spherical equivalent difference ≥ 1.0 diopter between eyes.The prevalence of refractive anisometropia was 5.3% (95% confidence interval [CI], 5.0% to 5.6%. The prevalence and severity of refractive anisometropia increased with both myopic and hyperopic refractive error. Multivariate logistic regression analysis revealed that refractive anisometropia was significantly associated with myopia (odds ratio [OR], 2.98; 95% CI, 2.53-3.51, hyperopia (OR, 2.37; 95% CI, 1.98-2.83, degree of astigmatism (OR, 1.005; 95% CI, 1.005-1.006, amblyopia (OR, 2.54; 95% CI, 2.06-3.12, male gender (OR, 0.88; 95% CI, 0.78-0.99 and senior high school level of maternal education (OR, 0.69; 95% CI, 0.52-0.92. Though anisometropic children were more likely to spend more time on near work (crude OR, 1.15; 95% CI, 1.02-1.29 and to have less eye-to-object distance in doing near work (crude OR, 1.15; 95% CI, 1.01-1.30, these associations became insignificant after additional adjustment for ocular, demographic and parental factors.The present study provides large-scale, population-based evidence showing no independent association between refractive anisometropia and near work habits, though myopia is associated with refractive anisometropia.
Sadat A. O. Bani
Full Text Available Amblyopia screening is often either costly or laborious. We evaluated the Canon Powershot TX1 (CPTX1 digital camera as an efficient screener for amblyogenic risk factors (ARF. We included 138 subjects: 84-amblyopes and 54-normal. With the red-eye-reduction feature off, we obtained Bruckner reflex photographs of different sized crescents which suggested anisometropia, while asymmetrical brightness indicated strabismus; symmetry implied normalcy. Eight sets of randomly arranged 138 photographs were made. After training, 8 personnel, marked each as normal or abnormal. Of the 84 amblyopes, 42 were strabismus alone (SA, 36 had anisometropia alone (AA while six were mixed amblyopes (MA. Overall mean sensitivity for amblyopes was 0.86 (95% CI: 0.83-0.89 and specificity 0.85 (95% CI: 0.77-0.93. Sub-group analyses on SA, AA and MA returned sensitivities of 0.86, 0.89 and 0.69, while specificities were 0.85 for all three. Overall Cohen′s Kappa was 0.66 (95% CI: 0.62-0.71. The CPTX1 appears to be a feasible option to screen for ARF, although results need to be validated on appropriate age groups.
Full Text Available Introduction. Identical twins account for 0.2% of the world population and 8% of all twins. A “mirror image” variation can be found in 25% of identical twins. Studies of twins assume a special place in human genetics due to the possibility of comparing genetic and other factors. We present two pairs of identical male twins with mirror-image astigmatism and esotropia. Case Outline. The first was a pair of twelve-year old identical twins with “mirror image” myopic astigmatism. The Twin 1 had myopic astigmatism in the right eye, while the Twin 2 was affected by the left eye myopic astigmatism. The second was a pair of six-year old identical twins with esotropia and hypermetropic astigmatism. The Twin 1 had esotropia in the left eye, while the right eye was affected in the Twin 2. Esotropia was surgically corrected. Conclusion. In this study we pointed to the role of genetic factors in the development of refractive error, as well as the type of strabismus. Refraction anomalies (myopia, hypermetropia and astigmatism are complex heterogeneous disorders and ideal for genetic investigation. The knowledge of genetic mechanisms involved in refractive error susceptibility may allow treatment to prevent progression or to further examine gene-environment interactions. We hope that this paper will initiate further investigation of refraction anomalies in twins and future multicentre studies, which, to our knowledge, have not been conducted in our country so far.
Zafar, S.N.; Islam, F.; Khan, A.M.
Objective: To determine the effect of ptosis on the refractive error in eyes having monocular elevation deficiency Place and Duration of Study: Al-Shifa Trust Eye Hospital, Rawalpindi, from January 2011 to January 2014. Methodology: Visual acuity, refraction, orthoptic assessment and ptosis evaluation of all patients having monocular elevation deficiency (MED) were recorded. Shapiro-Wilk test was used for tests of normality. Median and interquartile range (IQR) was calculated for the data. Non-parametric variables were compared, using the Wilcoxon signed ranks test. P-values of <0.05 were considered significant. Results: A total of of 41 MED patients were assessed during the study period. Best corrected visual acuity (BCVA) and refractive error was compared between the eyes having MED and the unaffected eyes of the same patient. The refractive status of patients having ptosis with MED were also compared with those having MED without ptosis. Astigmatic correction and vision had significant difference between both the eyes of the patients. Vision was significantly different between the two eyes of patients in both the groups having either presence or absence of ptosis (p=0.04 and p < 0.001, respectively). Conclusion: Significant difference in vision and anisoastigmatism was noted between the two eyes of patients with MED in this study. The presence or absence of ptosis affected the vision but did not have a significant effect on the spherical equivalent (SE) and astigmatic correction between both the eyes. (author)
Kekunnaya, Ramesh; Chandrasekharan, Anjali; Sachdeva, Virender
Strabismus in myopes can be related to anisometropia, accommodation/convergence effects, and/or muscle path deviations. This review article highlights management considerations in myopic patients. PMID:26180467
Conclusions and importance: Straatsma Syndrome can present with heterochromia iridum. When strabismus is present, early surgery should be withheld. Intensive treatment of Straatsma Syndrome can yield an unexpected good result, despite initial high degree anisometropia and low vision acuity.
Full Text Available AIM: To study the related factors of comprehensive treatment effect on anisometropic amblyopia children, and to provide a theoretical basis for clinical intervention. METHODS: Totally 100 cases of anisometropic amblyopia children in our hospital from October 2013 to October 2014 were selected and were divided into groups A, B and C according to curative effect after 6～18mo's treatment. Fifty-four cases of group A were judged to be cured, 34 cases of group B were judged to be improved, and 12 cases of group C was invalid. The age, compliance, anisometropia degree, anisometropia type, amblyopia degree and fixation behavior were analyzed. RESULTS: Anisometropia type among the three groups of patients showed no significant difference(P>0.05. While the age, compliance, anisometropia degree, amblyopia degree and fixation behavior among three groups of patients had statistically significant differences(PCONCLUSION: There are closed relationship between comprehensive treatment effect and age, compliance, anisometropia degree, amblyopia degree, fixation behavior, but there is no significant correlation between anisometropia type and comprehensive treatment effect.
Eshraghi, Bahram; Akbari, Mohammad Reza; Fard, Masoud Aghsaei; Shahsanaei, Azadeh; Assari, Raheleh; Mirmohammadsadeghi, Arash
To evaluate the prevalence of amblyopia risk factors in children that underwent probing for persistent congenital nasolacrimal duct obstruction (CNLDO). The medical records of children with CNLDO (after 1 year of age) that underwent probing were reviewed. Amblyopia risk factors, based on the American Association for Pediatric Ophthalmology and Strabismus referral criteria in 2013, were sought in the patientsʹ records before probing. The proportion of the patients with anisometropia >1.5 diopters (D) was separately calculated. In unilateral cases of CNLDO, sphere, astigmatism, and spherical equivalent of the eyes with CNLDO were compared with contralateral eyes in order to assess the effect of CNLDO on refractive error. In the follow-up examinations, the success of the probing or the need for additional procedures (Crawford intubation, Monoka intubation, or dacryocystorhinostomy) was evaluated. The prevalence of anisometropia between 'successful probing' and 'failed probing' groups was compared. A total of 433 cases were included in the study. 41 cases (9.46 %) had amblyopia risk factors. Twenty-four cases (5.5 %) had anisometropia >1.5 D (spherical or cylindrical). In unilateral cases of CNLDO, the sphere and spherical equivalent of the eyes with CNLDO were significantly greater than those of the contralateral eyes (p prevalence in this group, compared with the successful probing group, at the initial examination (p = 0.03). The findings of greater prevalence of anisometropia >1.5 D (compared with the prevalence in the general population) and significantly greater sphere and spherical equivalents in the eye with CNLDO (compared with contralateral eye) in unilateral cases with CNLDO, suggested some relationships between anisometropia and long-term untreated CNLDO. The finding of more anisometropia in failed probing cases may support the theory of structural abnormality as an explanation for the possible relationship between congenital nasolacrimal duct
Full Text Available Purpose: We aimed to compare the demographic features, visual acuities before and after treatment, amblyopia and strabismus degrees and binocular visual functions in cases with anisometropic, strabismic and/or anisometropic amblyopia. Material and Method: The study included 50 anisometropic, 50 strabismic and 50 anisometropic and strabismic cases that were followed up with the diagnosis of amblyopia, in our clinic, between January 2007 - September 2010. Amblyopia criteria was defined as the best corrected visual acuity of ≤0.8 and at least 2 lines difference between the visual acuities of two eyes. Anisometropia was defined as ≥1D difference in the spherical and cylindrical value between two eyes. Results: The groups were statistically similar in means of age and sex distribution. Visual acuities in amblyopic eyes before and after treatment were also statistically similar. There were no significant difference between 3 groups in means of compliance to occlusion therapy. In anisometropic cases, anisometropic spherical values were found to have position correlation with amblyopia degree. In hypermetropic and myopic cases, a strong correlation was shown between anisometropia and amblyopia, especially in hypermetropic cases, amblyopia degree increased as the anisometropia increased. In all strabismus cases, a positive correlation between strabismus and amblyopia degrees was shown even though it was statistically insignificant. In strabismic cases, esotropia was significantly higher than exotropia. In anisometropia group, stereopsis and fusion was found to be preserved better in comparison to the strabismic cases. It was concluded that deviation had a more profound effect on binocular function loss than anisometropia. Discussion: We recommend to follow the hypermetropic anisometropic cases and especially cases with high degree strabismus and esotropia more closely. And also we emphasize that strabismus affects binocular function loss more than
Lee, Soo Han
Purpose To investigate the relationship between higher-order aberrations (HOAs) and amblyopia treatment in children with hyperopic anisometropic amblyopia. Methods The medical records of hyperopic amblyopia patients with both spherical anisometropia of 1.00 diopter (D) or more and astigmatic anisometropia of less than 1.00 D were reviewed retrospectively. Based on the results of the amblyopia treatment, patients were divided into two groups: treatment successes and failures. Using the degree of spherical anisometropia, subjects were categorized into mild, moderate, or severe groups. Ocular, corneal, and internal HOAs were measured using a KR-1W aberrometer at the initial visit, and at 3-month, 6-month, and 12-month follow-ups. Results The results of the 45 (21 males and 24 females) hyperopic anisometropic amblyopia patients who completed the 12-month follow-up examinations were analyzed. The mean patient age at the initial visit was 70.3 months. In total, 28 patients (62.2%) had successful amblyopia treatments and 17 patients (37.8%) failed treatment after 12 months. Among the patient population, 24 (53.3%) had mild hyperopic anisometropia and 21 (46.7%) had moderate hyperopic anisometropia. When comparing the two groups (i.e., the success and failure groups), ocular spherical aberrations and internal spherical aberrations in the amblyopic eyes were significantly higher in the failure group at every follow-up point. There were no significant differences in any of the HOAs between mild and moderate cases of hyperopic anisometropia at any follow-up. When the amblyopic and fellow eyes were compared between the groups there were no significant differences in any of the HOAs. Conclusions HOAs, particularly ocular spherical aberrations and internal spherical aberrations, should be considered as reasons for failed amblyopia treatment. PMID:24505201
Koos, D; Koos, M J
The indications of contact lens adaptation in optical purpose are widely large, starting, with refractive errors [correction of vices], unilateral and bilateral aphakia, myopia, anisometropia and astigmatism, together with the use of contact lens in esthetic purpose. We have been presented the adaptation techniques, the supervise, and maintenance of contact lens.
Ranzani,J.J.T.; Mobricci,L.A.L.; Carvalho,L.R.; Brandão,C.V.S.
A refração ocular por retinoscopia com luz em faixa em 10 cães normais, sem raça definida, demonstrou que a maioria dos animais, independentemente do porte, apresentou tendência à hipermetropia, além de anisometropia e astigmatismo.
The youngest age of presentation for presbyopia was 36 years. Astigmatism occurred in 55.8% of the patients seen. Most of the patients (68.3%) had myopic astigmatism. One of the two patients who had anisometropia had developed amblyopia in the more hypermetropic eye. Conclusion: Since refractive errors were found ...
Fledelius, Hans C; Bangsgaard, Regitze; Slidsborg, Carina
: The refractive distribution presented a myopic tail (4.5%) and a hyperopic tail (11.9% ≥+2.5 D) as special preterm features, and corneas were more curved. Astigmatism and anisometropia were only marginally increased, and visual acuities were generally good. Best-corrected binocular median logMAR visual acuity...
Anisometropia is one of the main causes of amblyopia. This study was conducted to investigate the association between the depth of amblyopia and the magnitude of anisometropia. A retrospective record review was conducted at the Nepal Eye Hospital between July 2006 and June 2011. Those children included in this study were aged ≤13 years and diagnosed with unilateral anisometropic amblyopia, no strabismus and ocular pathology. Associations between the depth of amblyopia and the age and/or gender of the subjects, the laterality of the amblyopic eyes, the type and magnitude of refractive error of amblyopic eyes, and the magnitude of anisometropia were statistically analyzed. Out of the 189 children with unilateral anisometropic amblyopia (mean age 9.1 ± 2.8 years), 59% were boys. Amblyopia was more commonly found in left eye (p amblyopia was not associated with the gender (p = 0.864) or age (p = 0.341) of the subjects or the laterality of the eyes (p = 0.159), but it was associated with the type (p = 0.049) and magnitude (p = 0.013) of refractive error of the amblyopic eye and the magnitude of anisometropia (p = 0.002). Nepalese anisometropic amblyopic children were presented late to hospital. The depth of amblyopia was highly associated with the type and magnitude of refractive error of the amblyopic eye and the magnitude of anisometropia. So, basic vision screening programs may help to find out the anisometropic children and reefer them to the hospital for timely management of anisometropic amblyopia if present.
Kim, S-H; Suh, Y-W; Yun, C; Yoo, E-J; Yeom, J-H; Cho, Y A
To evaluate the degree of three-dimensional (3D) perception and ocular and systemic discomfort in patients with abnormal binocular vision (ABV), and their relationship to stereoacuity while watching a 3D television (TV). Patients with strabismus, amblyopia, or anisometropia older than 9 years were recruited for the ABV group (98 subjects). Normal volunteers were enrolled in the control group (32 subjects). Best-corrected visual acuity, refractive errors, angle of strabismus, and stereoacuity were measured. After watching 3D TV for 20 min, a survey was conducted to evaluate the degree of 3D perception, and ocular and systemic discomfort while watching 3D TV. One hundred and thirty subjects were enrolled in this study. The ABV group included 49 patients with strabismus, 22 with amblyopia, and 27 with anisometropia. The ABV group showed worse stereoacuity at near and distant fixation (Pwatching 3D TV. However, ocular and systemic discomfort was more closely related to better stereopsis.
Birch, Eileen E; Subramanian, Vidhya; Weakley, David R
Hyperopic anisometropia in children can be associated with abnormal stereoacuity and "microstrabismus," a small temporalward "flick" as each eye assumes fixation on cover testing. The prevailing hypothesis is that abnormal sensory experience leads to foveal suppression and, subsequently, secondary microstrabismus. This study investigated the hypothesis that disruption of bifoveal fusion by anisometropia directly affects ocular motor function. A total of 94 children with hyperopic anisometropia (ages 5-13 years) were evaluated prospectively between June 2010 and December 2012 with the use of the Nidek MP-1 microperimeter. Fixation instability was quantified by the area of the bivariate contour ellipse that included 95% of fixation points during a 30-second test interval. Each eye movement waveform during the 30-second test interval also was examined with the use of custom software and classified as normal, fusion maldevelopment nystagmus (FMNS), or infantile nystagmus. Finally, the Randot Preschool Stereoacuity Test (Stereo Optical Company Inc, Chicago, IL) was administered. Stereoacuity was correlated with fixation instability (Spearman r = 0.50; 95% CI, 0.33-0.64); visual acuity was more weakly correlated (r = 0.28). All children with normal stereoacuity had stable fixation, children with subnormal stereoacuity had fixation instability, and those with nil stereoacuity had the most instability. Eye movement records during attempted fixation were of sufficient quality for classification in 81 children; 61% of those with reduced stereoacuity and 88% of those with nil stereoacuity had FMNS eye movement waveforms. Our data support the hypothesis that the binocular decorrelation caused by anisometropia can disrupt ocular motor development, resulting in FMNS and its temporalward refoveating "flicks" that may mimic microstrabismus. Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
Hashemi, Hassan; Rezvan, Farhad; Ostadimoghaddam, Hadi; Abdollahi, Majid; Hashemi, Maryam; Khabazkhoob, Mehdi
The prevalence of myopia and hyperopia and determinants were determined in a rural population of Iran. Population-based cross-sectional study. Using random cluster sampling, 13 of the 83 villages of Khaf County in the north east of Iran were selected. Data from 2001 people over the age of 15 years were analysed. Visual acuity measurement, non-cycloplegic refraction and eye examinations were done at the Mobile Eye Clinic. The prevalence of myopia and hyperopia based on spherical equivalent worse than -0.5 dioptre and +0.5 dioptre, respectively. The prevalence of myopia, hyperopia and anisometropia in the total study sample was 28% (95% confidence interval: 25.9-30.2), 19.2% (95% confidence interval: 17.3-21.1), and 11.5% (95% confidence interval: 10.0-13.1), respectively. In the over 40 population, the prevalence of myopia and hyperopia was 32.5% (95% confidence interval: 28.9-36.1) and 27.9% (95% confidence interval: 24.5-31.3), respectively. In the multiple regression model for this group, myopia strongly correlated with cataract (odds ratio = 1.98 and 95% confidence interval: 1.33-2.93), and hyperopia only correlated with age (P < 0.001). The prevalence of high myopia and high hyperopia was 1.5% and 4.6%. In the multiple regression model, anisometropia significantly correlated with age (odds ratio = 1.04) and cataract (odds ratio = 5.2) (P < 0.001). The prevalence of myopia and anisometropia was higher than that in previous studies in urban population of Iran, especially in the elderly. Cataract was the only variable that correlated with myopia and anisometropia. © 2013 The Authors. Clinical and Experimental Ophthalmology © 2013 Royal Australian and New Zealand College of Ophthalmologists.
Results: Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9% of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004. Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ≥+2.00D, myopia ≤-0.50D, astigmatism ≥0.75D, and anisometropia (≥1.00D was 3.5%, 4.9%, 22.6%, and 3.9%, respectively. With increasing age, the prevalence of myopia increased (P<0.001, that of hyperopia decreased (P=0.007, but astigmatism showed no change. Strabismus was found in 2.3% of cases. Strabismus (OR=17.9 and refractive errors, especially anisometropia (OR=12.87 and hyperopia (OR=11.87, were important amblyogenic risk factors. Conclusion: The high prevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations.
Wolfram, Christian; Höhn, René; Kottler, Ulrike; Wild, Philipp; Blettner, Maria; Bühren, Jens; Pfeiffer, Norbert; Mirshahi, Alireza
To study the distribution of refractive errors among adults of European descent. Population-based eye study in Germany with 15010 participants aged 35-74 years. The study participants underwent a detailed ophthalmic examination according to a standardised protocol. Refractive error was determined by an automatic refraction device (Humphrey HARK 599) without cycloplegia. Definitions for the analysis were myopia +0.5 D, astigmatism >0.5 cylinder D and anisometropia >1.0 D difference in the spherical equivalent between the eyes. Exclusion criterion was previous cataract or refractive surgery. 13959 subjects were eligible. Refractive errors ranged from -21.5 to +13.88 D. Myopia was present in 35.1% of this study sample, hyperopia in 31.8%, astigmatism in 32.3% and anisometropia in 13.5%. The prevalence of myopia decreased, while the prevalence of hyperopia, astigmatism and anisometropia increased with age. 3.5% of the study sample had no refractive correction for their ametropia. Refractive errors affect the majority of the population. The Gutenberg Health Study sample contains more myopes than other study cohorts in adult populations. Our findings do not support the hypothesis of a generally lower prevalence of myopia among adults in Europe as compared with East Asia.
Merry Elizabeth Goedert
Full Text Available RESUMO Objetivo: Investigar a associação da hipermetropia com ambliopia, estrabismo, anisometropia e astigmatismo. Métodos: A hiperopia foi classificada em Grupo 1: maior ou igual a +5.00D; Grupo 2: maior que +3.25D e menor que +5.00D, com diferença de equivalente esférico maior ou igual a 0.50D; Grupo 3: maior que +3.25D e menor que +5.00D, com diferença de equivalente esférico menor que 0.50D e Grupo 4: com equivalente esférico maior e igual a +2.00D. O Grupo controle pertencente ao equivalente esférico menor que +2.00D. Resultados: A presença de hipermetropia maior e igual a SE+2.00D foi significativamente associada à maior proporção de crianças com ambliopia (27,2 vs. 14,8%, OR = 2,150, p<0,001 e estrabismo (70,8 vs. 39,3%, OR = 3,758, p<0,0001. A presença de hipermetropia também foi significativamente associada à maior proporção de anisometropia nos grupos com hipermetropia maior e igual a SE+2.00 (29,1 vs. 9,9%, OR = 3,708, p<0,0001 e astigmatismo (24 vs. 9,9%, OR = 2,859 p<0,0001. Conclusão: A presença e magnitude da hipermetropia entre crianças foram associadas à maior proporção de erros refrativos e visuais, como estrabismo, ambliopia, astigmatismo e anisometropia.
Linke, Stephan J; Druchkiv, Vasyl; Steinberg, Johannes; Richard, Gisbert; Katz, Toam
To explore eye laterality (higher refractive error in one eye) and its association with refractive state, spherical/astigmatic anisometropia, age and sex in refractive surgery candidates. Medical records of 12 493 consecutive refractive surgery candidates were filtered. Refractive error (subjective and cycloplegic) was measured in each subject and correlated with eye laterality. Only subjects with corrected distance visual acuity (CDVA) of >20/22 in each eye were enrolled to exclude amblyopia. Associations between eye laterality and refractive state were analysed by means of t-test, chi-squared test, Spearman's correlation and multivariate logistic regression analysis, respectively. There was no statistically significant difference in spherical equivalent between right (-3.47 ± 2.76 D) and left eyes (-3.47 ± 2.76 D, p = 0.510; Pearson's r = 0.948, p laterality for anisometropia >2.5 D in myopic (-5.64 ± 2.5 D versus -4.92 ± 2.6 D; p = 0.001) and in hyperopic (4.44 ± 1.69 D versus 3.04 ± 1.79 D; p = 0.025) subjects, (II) a tendency for left eye cylindrical laterality in myopic subjects, and (III) myopic male subjects had a higher prevalence of left eye laterality. (IV) Age did not show any significant impact on laterality. Over the full refractive spectrum, this study confirmed previously described strong interocular refractive correlation but revealed a statistically significant higher rate of right eye laterality for anisometropia >2.5 D. In general, our results support the use of data from one eye only in studies of ocular refraction. © 2013 The Authors. Acta Ophthalmologica © 2013 Acta Ophthalmologica Scandinavica Foundation.
Wang, Yue; Liang, Yuan Bo; Sun, Lan Ping; Duan, Xin Rong; Yuan, Rui Zhi; Wong, Tien Yin; Yi, Peng; Friedman, David S; Wang, Ning Li; Wang, Jie Jin
To determine the prevalence of and factors associated with amblyopia in a rural Chinese population. Population-based, cross-sectional study. Six thousand eight hundred thirty Han Chinese aged 30 years or more, recruited from Yongnian County, Handan, Hebei Province, China. Thirteen villages in the Yongnian County of Handan were selected randomly, and residents of these selected villages 30 years of age or older were invited to participate in the Handan Eye Study. Participants underwent a comprehensive eye examination, including standardized visual acuity (VA) tests using logarithm of the minimum angle of resolution charts. Prevalence rates were age- and gender-standardized to the 2000 China census. The proportion of rural Chinese population aged 30 years or older with amblyopia. Unilateral amblyopia was diagnosed if best-corrected VA (BCVA) was 20/32 or worse in the amblyopic eye and was not attributable directly to any underlying structural abnormality of the eye or visual pathway. Bilateral amblyopia was diagnosed if BCVA was 20/32 or less in both eyes and if there was a history of form deprivation during the sensitive period of visual development, such as media opacities or high, uncorrected ametropia. Amblyopia was diagnosed in 205 participants, with an age- and gender-adjusted prevalence of 2.8%. Of these, 1.7% were unilateral cases and 1.1% were bilateral cases. Underlying causes included anisometropia (67.3%), strabismus (5.4%), mixed strabismus and anisometropia (4.4%), visual deprivation (9.8%), astigmatism association (9.8%), and other (3.4%). Of the amblyopia cases, 47.6% were hypermetropic. In this rural Chinese population, 2.8% of adults 30 to 80 years of age had amblyopia, a prevalence rate broadly consistent with that of most other studies. One third of the cases were bilateral, and anisometropia was the most common cause of this condition. Copyright Â© 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Rajavi, Zhale; Sabbaghi, Hamideh; Baghini, Ahmad Shojaei; Yaseri, Mehdi; Moein, Hamidreza; Akbarian, Shadi; Behradfar, Narges; Hosseini, Simin; Rabei, Hossein Mohammad; Sheibani, Kourosh
Purpose: To determine the prevalence of amblyopia and refractive errors among 7 to 12-year-old primary school children in Tehran, Iran. Methods: This population-based cross-sectional study included 2,410 randomly selected students. Visual acuity was tested using an E-chart on Yang vision tester. Refractive errors were measured by photorefractometry and cycloautorefraction. Strabismus was checked using cover test. Direct ophthalmoscopy was used to assess the anterior segment, lens opacities, red reflex and fundus. Functional amblyopia was defined as best corrected visual acuity ≤20/40 in one or both eyes with no anatomical problems. Results: Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9%) of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004). Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ≥+2.00D, myopia ≤-0.50D, astigmatism ≥0.75D, and anisometropia (≥1.00D) was 3.5%, 4.9%, 22.6%, and 3.9%, respectively. With increasing age, the prevalence of myopia increased (Prefractive errors, especially anisometropia (OR=12.87) and hyperopia (OR=11.87), were important amblyogenic risk factors. Conclusion: The high prevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations. PMID:27051485
Wang, Xiaojuan; Liu, Dan; Feng, Ruifang; Zhao, Huashuo; Wang, Qinmei
The prevalence of refractive errors in urban preschool children in Xuzhou, China remains unknown. Children attending twelve randomly selected kindergartens participated in this study. Visual acuity, ocular alignment, cover-uncover test, cycloplegic refraction, slit-lamp and funduscopy were performed under a standardized testing environment. Cycloplegic streak retinoscopy was performed for all subjects. The mean spherical equivalent (SE) refractive error was the main outcome measure. Emmetropia was defined as refractive status between +1.75 diopters (D) and -0.75D. Myopia, hyperopia, astigmatism and anisometropia were defined as SE +2.0 D, cylindrical error > 1.0 D and SE difference ≥ 1 D between fellow eyes, respectively. Out of 2349 eligible children, 2255 (96%) children completed a refractive examination. Of the 2255 children, the mean SE of right eyes was +1.14 ± 0.95 diopters (D). Mean SE of the right eyes did not decline with age (r = -0.01; P = 0.56). The majority (86.6%) of children were emmetropia. The prevalence of myopia and hyperopia was 0.9% and 14.3%, respectively. The mean astigmatism for the right eyes was 0.87 ± 0.62 D. The prevalence of With-the-rule, against the rule and oblique astigmatism was 93.8%, 4.7% and 1.5%, respectively. The mean anisometropia between two eyes was 0.14 ± 0.38 D. The most common type of refractive error was hyperopia (14.3%), followed by astigmatism (8.8%), anisometropia (3.2%), and myopia (0.9%). The refractive status in this population of urban Xuzhou preschool children was stable and there was no evidence of a myopic refractive shift over this age range in our cross-sectional study.
Aldebasi, Yousef H
The worldwide prevalence of refractive errors (RE), which is a common cause of treatable visual impairment among children, varies widely. We assessed the prevalence of correctable visual impairment (uncorrected RE) in primary school children in Qassim, Saudi Arabia. A cross-sectional study was conducted in 21 primary schools. A total of 5176 children (mean age 9.5±1.8 years), 2573 boys (49.7%) and 2603 girls (50.3%), underwent a comprehensive eye examination. The examinations consisted of visual acuity, autorefraction, cover test, ocular motility, pupillary evaluation, anterior segment examination, cycloplegic auto-refraction and dilated fundus examination with direct ophthalmoscopy. The children were divided into groups based on their age and gender. The overall prevalence of RE in the better eye was 18.6% (n=963), and the prevalence of uncorrected RE 16.3% (n=846), with only 2.3% (n=127) of children wearing spectacles during examination. The prevalence of uncorrected myopia (5.8%) and myopic astigmatism (5.4%) was higher compared to that of hyperopic astigmatism (2.7%), mixed astigmatism (1.7%) and hyperopia (0.7%). The anisometropia prevalence was 3.6%. Risks for astigmatism, myopia and anisometropia were positively associated with age. In addition, myopia and anisometropia risks were also associated with female gender, while risk of astigmatism was correlated with male gender. Few children with vision reducing RE wore spectacles; an additional 16.3% of children could benefit from spectacle prescription. The prevalence of uncorrected RE in children is relatively high and represents an important public health problem in school-aged children in Qassim province. Performance of routine periodical vision screening throughout childhood may reverse this situation. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.
Wang, Jingyun; Ren, Xiaowei; Shen, Li; Yanni, Susan E; Leffler, Joel N; Birch, Eileen E
We investigated longitudinally the refraction development in children with regressed retinopathy of prematurity (ROP), including those with and those without a history of peripheral retinal laser photocoagulation. Longitudinal (0-7 years) cycloplegic refraction data were collected prospectively for two groups of preterm children: severe ROP group included those with regressed ROP following bilateral panretinal laser photocoagulation (n = 37; median gestational age [GA] = 25.2; range, 22.7-27.9 weeks) and mild/no ROP group included those with spontaneously regressed ROP or no ROP (n = 27; median GA = 27.1; range, 23.1-32.0 weeks). Analyses were based on spherical equivalent (SEQ), anisometropia, astigmatism, and age (corrected for gestation). The prevalence, magnitude, and rate of myopic progression all were significantly higher in the severe ROP group than in the mild/no ROP group. Longitudinal SEQ in the severe ROP group were best fit with a bilinear model. Before 1.3 years old, the rate of myopic shift was -4.7 diopters (D)/y; after 1.3 years, the rate slowed to -0.15 D/y. Longitudinal SEQ in the mild/no ROP group was best fit with a linear model, with a rate of -0.004 D/y. Anisometropia in the severe ROP group increased approximately three times faster than in the mild/no ROP group. In the severe ROP group, with-the-rule astigmatism increased significantly with age. The severe ROP group progressed rapidly toward myopia, particularly during the first 1.3 years; anisometropia and astigmatism also increased with age. The mild/no ROP group showed little change in refraction. Infants treated with laser photocoagulation for severe ROP should be monitored with periodic cycloplegic refractions and provided with early optical correction.
Full Text Available The most common cause of unilateral visual impairment in children is amblyopia. Anisometropia is the major cause in school-age and strabismus is in pre-school period. Amblyopia occurs from visual deprivation in the critical period or abnormal binocular interaction. If visual acuity in one eye is less than the other and if there are differences in refractive error, strabismus or strabismus history, diagnosis of amblyopia should be considered. Refractive correction, patching, and penalization are overriding treatment modalities. (Turk J Ophthalmol 2014; 44: 228-36
Ibironke, Josephine O; Friedman, David S; Repka, Michael X; Katz, Joanne; Giordano, Lydia; Hawse, Patricia; Tielsch, James M
Many parents are concerned about their child's development. The purpose of this study is to determine whether parental concerns about overall development are associated with significant refractive errors among urban preschool children. A cross-sectional population-based study was conducted to evaluate the prevalence of ocular disorders in white and African American children aged 6 through 71 months in Baltimore, Maryland. A comprehensive eye examination with cycloplegic refraction was performed. Parental concerns about development were measured with the Parents' Evaluation of Developmental Status screening tool. Of 2546 eligible children 2381 (93.5%), completed the refraction and the parental interview. Parental concerns about development were present in 510 of the 2381 children evaluated [21.4%; 95% confidence intervals (CI): 9.8 to 23.1]. The adjusted odds ratios [OR] of parental concerns with hyperopia [≥3.00 diopters (D)] was 1.26 (95% CI: 0.90 to 1.74), with myopia (≥1.00 D) was 1.29 (95% CI: 0.83 to 2.03), with astigmatism (≥1.50 D) was 1.44 (95% CI: 1.08 to 1.93) irrespective of the type of astigmatism, and with anisometropia (≥2.00 D) was 2.61 (95% CI: 1.07 to 6.34). The odds of parental concerns about development significantly increased in children older than 36 months with hyperopia ≥3.00 D, astigmatism ≥1.50 D, or anisometropia ≥2.00 D. Parental concerns about general developmental problems were associated with some types of refractive error, astigmatism ≥1.50 D and anisometropia ≥2.00 D, in children aged 6 to 71 months. Parental concerns were also more likely in children older than 36 months with hypermetropia, astigmatism, or anisometropia. Parental concerns were not associated with myopia. Because of the potential consequences of uncorrected refractive errors, children whose parents have expressed concerns regarding development should be referred for an eye examination with cycloplegic refraction to rule out significant refractive
Su, Liping; Yan, Hong; Xing, Yongxin; Zhang, Yuhai; Zhu, Baoyi
We studied 87 cases of children aged 3 to 10 with unilateral amblyopia (with types of anisometropia, strabismus, or both) who received good recovery after occlusion therapy. The proportional improvement had moderate positive correlation with amblyopic eye improvement (p amblyopia (p amblyopia residual had no correlation with amblyopic eye improvement (p amblyopia eye and residual amblyopia are simple and direct indicators for clinical application. The proportion of the deficit-corrected method should be graded as the proportion of change in visual acuity with respect to the absolute potential for improvement, and these optimum outcomes can provide powerful evidence for good therapeutic effect.
Dr P Vijayalakshmi
Full Text Available Amblyopia should always be anticipated in children with unilateral cataract, asymmetrical bilateral cataracts (or where there is a delay between the first and second eye operation, or a delay of more than a year between diagnosis/ detection and surgery, cataracts with anisometropia or traumatic cataracts with corneal scars. When amblyopia is detected, occlusion therapy (eye patching must be instituted at the earliest opportunity. The patching regimen is the same with any strabismic amblyopia and sometimes needs to be aggressive at the start. It is crucial to explain the need for patching to the parents, since compliance is the greatest obstacle to the success of amblyopia treatment.
Van Eenwyk, Jonathan; Agah, Arvin; Giangiacomo, Joseph; Cibis, Gerhard
Purpose To develop a low-cost automated video system to effectively screen children aged 6 months to 6 years for amblyogenic factors. Methods In 1994 one of the authors (G.C.) described video vision development assessment, a digitizable analog video-based system combining Brückner pupil red reflex imaging and eccentric photorefraction to screen young children for amblyogenic factors. The images were analyzed manually with this system. We automated the capture of digital video frames and pupil images and applied computer vision and artificial intelligence to analyze and interpret results. The artificial intelligence systems were evaluated by a tenfold testing method. Results The best system was the decision tree learning approach, which had an accuracy of 77%, compared to the “gold standard” specialist examination with a “refer/do not refer” decision. Criteria for referral were strabismus, including microtropia, and refractive errors and anisometropia considered to be amblyogenic. Eighty-two percent of strabismic individuals were correctly identified. High refractive errors were also correctly identified and referred 90% of the time, as well as significant anisometropia. The program was less correct in identifying more moderate refractive errors, below +5 and less than −7. Conclusions Although we are pursuing a variety of avenues to improve the accuracy of the automated analysis, the program in its present form provides acceptable cost benefits for detecting ambylogenic factors in children aged 6 months to 6 years. PMID:19277222
Full Text Available The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation. We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery on two different dates. The quality of evidence was rated as low to very low. None of the studies reported the prevalence of postoperative anisometropia. In conclusion, we cannot provide evidence-based recommendations on the use of ISBCS due to the lack of high quality evidence. Therefore, the decision to perform ISBCS should be taken after careful discussion between the surgeon and the patient.
Ganekal, Sunil; Jhanji, Vishal; Liang, Yuanbo; Dorairaj, Syril
To determine the prevalence and etiology of amblyopia in school children. A total of 4020 school children aged between 5 and 15 years were screened in a population-based, cross-sectional study. Best corrected visual acuity and detailed ophthalmic evaluation were performed in all participants. Amblyopia associated with degraded visual input due to high refractive error was labeled ametropic amblyopia. Anisometropic amblyopia was diagnosed in participants with interocular refractive error difference ≥1 diopter. Strabismic amblyopia included that due to conflicting visual inputs between the eyes due to squint. Stimulus deprivation amblyopia was defined as amblyopia due to obstruction of the visual axis. Prevalence of amblyopia was 1.1% (n = 44). The number of boys with amblyopia (n = 25, 57%) was slightly higher than the number of girls with amblyopia (n = 19, 43%; p = 0.6). A total of 28 (63.7%) children had mild to moderate amblyopia, whereas 16 (36.3%) had severe amblyopia. Underlying amblyogenic causes were ametropia (50%), anisometropia (40.9%), strabismus (6.8%), visual deprivation (4.5%) and combined causes (2.2%). No statistically significant difference was noted in the prevalence of amblyopia between rural (1.2%) and urban (0.9%) children (p = 0.5). In this study, the prevalence of amblyopia was 1.1% of the school children. Ametropia and anisometropia were the most common causes of amblyopia. We did not find any significant difference in amblyopia prevalence between rural and urban school children.
Matta, Noelle S; Silbert, David I
To report the percentage of children under the age of 3 with nasolacrimal duct obstruction (NLDO) and amblyopia risk factors who develop clinical evidence of amblyopia over time. Records of children under 3 years of age presenting to a pediatric oculoplastic specialist with NLDO between January 1, 2001, and August 8, 2009, were retrospectively reviewed to identify those who also had amblyopia risk factors. Amblyopia was diagnosed based on visual acuity and treatment history. A total of 375 children under the age of 3 had NLDO. Of these, 82 (22%) had amblyopia risk factors, and 70 received a follow-up examination. Average age at first visit was 12 months (1-27 months). In all patients with anisometropia and unilateral NLDO, the side with the NLDO had higher hyperopia. Of the 70 with risk factors, 44 (63%) were later treated for amblyopia: 29 with spectacles alone, 2 with occlusion therapy, 13 with spectacles and occlusion therapy. Six patients required strabismus surgery. In all patients with anisometropia and unilateral NLDO, the side with the NLDO had higher hyperopia. The percentage of children identified with amblyopia risk factors who later develop clinical amblyopia was much higher than the 1.6% to 3.6% expected in a cohort of normal children. Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.
Sapkota, K; Pirouzian, A; Matta, N S
Refractive error is a common cause of amblyopia. To determine prevalence of amblyopia and the pattern and the types of refractive error in children with amblyopia in a tertiary eye hospital of Nepal. A retrospective chart review of children diagnosed with amblyopia in the Nepal Eye Hospital (NEH) from July 2006 to June 2011 was conducted. Children of age 13+ or who had any ocular pathology were excluded. Cycloplegic refraction and an ophthalmological examination was performed for all children. The pattern of refractive error and the association between types of refractive error and types of amblyopia were determined. Amblyopia was found in 0.7 % (440) of 62,633 children examined in NEH during this period. All the amblyopic eyes of the subjects had refractive error. Fifty-six percent (248) of the patients were male and the mean age was 7.74 ± 2.97 years. Anisometropia was the most common cause of amblyopia (p less than 0.001). One third (29 %) of the subjects had bilateral amblyopia due to high ametropia. Forty percent of eyes had severe amblyopia with visual acuity of 20/120 or worse. About twothirds (59.2 %) of the eyes had astigmatism. The prevalence of amblyopia in the Nepal Eye Hospital is 0.7%. Anisometropia is the most common cause of amblyopia. Astigmatism is the most common types of refractive error in amblyopic eyes. © NEPjOPH.
Robaei, D; Kifley, A; Rose, K A; Mitchell, P
To report prevalence of amblyopia and long-term impact of its treatment on vision in a population-based sample of 12-year-old Australian children. Logarithm of minimum angle of resolution (logMAR) visual acuity (VA) was measured in 2353 children (response rate 75.3%); visual impairment was defined as VAAmblyopia was defined using various criteria of best-corrected VA, together with an amblyogenic factor and absence of significant organic pathology. Corroborative historical data on previous diagnosis and treatment were obtained from parental questionnaires. Forty-four children (1.9%) were diagnosed with amblyopia, unilateral in 40 and bilateral in four. Isolated anisometropia was the most frequent cause (41%), followed by strabismus (25%), combined anisometropia and strabismus (23%), and high ametropia (9%). Myopia, hyperopia, and astigmatism were present in 28, 51, and 44% of amblyopic children, respectively, compared to 12, 4, and 9% of non-amblyopic children. Mean best-corrected VA in amblyopic eyes was 44.5 logMAR letters (Snellen equivalent 6/9), range: 11-60 letters. Most children with amblyopia (84%) had been treated. Only 27% were visually impaired in their amblyopic eye. This report documents a low amblyopia prevalence in a population of 12-year-old Australian children. Amblyopic visual impairment was infrequent in this sample despite absence of mandatory vision screening.
Yoo, Y C; Kim, J M; Park, K H; Kim, C Y; Kim, T-W
Purpose To assess the prevalence of refractive errors, including myopia, high myopia, hyperopia, astigmatism, and anisometropia, in rural adult Koreans. Methods We identified 2027 residents aged 40 years or older in Namil-myeon, a rural town in central South Korea. Of 1928 eligible residents, 1532 subjects (79.5%) participated. Each subject underwent screening examinations including autorefractometry, corneal curvature measurement, and best-corrected visual acuity. Results Data from 1215 phakic right eyes were analyzed. The prevalence of myopia (spherical equivalent (SE) +0.5 D) was 41.8% (95% CI: 38.9−44.4%), of astigmatism (cylinder 1.0 D) was 13.8% (95% CI: 11.9−15.8%). Myopia prevalence decreased with age and tended to transition into hyperopia with age up to 60−69 years. In subjects older than this, the trend in SE refractive errors reversed with age. The prevalence of astigmatism and anisometropia increased consistently with age. The refractive status was not significantly different between males and females. Conclusions The prevalence of myopia and hyperopia in rural adult Koreans was similar to that of rural Chinese. The prevalence of high myopia was lower in this Korean sample than in other East Asian populations, and astigmatism was the most frequently occurring refractive error. PMID:24037232
Zhu, Hui; Yu, Jia-Jia; Yu, Rong-Bin; Ding, Hui; Bai, Jing; Chen, Ji; Liu, Hu
To investigate the association between concomitant esotropia or concomitant exotropia and refractive error in preschool children. A population-based sample of 5831 children aged 3 to 6 years was selected from all kindergartens in a representative county (Yuhuatai District, Nanjing, Jiangsu Province) of Nanjing, China. Clinical examinations including ocular alignment, ocular motility, visual acuity, optometry, stereopsis screening, slit lamp examination and fundus examination were performed by trained ophthalmologists and optometrists. Odd ratios (OR) and 95% confidence intervals (95% CI) were calculated to evaluate the association of refractive error with concomitant esotropia and concomitant exotropia. In multivariate logistic regression analysis, concomitant esotropia was associated independently with spherical equivalent anisometropia (OR, 3.15 for 0.50 to = 1.00 D of anisometropia) and hyperopia. There was a severity-dependent association of hyperopia with the development of concomitant esotropia, with ORs increasing from 9.3 for 2.00 to = 5.00 D of hyperopia. Concomitant exotropia was associated with astigmatism (OR, 3.56 for 0.50 to 1.00 D of astigmatism, and 1.9 for refractive error and the prevalence of concomitant esotropia and concomitant exotropia, which should be considered when managing childhood refractive error.
Nojood Hameed R. Alrahili
Full Text Available Objectives: To determine the prevalence of uncorrected refractive errors (URE among children 3-10 years and to affirm the necessity of a national school-based visual screening program for school-aged children. Methods: This retrospective cross-sectional study was conducted in Medina, Saudi Arabia in 2015. Children were selected through a multistage stratified random sampling from 8 kindergarten and 8 primary schools. Those included were screened to diagnose UREs using a visual acuity chart and an auto refractometer according to American guidelines. The prevalence and types of UREs were estimated. Results: Of the 2121 children enumerated, 1893 were examined, yielding a response rate of 89.3%. The prevalence of UREs was 34.9% (95% CI = 32.8%-37.1%, with significant differences in different age groups. The prevalence of astigmatism (25.3% was higher compared to that of anisometropia (7.4%, hypermetropia (1.5%, and myopia (0.7%. Risk of uncorrected refractive error was positively associated with age, and this was noted in astigmatism, myopia, and anisometropia. In addition, the risk of hypermetropia was associated with boys and that of myopia was associated with girls. Conclusions: The prevalence of UREs, particularly astigmatism, was high among children aged 3-10 years in Medina, with significant age differences. Vision screening programs targeting kindergarten and primary schoolchildren are crucial to lessen the risk of preventable visual impairment due to UREs.
Van Eenwyk, Jonathan; Agah, Arvin; Giangiacomo, Joseph; Cibis, Gerhard
To develop a low-cost automated video system to effectively screen children aged 6 months to 6 years for amblyogenic factors. In 1994 one of the authors (G.C.) described video vision development assessment, a digitizable analog video-based system combining Brückner pupil red reflex imaging and eccentric photorefraction to screen young children for amblyogenic factors. The images were analyzed manually with this system. We automated the capture of digital video frames and pupil images and applied computer vision and artificial intelligence to analyze and interpret results. The artificial intelligence systems were evaluated by a tenfold testing method. The best system was the decision tree learning approach, which had an accuracy of 77%, compared to the "gold standard" specialist examination with a "refer/do not refer" decision. Criteria for referral were strabismus, including microtropia, and refractive errors and anisometropia considered to be amblyogenic. Eighty-two percent of strabismic individuals were correctly identified. High refractive errors were also correctly identified and referred 90% of the time, as well as significant anisometropia. The program was less correct in identifying more moderate refractive errors, below +5 and less than -7. Although we are pursuing a variety of avenues to improve the accuracy of the automated analysis, the program in its present form provides acceptable cost benefits for detecting ambylogenic factors in children aged 6 months to 6 years.
Vajpayee, Rasik B; Sharma, Namrata; Sinha, Rajesh; Bhartiya, Prashant; Titiyal, Jeewan S; Tandon, Radhika
Laser in situ keratomileusis (LASIK) after penetrating keratoplasty has been used more commonly for the correction of myopia or myopic astigmatism and less so for hypermetropia or hyperopic astigmatism. The primary goal after LASIK in such cases is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and decrease anisometropia. All sutures should be removed prior to LASIK and the interval between penetrating keratoplasty and LASIK should be a minimum of 1 year. Preoperative evaluation includes refraction, slit-lamp biomicroscopy, corneal topography, and specular microscopy. The technique of LASIK surgery after penetrating keratoplasty is similar to the standard procedure. However, many variations have been described. These include maneuvers during surgery such as augmentation with arcuate cuts on the stromal bed and topographically guided LASIK. Other variations are relaxing incisions followed by LASIK surgery and sequential treatment by LASIK, that is, raising of the flap as a first stage procedure followed by ablation if required, 4 to 6 weeks later after relifting the flap in the second stage. Improvement in both uncorrected visual acuity and spectacle-corrected visual acuity, as well as a decrease in spherical equivalent, cylinder, and anisometropia, has been reported in various studies. All grafts were clear and no occurrence of wound dehiscence has been reported. Intraoperative complications include hemorrhage, microkeratome failure, flap buttonhole, dislocation, and perforation. Postoperative complications include undercorrection, decentered ablation, and regression. Re-enhancements after LASIK following keratoplasty are possible with acceptable visual outcome.
Achados oculares em crianças de zero a seis anos de idade, residentes na cidade de São Caetano do Sul, SP Ocular findings in children between 0 and 6 years of age, residing in the city of São Caetano do Sul, SP
Sandra Maria Canelas Beer
Full Text Available OBJETIVO: Determinar a prevalência de erros refrativos, estrabismo, ambliopia e anisometropia nas crianças pertencentes à população em estudo, utilizando dois métodos de rastreamento (triagem na escola e triagem durante o dia da vacinação contra a poliomielite. MÉTODOS: Foram examinadas 2.640 crianças, residentes da cidade de São Caetano do Sul, entre zero e seis anos de idade, divididas em duas amostras (A e B. A amostra A consistiu de 476 crianças que foram examinadas por dez oftalmologistas e onze técnicos oftálmicos, durante o Dia Nacional de Vacinação (20 de junho de 1998 contra a Poliomielite. A amostra B consistiu de 2.164 crianças que freqüentavam escolas municipais, entre quatro e seis anos de idade e foram examinadas por dois oftalmologistas durante o ano de 1998. RESULTADOS: Na amostra A, a prevalência de estrabismo foi de 3,36% e de anisometropia foi de 1,26%. O principal tipo de erro refrativo encontrado foi a hipermetropia PURPOSE: To establish the prevalence of refractive errors, strabismus, amblyopia and anisometropia, among children in a population, using two methods of screening (at school and at the National Polio Vaccination Day. METHODS: We examined 2,640 children, between 0 and 6 years of age. The children, residents of the city São Caetano do Sul, were divided into two groups (A and B. Group A: 476 children, with an age range of a few months to 6 years, had their eyes examined by 10 ophthalmologists and 11 ophthalmology technicians, during the National Polio Vaccination Day (June 20,1998. Group B: 2,164 children attending municipal schools (EMEIs and EMIs, between 4 and 6 years of age, who had their eyes examined by two ophthalmologists during the year of 1998. RESULTS: In group A, the prevalence of strabismus was 3.36% and that of anisometropia was 1.26%. The most common type of refractive error was hypermetropia £ 2D and 14.11% required optical prescription. In group B, the prevalence of strabismus
Pai, Amy Shih-I; Rose, Kathryn A; Leone, Jody F; Sharbini, Sharimawati; Burlutsky, George; Varma, Rohit; Wong, Tien Yin; Mitchell, Paul
To determine the prevalence of and factors associated with amblyopia in a sample of Australian preschool children. Population-based, cross-sectional study. The Sydney Paediatric Eye Disease Study examined 2461 (73.8% participation) children aged between 6 and 72 months from 2007 to 2009. Visual acuity (VA) was assessed in children aged ≥ 30 months using the Electronic Visual Acuity system, and a subset using the logarithm of the minimum angle of resolution chart. Amblyopia was categorized into unilateral and bilateral subtypes: Unilateral amblyopia was defined as a 2-line difference in reduced VA between the 2 eyes, in addition to strabismus, anisometropia, and/or visual axis obstruction; bilateral amblyopia was defined as bilateral reduced VA with either bilateral visual axis obstruction or significant bilateral ametropia. Information on ethnicity, birth parameters, and measures of socioeconomic status were collected in questionnaires completed by parents. Amblyopia. We included 1422 children aged 30 to 72 months, of whom 27 (1.9%) were found to have amblyopia or suspected amblyopia. Mean spherical equivalent for the amblyopic eyes was +3.57 diopters, with a mean VA of 20/50. Only 3 of the 27 amblyopic children had previous diagnoses or treatments for amblyopia. In regression analysis controlling for age, gender, and ethnicity, amblyopia was significantly associated with hyperopia (odds ratio [OR], 15.3; 95% confidence interval [CI], 6.5-36.4), astigmatism (OR, 5.7; 95% CI, 2.5-12.7), anisometropia (OR, 27.8; 95% CI, 11.2-69.3), and strabismus (OR, 13.1; 95% CI, 4.3-40.4). There were no significant associations of amblyopia with low birthweight (0.05). Amblyopia was found in 1.9% of this Australian preschool sample, which is comparable with prevalence rates reported by other recent studies in preschool children. Refractive errors, particularly significant hyperopia and astigmatism, in addition to anisometropia and strabismus, were the major amblyogenic factors
Full Text Available Amblyopia is the most common form of impairment of visual function affecting one eye, with a prevalence of about 1% to 5% of the total world population. This pathology is caused by early abnormal visual experience with a functional imbalance between the two eyes owing to anisometropia, strabismus or congenital cataract, resulting in a dramatic loss of visual acuity in an apparently healthy eye and various other perceptual abnormalities, including deficits in contrast sensitivity and in stereopsis. It is currently accepted that, due to a lack of sufficient plasticity within the brain, amblyopia is untreatable in adulthood. However, recent results obtained both in clinical trials and in animal models have challenged this traditional view, unmasking a previously unsuspected potential for promoting recovery after the end of the critical period for visual cortex plasticity. These studies point toward the intracortical inhibitory transmission as a crucial brake for therapeutic rehabilitation and recovery from amblyopia in the adult brain.
Arnold, Robert W
In 2003, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) published a set of risk factors for amblyopia. The intent was to promote uniformity of reporting and development in screening. Because this prevalence is not yet known, this meta-analysis is an attempt to estimate it. Major community preschool eye examination studies were reviewed and AAPOS cut-offs estimated. The approximate prevalence of anisometropia is 1.2%, hyperopia is 6%, astigmatism is 15%, myopia is 0.6%, strabismus is 2.5%, and visual acuity less than 20/40 is 6%. The mean combined prevalence is 21% ± 2% compared to a prevalence of amblyopia 20/40 and worse of 2.5%. Knowing risk factor prevalence simplifies validation efforts. Amblyopia screening with a risk factor sensitivity less than 100% is expected and desirable. Copyright 2013, SLACK Incorporated.
Pang, Yi; Frantz, Kelly A; Roberts, Daniel K
To evaluate the association of refractive error with optic nerve hypoplasia (ONH). A total of 30 ONH subjects were recruited and underwent comprehensive eye exams. Refractive error data from this group was compared to data from a group of 3232 non-ONH subjects from the same facility. Spherical equivalent was calculated to assess refractive error. Multiple logistic regression was used to evaluate the relationship between ONH and refractive error while controlling for age, race, and gender. The prevalence of hyperopia (≥+1.00 D), myopia (refractive errors, particularly hyperopia. Anisometropia tended to be more likely to occur in subjects with unilateral ONH than in bilateral ONH. Based on our findings, we recommend that clinicians perform a comprehensive eye examination on all patients with ONH and prescribe for existing refractive error when visual acuity or general visual function can realistically be improved. © 2015 The Authors Ophthalmic & Physiological Optics © 2015 The College of Optometrists.
Kessel, Line; Andresen, Jens; Erngaard, Ditte
The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence......-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were...... performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery...
Full Text Available AIM: To investigate curative effects of excimer laser corneal refractive surgery for adults or older adolescent with hyperopic anisometropic amblyopia. METHODS: From March 2014 to March 2016, we selected 26 cases 26 eyes of adults or older adolescent with hyperopic anisometropic amblyopia in our hospital. All eyes underwent laser in situ keratomileusis, observed for the uncorrected visual acuity(UCVA, best corrected visual acuity(BCVA, diopter and stereopsis. RESULTS: At the end of the follow-up, the patient's spherical equivalent and anisometropia were 1.47±0.51D and 1.15±0.22D, were significantly lower than that before operation(PPPCONCLUSION: In adult or older adolescent with hyperopic anisometropic amblyopia, excimer laser corneal refractive surgery has a certain effect.
Full Text Available Unilateral extensive myelination of the peripapillary nerve fibers may be associated with anisometropic myopia, strabismus, and reduced vision. Myelination of optic nerve fibers terminate at lamina cribrosa. Yet in some patients, myelination progresses into the peripapillary retinal nerve fibers and may affect the visual acuity. In this report, we described 4 patients. All patients presented extensive peripapillary myelinated nerve fibers associated with myopic anisometropia. After routine ophthalmic and orthoptic examinations, all patients underwent treatment for amblyopia through correction with spectacles, contact lenses, and the occlusion of the good eye. Corrected visual acuity improved in 1 patient, but 3 patients had no increase in visual acuity despite treatment with full cycloplegic refraction and appropriate patching. Probably because of structural abnormalies of the macula, visual results are often disappointing with appropriate correction of the refractive error and occlusion.
Braunstein, Richard E; Airiani, Suzanna; Chang, Stanley
A 47-year-old man was referred to us for management of a cataract in the left eye. The patient had an ocular history of high myopia with anisometropia, amblyopia in the left eye, and stable myopic lattice degeneration in both eyes. The patient had successful bilateral laser in situ keratomileusis 3 years before and multiple retinal surgeries for treatment of a rhegmatogenous retinal detachment associated with a giant retinal tear in the temporal region of the retina with subsequent proliferative vitreoretinopathy. Phacoemulsification was performed uneventfully. A single interrupted 10-0 nylon suture was placed in the temporal clear corneal wound and removed 7 weeks postoperatively. One month later, slitlamp examination revealed a 1.5 mm tongue-like area of epithelial ingrowth under the corneal flap. The epithelial cells seemed to enter the flap-stroma interface through the previously placed suture tract and advanced centrally.
Sinskey, R M; Amin, P; Stoppel, J O
We conducted a retrospective review of 79 patients who had intraocular lens (IOL) explantation and exchange over a 12-year period. Seventy-nine eyes of 40 males and 39 females from 17 to 94 years of age were followed from three months to more than 12 years. Sixty-one percent (61%) were posterior chamber lenses and 39% were anterior chamber lenses replaced by 76% posterior chamber and 24% anterior chamber lenses. The indications for lens exchange were eccentric or displaced IOL (41.7%), endothelial decompensation (27.7%), incorrect IOL power (12.6%), and uveitis-glaucoma-hyphema syndrome (10.0%). Analysis of the clinical results revealed that 72% of the cases had postoperative visual acuity better than or equal to 20/30, and 8% had a loss of one or more lines of visual acuity. Among the complications occurring after IOL exchange were retinal detachment, glaucoma, corneal decompensation, and anisometropia.
Zhang, Fuxiang; Sugar, Alan; Arbisser, Lisa; Jacobsen, Gordon; Artico, Jessica
To compare patient satisfaction, visual function, and spectacle independence in patients with crossed or conventional pseudophakic monovision. Department of Ophthalmology, Henry Ford Health System, Taylor, Michigan, USA. Retrospective comparative cohort study. Cataract surgery patient records from June 1999 to December 2013 were reviewed. Crossed monovision patients were identified. Control conventional monovision cases were matched for age, sex, general health, personal lifestyle/main hobbies, preoperative refractive status, postoperative refractive status, uncorrected distance visual acuity, uncorrected near visual acuity, astigmatism level, and anisometropia level. A survey was mailed to participants, and results were independently analyzed. The review comprised 7311 patient records. Forty-four crossed monovision patients were identified, and 30 of them were enrolled. Thirty matched pairs were surveyed. The mean anisometropia was 1.19 diopters (D) in the conventional and 1.12 D in the crossed monovision groups. No significant difference was identified for eye-hand coordination, eye-foot coordination, or sport-related depth perception, but satisfaction was slightly better in the crossed monovision group (P = .028). No significant difference was identified for 6 of 8 spectacle independence measures, but nighttime driving was a little easier for the crossed monovision group (P = .025). Seventy-seven percent of crossed and 50% of conventional monovision patients did not use glasses for intermediate distance activities (P = .037). Crossed pseudophakic monovision appears to work as well as conventional pseudophakic monovision in terms of patient satisfaction and spectacle independence in patients with a mild degree of anisometropic pseudophakia. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Xiao, Ou; Morgan, Ian G; Ellwein, Leon B; He, Mingguang
To estimate the age-, gender-, and ethnicity-specific prevalence of amblyopia in children aged 5 to 15 years using data from the multi-country Refractive Error Study in Children (RESC). Population-based, cross-sectional study. Among 46 260 children aged 5 to 15 years who were enumerated from 8 sites in the RESC study, 39 551 had a detailed ocular examination and a reliable visual acuity (VA) measurement in 1 or both eyes. Information on ethnicity was available for 39 321 of these participants. This study focused on findings from the 39 321 children. The examination included VA measurements, evaluation of ocular alignment and refractive error under cycloplegia, and examination of the external eye, anterior segment, media, and fundus. The proportion of children aged 5 to 15 years with amblyopia in different ethnic cohorts. Amblyopia was defined as best-corrected visual acuity (BCVA) of ≤20/40 in either eye, with tropia, anisometropia (≥2 spherical equivalent diopters [D]), or hyperopia (≥+6 spherical equivalent D), after excluding children with fundus or anterior segment abnormalities. The overall prevalence of amblyopia was 0.74% (95% confidence interval, 0.64-0.83) with significant (P Amblyopia was not associated with age or gender. The most common cause of amblyopia was anisometropia. In this study, the prevalence of amblyopia varied with ethnicity and was highest in Hispanic children and lowest in African children. Most cases were unilateral and developed before the age of 5 years. The impact of changes of definitions on prevalence estimates is discussed. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Jeong, Seong Hun; Kim, Ungsoo Samuel
To characterize the prevalence of refractive error and amblyopia among three- to six-year-old children during the period from 2002 to 2011. About 31,400 children annually (from 16,592 to 40,816) during the period from 2002 to 2011 were enrolled. The preschool vision screening was performed by the Korean Foundation for the Prevention of Blindness (KFPB) annually during a period that extended from March to September. We reviewed the KFPB annual report about the home vision-screening test as performed during the period from 2002 to 2011. Changes in the prevalence and types of refractive error, strabismus, and amblyopia that manifested throughout this period were analyzed. The prevalence of refractive errors ranged from 1.10% in 2002 to 0.42% in 2011. The prevalence of hyperopia and myopia changed little throughout the 10-year study period. Myopia and hyperopia were equally common among the population examined (χ(2)-test, p = 0.137). The prevalence of anisometropia decreased over time. The annual prevalence of amblyopia ranged from 0.39% to 0.06%, while the overall prevalence of amblyopia dropped from 0.25% in 2002 to 0.06% in 2011. The prevalence of strabismus was highest in 2006 (0.30%) and had decreased by 0.06% in 2011. The type of strabismus showed no significant difference over time (χ(2)-test, p = 0.579). The prevalence of amblyopia, refractive error, anisometropia, and strabismus was lower in 2011 than in early 2000. The prevalence of hyperopia and myopia as well as strabismus remained similar throughout the study period.
Rajavi, Zhale; Sabbaghi, Hamideh; Baghini, Ahmad Shojaei; Yaseri, Mehdi; Moein, Hamidreza; Akbarian, Shadi; Behradfar, Narges; Hosseini, Simin; Rabei, Hossein Mohammad; Sheibani, Kourosh
To determine the prevalence of amblyopia and refractive errors among 7 to 12-year-old primary school children in Tehran, Iran. This population-based cross-sectional study included 2,410 randomly selected students. Visual acuity was tested using an E-chart on Yang vision tester. Refractive errors were measured by photorefractometry and cycloautorefraction. Strabismus was checked using cover test. Direct ophthalmoscopy was used to assess the anterior segment, lens opacities, red reflex and fundus. Functional amblyopia was defined as best corrected visual acuity ≤20/40 in one or both eyes with no anatomical problems. Amblyopia was present in 2.3% (95% CI: 1.8% to 2.9%) of participants with no difference between the genders. Amblyopic subjects were significantly younger than non-amblyopic children (P=0.004). Overall, 15.9% of hyperopic and 5.9% of myopic cases had amblyopia. The prevalence of hyperopia ≥+2.00D, myopia ≤-0.50D, astigmatism ≥0.75D, and anisometropia (≥1.00D) was 3.5%, 4.9%, 22.6%, and 3.9%, respectively. With increasing age, the prevalence of myopia increased (Pprevalence of amblyopia in our subjects in comparison to developed countries reveals the necessity of timely and sensitive screening methods. Due to the high prevalence of amblyopia among children with refractive errors, particularly high hyperopia and anisometropia, provision of glasses should be specifically attended by parents and supported by the Ministry of Health and insurance organizations.
Dirani, Mohamed; Chan, Yiong-Huak; Gazzard, Gus; Hornbeak, Dana Marie; Leo, Seo-Wei; Selvaraj, Prabakaran; Zhou, Brendan; Young, Terri L; Mitchell, Paul; Varma, Rohit; Wong, Tien Yin; Saw, Seang-Mei
To determine the prevalence of refractive error types in Singaporean Chinese children aged 6 to 72 months. The Strabismus, Amblyopia and Refractive Error in Singaporean Children (STARS) is a population-based study in southwest Singapore. Door-to-door recruitment of participants was used, with disproportionate random sampling in 6-month increments. Parental questionnaires were administered. Participant eye examinations included logMAR visual acuity, cycloplegic autorefraction, and ocular biometry. Overall and age-specific prevalences of myopia (spherical equivalence [SE] or= +3.00 D), astigmatism (cylinder >or= +1.50 D), and anisometropia (SE difference between each eye >or=2.00 D) were calculated. A total of 3009 children were examined (participation rate, 72.3%). Right eye (OD) cycloplegia data were available for 1375 boys and 1264 girls (mean age, 41 months). Mean OD SE was +0.69 D (SD 1.15). Overall myopia prevalence was 11.0% with no variance between the sexes (P = 0.91). The prevalence of high myopia (at least -6.00 D) was 0.2%. The prevalences of hyperopia, astigmatism, and anisometropia were 1.4%, 8.6%, and 0.6%, respectively. Most astigmatism (>95%) was with-the-rule (cylinder axes between 1 degrees and 15 degrees or 165 degrees and 180 degrees ). Myopia was present in 15.8%, 14.9%, 20.2%, 8.6%, 7.6%, and 6.4% of children aged 6 to 11, 12 to 23, 24 to 35, 36 to 47, 48 to 59, and 60 to 72 months, respectively. Prevalence increased with age for astigmatism (P prevalences of myopia and astigmatism in young Singaporean Chinese children are high, but that of hyperopia is low. Age effects were observed for each refractive error category, but differences between the sexes were not significant. Age-related variation in myopia prevalence may be influenced by ocular development, environment, and/or testability.
Full Text Available To investigate the association between concomitant esotropia or concomitant exotropia and refractive error in preschool children.A population-based sample of 5831 children aged 3 to 6 years was selected from all kindergartens in a representative county (Yuhuatai District, Nanjing, Jiangsu Province of Nanjing, China. Clinical examinations including ocular alignment, ocular motility, visual acuity, optometry, stereopsis screening, slit lamp examination and fundus examination were performed by trained ophthalmologists and optometrists. Odd ratios (OR and 95% confidence intervals (95% CI were calculated to evaluate the association of refractive error with concomitant esotropia and concomitant exotropia.In multivariate logistic regression analysis, concomitant esotropia was associated independently with spherical equivalent anisometropia (OR, 3.15 for 0.50 to = 1.00 D of anisometropia and hyperopia. There was a severity-dependent association of hyperopia with the development of concomitant esotropia, with ORs increasing from 9.3 for 2.00 to = 5.00 D of hyperopia. Concomitant exotropia was associated with astigmatism (OR, 3.56 for 0.50 to 1.00 D of astigmatism, and 1.9 for <0.00 D of astigmatism, myopia (OR, 40.54 for -1.00 to <0.00 D of myopia, and 18.93 for <-1.00 D of myopia, and hyperopia (OR, 67.78 for 1.00 to <2.00 D of hyperopia, 23.13 for 2.00 to <3.00 D of hyperopia, 25.57 for 3.00 to <4.00 D of hyperopia, and 8.36 for 4.00 to <5.00 D of hyperopia.This study highlights the close associations between refractive error and the prevalence of concomitant esotropia and concomitant exotropia, which should be considered when managing childhood refractive error.
Huurneman, Bianca; Boonstra, F Nienke
To compare interocular acuity differences, crowding ratios, and binocular summation ratios in 4- to 8-year-old children with albinism (n = 16), children with infantile nystagmus syndrome (n = 10), and children with normal vision (n = 72). Interocular acuity differences and binocular summation ratios were compared between groups. Crowding ratios were calculated by dividing the single Landolt C decimal acuity with the crowded Landolt C decimal acuity mono- and binocularly. A linear regression analysis was conducted to investigate the contribution of 5 predictors to the monocular and binocular crowding ratio: nystagmus amplitude, nystagmus frequency, strabismus, astigmatism, and anisometropia. Crowding ratios were higher under mono- and binocular viewing conditions for children with infantile nystagmus syndrome than for children with normal vision. Children with albinism showed higher crowding ratios in their poorer eye and under binocular viewing conditions than children with normal vision. Children with albinism and children with infantile nystagmus syndrome showed larger interocular acuity differences than children with normal vision (0.1 logMAR in our clinical groups and 0.0 logMAR in children with normal vision). Binocular summation ratios did not differ between groups. Strabismus and nystagmus amplitude predicted the crowding ratio in the poorer eye (p = 0.015 and p = 0.005, respectively). The crowding ratio in the better eye showed a marginally significant relation with nystagmus frequency and depth of anisometropia (p = 0.082 and p = 0.070, respectively). The binocular crowding ratio was not predicted by any of the variables. Children with albinism and children with infantile nystagmus syndrome show larger interocular acuity differences than children with normal vision. Strabismus and nystagmus amplitude are significant predictors of the crowding ratio in the poorer eye.
Terveen, Daniel C; Moser, Jess M; Spencer, Terrence S
South Dakota is one of eight states that do not require any vision screening for children. This study describes the results of the first children's vision screening program in the state. Children ages 6 months to 12 years were screened using the SPOT photoscreener by lay volunteers as part of the Northern Plains Eye Foundation's Western South Dakota Children's Vision Screening Initiative (CVSI). Referral criteria were based on the recommendations of the manufacturer. Data was stratified by age group, sex, and percentage of children referred for hyperopia, myopia, astigmatism, anisocoria, anisometropia, and ocular misalignment. The cost benefit of amblyopia treatment in South Dakota was also calculated. Screenings were completed on 4,784 children from August 2012 to May 2014 with 62 excluded due to age. Mean age of the 4,722 (2,373 females) subjects was 6 years 7 months. Overall, the SPOT device referred 563 (11.9 percent) children. There was no significant difference in referral rate based on sex (p = 0.598). Children aged 73-144 months had the highest referral rate (12.2 percent) and children aged 12-30 months had the lowest referral rate (7.9 percent). The suspected reasons for referral based upon the screenings were as follows: 371 (7.9 percent) astigmatism, 24 (0.5 percent) ocular misalignment, 101 (2.1 percent) anisometropia, 135 (2.9 percent) myopia, 36 (0.8 percent) hyperopia, and 16 (0.3 percent) anisocoria. The SPOT photoscreener yielded an acceptable referral rate of 11.9 percent. This study represents an effective model for pediatric vision screening in South Dakota.
Kulp, Marjean Taylor; Ciner, Elise; Maguire, Maureen; Pistilli, Maxwell; Candy, T Rowan; Ying, Gui-Shuang; Quinn, Graham; Cyert, Lynn; Moore, Bruce
Among 4- and 5-year-old children, deficits in measures of attention, visual-motor integration (VMI) and visual perception (VP) are associated with moderate, uncorrected hyperopia (3 to 6 diopters [D]) accompanied by reduced near visual function (near visual acuity worse than 20/40 or stereoacuity worse than 240 seconds of arc). To compare attention, visual motor, and visual perceptual skills in uncorrected hyperopes and emmetropes attending preschool or kindergarten and evaluate their associations with visual function. Participants were 4 and 5 years of age with either hyperopia (≥3 to ≤6 D, astigmatism ≤1.5 D, anisometropia ≤1 D) or emmetropia (hyperopia ≤1 D; astigmatism, anisometropia, and myopia each attention (sustained, receptive, and expressive), VMI, and VP. Binocular visual acuity, stereoacuity, and accommodative accuracy were also assessed at near. Analyses were adjusted for age, sex, race/ethnicity, and parent's/caregiver's education. Two hundred forty-four hyperopes (mean, +3.8 ± [SD] 0.8 D) and 248 emmetropes (+0.5 ± 0.5 D) completed testing. Mean sustained attention score was worse in hyperopes compared with emmetropes (mean difference, -4.1; P Attention score was worse in 4 to 6 D hyperopes compared with emmetropes (by -2.6, P = .01). Hyperopes with reduced near visual acuity (20/40 or worse) had worse scores than emmetropes (-6.4, P attention; -3.0, P = .004 for Receptive Attention; -0.7, P = .006 for VMI; -1.3, P = .008 for VP). Hyperopes with stereoacuity of 240 seconds of arc or worse scored significantly worse than emmetropes (-6.7, P attention; -3.4, P = .03 for Expressive Attention; -2.2, P = .03 for Receptive Attention; -0.7, P = .01 for VMI; -1.7, P attention. Hyperopic children with reduced near visual function also had lower scores on VMI and VP than emmetropic children.
Osuagwu, Uchechukwu L; Suheimat, Marwan; Atchison, David A
To investigate mirror symmetry of peripheral ocular aberrations in fellow eyes of iso- and anisomyopes. Peripheral aberration was measured over the central 42° × 32° visual field for a 5-mm pupil in both eyes of 19 isomyopic (spherical equivalent refraction M [right/left]: -2.5 ± 2.1 diopters [D]/-2.7 ± 2.3 D) and 10 anisomyopic (M: -4.0 ± 1.8 D/-4.3 ± 2.8 D) young adults. Isomyopes had less than 1.0 D fellow eye refraction difference and anisomyopes had between 1.0 D and 2.6 D fellow eye differences (mean difference: 1.3 ± 0.6 D). Orthogonal regression of Zernike coefficients determined right-left eye correlations in isomyopes. For anisomyopes, higher and lower myopic eye coefficients were compared. For isomyopes, the percentages of visual field locations with significant coefficient correlations between fellow eyes varied from 100% for astigmatism ( ) to 18% for tetrafoil ( ). Positive correlations were found for , , , , , and , and negative correlations were found for , , , , and coefficients, indicating that the signs are different for corresponding locations of fellow eyes for the last five of these coefficients. Slopes of correlations were not different from ± 1, except for , , and (+0.95, -0.97, and +0.52, respectively). In anisomyopes, significant but small fellow eye differences were found for only and coefficients, with significant interactions between anisometropia and field position for only two coefficients. Peripheral aberration coefficients across the visual field show mirror symmetry in isomyopes, and in a pooled data set the coefficients with negative correlations require sign changes for left eye data. Anisometropia contributes no more to peripheral aberration differences between fellow eyes than could be expected on the basis of refraction differences between people.
Gao, Tina Y; Anstice, Nicola; Babu, Raiju J; Black, Joanna M; Bobier, William R; Dai, Shuan; Guo, Cindy X; Hess, Robert F; Jenkins, Michelle; Jiang, Yannan; Kearns, Lisa; Kowal, Lionel; Lam, Carly S Y; Pang, Peter C K; Parag, Varsha; South, Jayshree; Staffieri, Sandra Elfride; Wadham, Angela; Walker, Natalie; Thompson, Benjamin
Optical treatment alone can improve visual acuity (VA) in children with amblyopia, thus clinical trials investigating additional amblyopia therapies (such as patching or videogames) for children require a preceding optical treatment phase. Emerging therapies for adult patients are entering clinical trials. It is unknown whether optical treatment is effective for adults with amblyopia and whether an optical correction phase is required for trials involving adults. We examined participants who underwent optical treatment in the Binocular Treatment for Amblyopia using Videogames (BRAVO) clinical trial (ANZCTR ID: ACTRN12613001004752). Participants were recruited in three age groups (7 to 12, 13 to 17, or ≥18 years), and had unilateral amblyopia due to anisometropia and/or strabismus, with amblyopic eye VA of 0.30-1.00 logMAR (6/12 to 6/60, 20/40 to 20/200). Corrective lenses were prescribed based on cycloplegic refraction to fully correct any anisometropia. VA was assessed using the electronic visual acuity testing algorithm (e-ETDRS) test and near stereoacuity was assessed using the Randot Preschool Test. Participants were assessed every four weeks up to 16 weeks, until either VA was stable or until amblyopic eye VA improved to better than 0.30 logMAR, rendering the participant ineligible for the trial. Eighty participants (mean age 24.6 years, range 7.6-55.5 years) completed four to 16 weeks of optical treatment. A small but statistically significant mean improvement in amblyopic eye VA of 0.05 logMAR was observed (S.D. 0.08 logMAR; paired t-test p < 0.0001). Twenty-five participants (31%) improved by ≥1 logMAR line and of these, seven (9%) improved by ≥2 logMAR lines. Stereoacuity improved in 15 participants (19%). Visual improvements were not associated with age, presence of strabismus, or prior occlusion treatment. Two adult participants withdrew due to intolerance to anisometropic correction. Sixteen out of 80 participants (20%) achieved better than 0
Shapira, Yinon; Machluf, Yossy; Mimouni, Michael; Chaiter, Yoram; Mezer, Eedy
To estimate the prevalence of amblyopia, present strabismus and amblyopia risk factors (ARFs) among young adults in Israel and to analyse trends over time of prevalence rates. We conducted a cross-sectional study including 107 608 pre-enlistees aged 17.4±0.6 years born between 1971 and 1994. Across the birth years, the following trends of prevalence rates among young adults were analysed: prevalence of amblyopia, prevalence of strabismus, severity of amblyopia and prevalence of ARFs (strabismsus, anisometropia and isoametropia). Unilateral amblyopia was defined as best corrected visual acuity (BCVA) of amblyopia was defined as BCVA of amblyopia was classified as mild (BCVA ≥0.5 [6/12]), moderate (BCVA prevalence of young adulthood amblyopia declined by 33%, from 1.2% to 0.8% (R 2 =0.87, pamblyopia from 1% to 0.6% (R 2 =0.93, pprevalence of bilateral amblyopia remained stable (0.2%, p=0.12). The decline in amblyopia was apparent in mild and moderate amblyopia, but not in severe amblyopia. Strabismus and anisometropia were detected in 6-12% and 11-20% of subjects with unilateral amblyopia, respectively, without significant trends. Strabismic amblyopia remained constant in the entire population across years. Isoametropia was detected in 46-59% of subjects with bilateral amblyopia without a significant trend across birth years. Prevalence of strabismus in the study population decreased by 50%, from 1.2% to 0.6% (R 2 =0.75, pprevalence of mild unilateral amblyopia increased, while moderate or severe unilateral amblyopia remained relatively stable. Among young adults, the prevalence of unilateral amblyopia, as well as the prevalence of present strabismus, decreased significantly over a period of a generation. The prevalence of strabismic, bilateral or severe (both unilateral and bilateral) amblyopia remained stable. The establishment of the national screening programme for children and the improved utility of treatment for amblyopia and strabismus coincide with
Jamali, Payman; Fotouhi, Akbar; Hashemi, Hassan; Younesian, Masud; Jafari, Alireza
To determine the prevalence of amblyopia, strabismus, and refractive errors in children entering school. In this cross-sectional population-based study, 6-year-old children enrolling in Shahrood schools were randomly sampled. Those with organic blindness or mental retardation were excluded. Ocular alignment, visual acuity, stereopsis, cover testing, and cycloplegic refraction were recorded for all children by an optometrist. A diagnosis of amblyopia was based on a best-corrected visual acuity of 6/12 or less in one or both eyes, or a bilateral difference of at least two best-corrected visual acuity lines. A total of 902 children were invited for optometry examinations, among which 827 (91.7%) responded and 815 children (98.5%) were included in the study. The prevalence of significantly reduced visual acuity (uncorrected VA amblyopia was 3.6 and 1.7%, respectively. The prevalence of hyperopia (+2.00 D or worse), myopia (-0.50 D or worse), astigmatism (0.75 D or worse), and anisometropia (1.00 D or more) were 20.5, 1.7, 19.6, and 2.2%, respectively. Significant refractive error, defined as hyperopia >+3.50 D, myopia >-3.00 D, astigmatism >1.50 D in the orthogonal meridian or >1.00 D in the oblique meridian, or anisometropia (hyperopic >1.00 D, myopic >3.00 D) was detected in 2.1, 0.1, 5.0, and 0.9% of the sample, respectively. Strabismus was diagnosed in 1.2% of children. Overall, 52 children (6.4%; 95% confidence interval [CI], 4.7-8.1%) were at risk of amblyopia; of these, 81% had significant refractive errors, 11% had strabismus, and 8% had both. A considerable proportion of 6-year-old children have strabismus and/or significant, potentially amblyogenic refractive errors. The relatively high rate of hyperopia and astigmatism in the studied population needs more attention. The results of the study emphasize the need for adequate diagnostic and therapeutic eye care services for preschool children.
Ferraz, Fabio H; Corrente, José E; Opromolla, Paula; Padovani, Carlos Roberto; Schellini, Silvana A
To determine the prevalence of refractive errors and their distribution according to age and sex in a Brazilian population. This population-based cross-sectional study involved 7654 Brazilian inhabitants of nine municipalities of Sao Paulo State, Brazil, between March 2004 and July 2005. Participants aged >1 year were selected using a random, stratified, household cluster sampling technique, excluding individuals with previous refractive or cataract surgery. Myopia was defined as spherical equivalent (SE) ≤-0.5D, high myopia as SE ≤-3.0D, hyperopia as SE ≥+0.5D, high hyperopia as SE ≥+3D, astigmatism as ≤-0.5DC and anisometropia as ≥1.0D difference between eyes. Age, sex, complaints and a comprehensive eye examination including cycloplegic refraction test were collected and analysed using descriptive analysis, univariate and multivariate methods. The prevalence of astigmatism was 59.7%, hyperopia 33.8% and myopia was 25.3%. Astigmatism had a progressive increase with age. With-the-rule (WTR) axes of astigmatism were more frequently observed in the young participants and the against-the-rule (ATR) axes were more frequent in the older subjects. The onset of myopia occurred more frequently between the 2nd and 3rd decades of life. Anisometropia showed a prevalence of 13.2% (95% CI 12.4-13.9; p refractive error and hyperopia was also associated with sex. Hyperopia was associated with WTR axes (odds ratio 0.73; 95% CI: 0.6-0.8; p prevalent refractive error in a Brazilian population. There was a strong relationship between age and all refractive errors and between hyperopia and sex. WTR astigmatism was more frequently associated with hyperopia and ATR astigmatism with myopia. The vast majority of participants had low-grade refractive error, which favours planning aimed at correction of refractive error in the population. © 2014 The Authors Ophthalmic & Physiological Optics © 2014 The College of Optometrists.
Renato Ambrósio Junior
Full Text Available OBJETIVO: Verificar se a aberrometria ocular total (análise da frente de onda ou 'wavefront' possibilita melhora na acuidade visual corrigida (AVc com lentes esfero-cilíndricas, obtida com a refratometria manifesta em casos de ceratocone com algum grau de intolerância ao uso de lentes de contato. MÉTODOS: Os prontuários de 46 pacientes (89 olhos, referidos com diagnóstico de ceratocone e intolerantes ao uso de lentes de contato, submetidos ao exame de aberrometria ocular total seguido de refração manifesta, foram estudados de forma retrospectiva. A AVc (logMAR com a correção existente antes do exame foi comparada com a obtida com a nova refração manifesta, realizada considerando-se os dados objetivos da aberrometria. O teste não-paramétrico de Wilcoxon para amostras pareadas foi utilizado para verificação de diferenças estatisticamente significantes na AVc. RESULTADOS: Houve uma melhora estatisticamente significante na AVc com a nova refração manifesta (p<0,0001. A AVc média passou de 0,37 ou 20/47 (variando entre 1,3 e 0; desvio padrão[DP]=0,25 com a refração prévia para 0,23 ou 20/34 (variando entre 1 e 0,1; DP=0,21. Cinquenta e dois olhos (58,4% de 28 pacientes apresentaram melhora na AVc com a nova refração. A melhora média foi de 0,13 logMAR (1,3 linhas na tabela de Snellen, variando entre nula e 0,6 (6 linhas, com desvio padrão de 0,16. Oito pacientes apresentaram anisometropia significativa que limitou a prescrição de óculos em um dos olhos. CONCLUSÃO: A aberrometria facilitou a refratometria, determinando melhora significativa na acuidade visual corrigida com as lentes esfero-cilíndricas de pacientes com ceratocone intolerantes ao uso de lentes de contato. A anisometropia foi um fator limitante na prescrição de óculos.
Zeri, Fabrizio; Berchicci, Marika; Naroo, Shehzad A; Pitzalis, Sabrina; Di Russo, Francesco
Monovision is an optical correction for presbyopes that consists of correcting one eye for far distance and the other for near distance, creating a superimposition of an in-focus with a blurred image. Brain adaptation to monovision was studied in unexperienced observers by measuring visual evoked potentials from 64-channels. The first clear effect of monovision on visual evoked potentials was the C1 amplitude reduction, indicating that the unilateral blurring induced by monovision reduces feed-forward activity in primary visual area. Monovision led also to an increased amplitude of the P1 and pP1 components, with the latter originating in prefrontal regions. This effect probably works as an attentional compensatory activity used to compensate for the degraded V1 signal. A common and often successful option to correct presbyopia with contact lenses is monovision. This is an unbalanced correction across the two eyes where one eye is corrected for far vision and the other eye is corrected for near vision. Monovision is therefore a form of acquired anisometropia that causes a superimposition of an in-focus image with a blurred image. In spite of this visual anisometropia, monovision has been successfully used for many decadesl however the brain mechanism supporting monovision is not well understood. The present study aimed to measure the visual evoked potentials with a high-density electrode array (64-channel) in a group of presbyopes and to provide a detailed spatiotemporal analysis of the cortical activity after a short period of adaptation to monovision with contact lenses. When compared with a balanced eye near correction, monovision produced both a clear reduction of the earliest visual evoked potential components, the C1 and the N1, and an amplitude increase of the P1 and pP1. These results indicate that the unilateral blurring induced by wearing monovision contact lenses reduces feed-forward activity in the primary visual area and feedback activity in
Full Text Available Purpose. To study the effect of surgery on amblyopia and suppression associated with congenital cyclovertical strabismus. Methods. The fixation pattern was investigated with microperimetry before and soon after surgery in ten consecutive children operated for congenital superior oblique palsy at the S. Martino Hospital, Belluno, Italy, between September 2014 and December 2015. Changes in visual performance in terms of best-corrected visual acuity (BCVA and stereopsis between the day before and one week after surgery were also evaluated. No other amblyopia treatment has been administered during the time study. Results. Surgical correction of the excyclodeviation in congenital SO palsy determined monocular and binocular sensory consequences: monocularly, in the cyclodeviated amblyopic eye, BCVA (0.46–0.03 LogMAR; p<0.0001 and the fixation pattern improved, as demonstrated by microperimetry examination. Binocularly, stereopsis improved or emerged while suppression at the Worth four-dot test disappeared. Conclusions. In the absence of further amblyopic factors such as coexisting constant vertical and/or horizontal deviation and anisometropia, the amblyopia encountered in congenital SO palsy may resolve soon after the surgical alignment. Therefore, it may be considered and defined “pseudoamblyopia.”
Anderson, Justin E; Brown, Sandra M; Mathews, Taryn A; Mathews, Steven M
To investigate the usefulness of daily-wear opaque contact lens treatment for older children with amblyopia. A retrospective chart review of all children undergoing opaque contact lens therapy for amblyopia between 2000 and 2003 was performed. All patients were included except for those younger than 5 years of age, those undergoing maintenance treatment only, those lost to follow-up, or those unable to cooperate with Snellen visual acuity testing. Thirteen children were identified, and seven met the inclusion criteria. The seven patients had a mean age of 7.5 years (range, 5.7-8.7 years). The causes of amblyopia were anisometropia (five patients), cataract (one patient), and strabismus (one patient). For all seven patients, the mean logMAR improvement in visual acuity was 0.52 (range, 0.26-1.22). The average duration of opaque contact lens use was 9.3 months (range, 2-21 months). Compliance problems were encountered in three patients. No major complications occurred, but one patient had an episode of mild superficial punctate keratitis. Daily-wear opaque contact lens treatment is a useful occlusion method for amblyopia treatment in older children with various practical and social impediments to skin patching. Meaningful improvement in visual acuity can be obtained, even in children older than 8 years of age.
Drover, James R; Kean, Patrick G; Courage, Mary L; Adams, Russell J
Currently, there is a lack of adequate data on pediatric eye and vision disorders in Canada, particularly in the province of Newfoundland and Labrador. In the present study, we estimate the prevalence of eye and vision disorders among young children who participated in a vision screening program in the St. John's, Newfoundland, metropolitan region. In daycare settings, 946 children (mean age 4.2 years) were screened with the latest tests of optics and functional vision. Those with suspected vision disorders were referred to an optometrist for a complete eye examination. From the results of these examinations, prevalence rates were estimated for several categories of vision disorders. Overall, we estimate that 14.0% of the children possessed significant vision disorders, the most prevalent of which were hyperopia, amblyopia, and strabismus (4.8%, 4.7%, and 4.3%, respectively). Myopia and anisometropia, on the other hand, were relatively rare (1.1% and 1.4%, respectively). In general, prevalence estimates are within the range of existing estimates from other developed nations. Although the prevalence rates reported here must be interpreted cautiously because of methodological limitations, it appears that children in the present study do not possess an abnormally high prevalence of visual dysfunction. Nevertheless, because an estimated 14.0% of children tested had treatable vision disorders, early screening is clearly warranted in Newfoundland and Labrador.
Elflein, H M
Amblyopia is the main cause for mostly monocular, impaired vision in childhood. Treatment and prevention of amblyopia is only effective during childhood. Ophthalmological screening of children does not yet exist in Germany. The prevalence of amblyopia in Germany is 5.6%, which is higher than in reports from studies in Australia; however, the prevalence of amblyopia is not comparable in these studies due to different definitions of amblyopia and the inclusion/exclusion criteria of the study cohorts. At present it is unknown at what age ophthalmological screening should be carried out to prevent amblyopia and the appropriate frequency of screening examinations. Amblyopia is a disorder of the visual cortex that is due to suppression and deprivation of one eye leading to unilateral visual impairment. Approximately 50% of cases of amblyopia are caused by anisometropia, 25% by strabismus and in every sixth person by a combination of both. Other causes, such as unilateral congenital cataracts are relatively rare. A variety of factors, such as ocular pathologies, premature birth, familial disposition and general diseases are associated with an increased risk for amblyopia.
Full Text Available Amblyopia is the most diffused form of visual function impairment affecting one eye, with a prevalence of 1-5% in the total world population. Amblyopia is usually caused by an early functional imbalance between the two eyes, deriving from anisometropia, strabismus, or congenital cataract, leading to severe deficits in visual acuity, contrast sensitivity and stereopsis. While amblyopia can be efficiently treated in children, it becomes irreversible in adults, as result of a dramatic decline in visual cortex plasticity which occurs at the end of the critical period in the primary visual cortex. Notwithstanding this widely accepted dogma, recent evidence in animal models and in human patients have started to challenge this view, revealing a previously unsuspected possibility to enhance plasticity in the adult visual system and to achieve substantial visual function recovery. Among the new proposed intervention strategies, non invasive procedures based on environmental enrichment, physical exercise or visual perceptual learning appear particularly promising in terms of future applicability in the clinical setting. In this survey, we will review recent literature concerning the application of these behavioral intervention strategies to the treatment of amblyopia, with a focus on possible underlying molecular and cellular mechanisms.
Yekta, Abbasali; Hashemi, Hassan; Norouzirad, Reza; Ostadimoghaddam, Hadi; Nabovati, Payam; Dadbin, Nooshin; Nirouzad, Fereidon; Shir-Alivand, Ehsan; Khabazkhoob, Mehdi
To determine the prevalence of amblyopia, strabismus, and ptosis among schoolchildren in Dezful in the west of Iran. In this cross-sectional study, 1,375 schoolchildren of Dezful were selected through multistage cluster sampling. After obtaining written consents, participants had uncorrected and corrected visual acuity tests, cycloplegic refraction, and the cover test, and were examined for ptosis at the school site. Of the 1,151 study participants (83.7%), examinations were completed for 1,130 schoolchildren. Prevalence rates of amblyopia, strabismus, and ptosis were 2.7% (95% confidence interval [CI] 0.8-4.7), 1.9% (95% CI: 0.2-3.8), and 0.8%, respectively. Anisometropia was the most common cause of amblyopia; 45.2% of cases had anisometropic amblyopia. Among cases with strabismus, 63.6% were exotropic and 36.4% were esotropic. The present study indicated that the prevalence of amblyopia and strabismus in Dezful schoolchildren falls in the average range. Since the Amblyopia Screening Program has been running for years, we expected lower rates compared to previous years, but this was not observed. Correcting refractive errors can significantly reduce amblyopic cases.
Full Text Available Amblyopia is the most common form of impairment of visual function affecting one eye, with a prevalence of about 1-5% of the total world population. Amblyopia usually derives from conditions of early functional imbalance between the two eyes, owing to anisometropia, strabismus, or congenital cataract, and results in a pronounced reduction of visual acuity and severe deficits in contrast sensitivity and stereopsis. It is widely accepted that, due to a lack of sufficient plasticity in the adult brain, amblyopia becomes untreatable after the closure of the critical period in the primary visual cortex. However, recent results obtained both in animal models and in clinical trials have challenged this view, unmasking a previously unsuspected potential for promoting recovery even in adulthood. In this context, non invasive procedures based on visual perceptual learning, i.e. the improvement in visual performance on a variety of simple visual tasks following practice, emerge as particularly promising to rescue discrimination abilities in adult amblyopic subjects. This review will survey recent work regarding the impact of visual perceptual learning on amblyopia, with a special focus on a new experimental model of perceptual learning in the amblyopic rat.
Repka, Michael; Simons, Kurt; Kraker, Raymond
To determine the frequency of unilateral amblyopia in right versus left eyes among children younger than 18 years. Analysis of data collected in randomized clinical trials conducted by the Pediatric Eye Disease Investigator Group. The laterality of the amblyopic eye was analyzed in 2635 subjects younger than 18 years who participated in 9 multicenter prospective, randomized treatment trials. Eligibility criteria for these clinical trials included unilateral amblyopia associated with strabismus, anisometropia, or both, with visual acuity between 20/40 and 20/400. Logistic regression was used to assess the association of baseline and demographic factors with the laterality of amblyopia. Among subjects with anisometropic amblyopia (with or without strabismus), amblyopia was present more often in left than right eyes, with a relative prevalence of 59% in left eyes (95% confidence interval, 57% to 62%; P amblyopia, there was no laterality predilection (relative prevalence of 50% in left eyes; 95% confidence interval, 47% to 54%; P = .94). Anisometropic amblyopia, with or without strabismus, occurs more often in left eyes than right eyes. This finding of amblyopia laterality may be related to microtropia, sighting dominance, or other forms of ocular dominance; developmental or neurological factors; laterality in the development of refractive error; or a combination thereof. Copyright (c) 2010 Elsevier Inc. All rights reserved.
Bonaccorsi, Joyce; Berardi, Nicoletta; Sale, Alessandro
Amblyopia is the most common form of impairment of visual function affecting one eye, with a prevalence of about 1-5% of the total world population. Amblyopia usually derives from conditions of early functional imbalance between the two eyes, owing to anisometropia, strabismus, or congenital cataract, and results in a pronounced reduction of visual acuity and severe deficits in contrast sensitivity and stereopsis. It is widely accepted that, due to a lack of sufficient plasticity in the adult brain, amblyopia becomes untreatable after the closure of the critical period in the primary visual cortex. However, recent results obtained both in animal models and in clinical trials have challenged this view, unmasking a previously unsuspected potential for promoting recovery even in adulthood. In this context, non invasive procedures based on visual perceptual learning, i.e., the improvement in visual performance on a variety of simple visual tasks following practice, emerge as particularly promising to rescue discrimination abilities in adult amblyopic subjects. This review will survey recent work regarding the impact of visual perceptual learning on amblyopia, with a special focus on a new experimental model of perceptual learning in the amblyopic rat.
Høeg, Tracy B; Moldow, Birgitte; Ellervik, Christina; Klemp, Kristian; Erngaard, Ditte; la Cour, Morten; Buch, Helena
To determine the prevalence of amblyopia in Denmark before and after the initiation of the Danish national preschool vision screening programme. In a population-based cross-sectional study, 3826 participants of the Danish General Suburban Population Study (GESUS) aged 20 years and older from a Danish rural municipality received a complete general health examination and an ophthalmological interview and examination. This study included a comprehensive ophthalmologic interview, measurement of best corrected visual acuity (BCVA) in each eye, Hirschberg's test for strabismus and two 45-degree retinal fundus photographs of each eye. A complete ophthalmologic examination was performed when indicated. The prevalence of monocular visual impairment (MVI) was 4.26% (95% CI, 3.66-4.95, n = 163). Amblyopia was the most common cause, accounting for 33%. The prevalence of amblyopia was 1.44% (95% CI, 1.01-1.81, n = 55), being higher among non-preschool vision screened persons compared to those who were offered (estimated 95% attendance) preschool vision screening (1.78%, n = 41, 95% CI 1.24-2.33 versus 0.44%, n = 2, 95% CI, 0.12-1.60, p = 0.024). The leading cause of amblyopia was anisometropia (45.5%, 25/55). Amblyopia was the most common cause of MVI. Following the initiation of the Danish national preschool vision screening programme, which has an approximate attendance rate of 95%, the prevalence of amblyopia decreased by fourfold. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Kim, Jung Wan; Lee, Hwa; Chang, Minwook; Park, Minsoo; Lee, Tae Soo; Baek, Sehyun
This study aims to report the prevalence of amblyopia risk factors in patients with congenital nasolacrimal duct obstructions. We recruited patients who were treated for congenital nasolacrimal duct obstruction from April 2007 to December 2011 at Korea University Ansan Hospital. We evaluated visual acuity and refraction, performed strabismus test and slit-lamp examination, and assessed marginal reflex distance 1 (MRD1) to rule out amblyopia risk factors. We examined 26 children among 115 patients. Ten patients underwent probing procedure and 16 underwent Monoka stent intubation. Nine (35%) patients showed amblyopia risk factors, which occurred in the same eye as the congenital nasolacrimal duct obstruction in 8 (89%) patients. Seven out of 9 patients had refractive error alone, and 2 patients had both refractive error and strabismus. One (11%) had anisometropia, 2 (22%) had hyperopia, and 8 (89%) had astigmatism. Children with congenital nasolacrimal duct obstruction had a higher prevalence of amblyopia risk factors than children in the general population. Children with congenital nasolacrimal duct obstruction require special attention and treatments for refractive error. We recommend early treatment, such as probing or intubation, for congenital nasolacrimal duct obstruction.
Amblyopia is a developmental disorder of the entire visual system, including the extra-striate cortex. It manifests mainly by impaired visual acuity in the amblyopic eye. However, other abnormalities of visual function can be observed, such as decreased contrast sensitivity and stereoscopic vision, and some abnormalities can be found in the "good" eye. Amblyopia occurs during the critical period of brain development. It may be due to organic pathology of the visual pathways, visual deprivation or functional abnormalities, mainly anisometropia or strabismus. The diagnosis of amblyopia must be confirmed prior to treatment. Confirmation is based on cycloplegic refraction, visual acuity measurement and orthoptic assessment. However, screening for amblyopia and associated risk factors permits earlier diagnosis and treatment. The younger the child, the more effective the treatment, and it can only be achieved during the critical period. It requires parental cooperation in order to be effective and is based on occlusion or penalization of the healthy eye. The amblyopic eye may then develop better vision. Maintenance therapy must be performed until the end of the critical period to avoid recurrence. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Nguyen, Thuan B; Shock, Leslie A; Missoi, Tara G; Muzaffar, Arshad R
Ophthalmic abnormalities in children with syndromic craniosynostosis have been reported previously, and referral of these children to a pediatric ophthalmologist is recommended. However, it is not as clear whether a child with nonsyndromic synostosis needs to be referred to a pediatric ophthalmologist. The aim of this study is to report the incidence of amblyopia and its risk factors in children with isolated metopic craniosynostosis. An institutional review board-approved, retrospective review was performed on 91 children diagnosed with isolated metopic craniosynostosis. Ophthalmologic records were reviewed for diagnoses of amblyopia, strabismus, and refractive error. Of the 91 children, 19 (20.9%) had astigmatism, eight (8.8%) had amblyopia, eight (8.8%) had strabismus, five had myopia (5.5%), five had hyperopia (5.5%), and five had anisometropia (5.5%). The incidence of amblyopia and its risk factors found in our study are higher than the rate found in the clinically normal pediatric population. In our patient population, children with isolated metopic craniosynostosis demonstrate an increased rate of amblyopia and its risk factors. Amblyopia is best treated early in life to achieve a successful outcome. A referral to a pediatric ophthalmologist for a formal eye exam and potential treatment is therefore recommended for children with isolated metopic craniosynostosis.
Mücella Arıkan Yorgun
Full Text Available Objectives: Identifying effects of different types of refractiveerrors on final visual acuity and stereopsis levels inpatients with bilateral amblyopia.Materials and methods: Patients with bilateral amblyopialower than ≥1.5 D anisometropia were included. Thepatients were classified according to the level of sphericalequivalent (0-4 D and >4 D of hypermetropia, the levelof astigmatism (below and above 2D in positive cylinderand type of composed refractive error [ 4 D of hypermetropiaand 2 D of astigmatism (group III]. Initialand final binocular best corrected visual acuities (BCVAwere compared between groups.Results: The initial binocular BCVA levels were significantlylower in patients with > 4 D of hypermetropia(p=0.028, without correction after treatment (p=0.235.The initial binocular BCVA was not different betweenastigmatism groups, but final BCVA levels were significantlylower in 4-6D of astigmatism compared with 2-4D of astigmatism (p=0.001. During comparison of composedrefractive errors, only the initial binocular BCVAwas significantly lower in group I compared to group II(p=0.015. The final binocular BCVA levels were not differentbetween groups I and III (p>0.05.Conclusions: Although the initial BCVA is lower in patientswith higher levels of hypermetropia, the response ofpatients to treatment with glasses is good. The responseof patients with high levels of astigmatism seems to belimited. J Clin Exp Invest 2012; 3(4: 467-471Key words: Amblyopia, isoametropic amblyopia, hypermetropia,refractive amblyopia, visual acuity
Erkan Turan, Kadriye; Taylan Sekeroglu, Hande; Karahan, Sevilay; Sanac, Ali Sefik
The purpose of this study was to analyze the reliability of the fixation preference test (FPT) in the detection of amblyopia, and to determine interexaminer agreement. Eighty patients whose visual acuity could be tested objectively and had a horizontal misalignment of more than 10 prism diopters were enrolled. The best corrected visual acuity (BCVA) and orthoptic findings were all recorded. Non-preferred eye in primary position and fixation preference grade were assessed independently by two masked experienced examiners. The primary outcome measures were reliability of FPT in terms of its correlation with BCVA and interexaminer agreement. There was no significant correlation between fixation preference grades and interocular visual acuity difference as well as the type and amount of deviation, the presence of fusion, stereopsis, anisometropia, and previous strabismus surgery for none of the examiners (p > 0.05 for all). Sensitivity was 52.0% for examiner 1 and 54.0% for examiner 2 while specificity was 50.0 and 46.7%, respectively. Interexaminer agreement was 76.7% (p amblyopia and also in predicting the visual acuity difference between both eyes, even though it was found to show a high degree of agreement between examiners. In conclusion, it should be kept in mind that the reliability of FPT may be limited and the results should be interpreted with caution and be supported by other tests.
Full Text Available Shinji MakinoDepartment of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, JapanAbstract: Antimetropia is a condition in which one eye is myopic, while the fellow eye is hyperopic. This report describes a case of antimetropia associated with unilateral tilted disc syndrome. A 10-year-old boy presented with the complaint of diminished vision for distant objects in his right eye for several months. His uncorrected distance visual acuity was 0.15 in the right eye and 1.0 in the left eye. Best corrected visual acuity was 1.0, with -6.00 D/-2.00 D 170° in the right eye and +1.50 D in the left eye. The cover test revealed right esotropia and hypertropia. Bifoveal fixation was achieved using a 14 prism diopter (PD base at 220° in the right eye. Fundus examination revealed a tilted disc with inferior staphyloma in the right eye, but no abnormal findings were observed in the left eye. In addition, the patient occasionally experienced diplopia under casual viewing conditions. A cycloplegic refraction revealed -6.00 D/-2.00 D 170° in the right eye and +1.50 D/-2.00 D 5° in the left eye. Thus, prism glasses were prescribed. While wearing the prism glasses, the patient has shown no diplopia and maintains good binocular function.Keywords: amblyopia, strabismus, anisometropia, staphyloma
Avram, Elena; Stănilă, Adriana
Amblyopia or "lazy eye" represents a disorder of the visual system characterized by poor vision in an eye that is otherwise physically normal. Anisometropia, the condition in which the two eyes have an unequal refractive error, is considered the second most common cause of amblyopia. The purpose of this study is to determine the efficiency of HTS Amblyopia iNet Software by studying the progress of visual acuity, contrast sensitivity and stereopsis vision in anisometropic amblyopic children. 5 patients (age: 5-13 years), treated with HTS Amblyopia iNet Software at OftaTotal Clinic from Sibiu, between 2010-2013, participated in this clinical trial. Initially, visual acuity ranged from 0.25 to 0.8, contrast sensitivity from 1.35 to 1.65 Log. Unit. and 1 patient presented stereoscopic vision. After treatment, visual acuity ranged from 0.8 to 1, contrast sensitivity from 1.35 to 1.95 Log. Unit., also all patients presented stereoscopic vision. HTS Amblyopia iNet Software represents an effective modern approach in the treatment of anisometropic amblyopia.
Erin M. Harvey
Full Text Available Purpose. To determine if spectacle corrected and uncorrected astigmats show reduced performance on visual motor and perceptual tasks. Methods. Third through 8th grade students were assigned to the low refractive error control group (astigmatism < 1.00 D, myopia < 0.75 D, hyperopia < 2.50 D, and anisometropia < 1.50 D or bilateral astigmatism group (right and left eye ≥ 1.00 D based on cycloplegic refraction. Students completed the Beery-Buktenica Developmental Test of Visual Motor Integration (VMI and Visual Perception (VMIp. Astigmats were randomly assigned to testing with/without correction and control group was tested uncorrected. Analyses compared VMI and VMIp scores for corrected and uncorrected astigmats to the control group. Results. The sample included 333 students (control group 170, astigmats tested with correction 75, and astigmats tested uncorrected 88. Mean VMI score in corrected astigmats did not differ from the control group (p=0.829. Uncorrected astigmats had lower VMI scores than the control group (p=0.038 and corrected astigmats (p=0.007. Mean VMIp scores for uncorrected (p=0.209 and corrected astigmats (p=0.124 did not differ from the control group. Uncorrected astigmats had lower mean scores than the corrected astigmats (p=0.003. Conclusions. Uncorrected astigmatism influences visual motor and perceptual task performance. Previously spectacle treated astigmats do not show developmental deficits on visual motor or perceptual tasks when tested with correction.
Holmström, Gerd E; Källen, Karin; Hellström, Ann; Jakobsson, Peter G; Serenius, Fredrik; Stjernqvist, Karin; Tornqvist, Kristina
Follow-up at 30 months' corrected age reveals eye and visual problems in one-third of children born extremely prematurely (children at 30 months' corrected age. DESIGN, SETTING, AND PARTICIPANTS A prospective, population-based follow-up study (Extremely Preterm Infants in Sweden Study [EXPRESS]) was conducted in Sweden. The population included extremely preterm infants (children (83.7%). Visual acuity, manifest strabismus, and refractive errors were evaluated. Visual impairment was identified in 3.1% of the children, and 1.0% were blind. Refractive errors, defined as myopia less than -3 diopters (D), hypermetropia greater than +3 D, astigmatism 2 D or more, and/or anisometropia 2 D or more, were found in 25.6% of the children, and 14.1% had manifest strabismus. There were significant associations between visual impairment and treated ROP (P = .02), cognitive disability (P Children who had been treated for ROP had the highest frequency (69.0%) of eye and visual abnormalities. One-third of the extremely prematurely born children in this study had some kind of eye or visual problems, such as visual impairment, strabismus, or major refractive error. Despite being born extremely preterm, the present cohort has a similar prevalence of blindness and visual impairment as in previous Swedish cohorts of children born less prematurely.
Full Text Available AIM: To evaluate retinal parameters in a sample of healthy young Caucasian adults to define the normal or physiological range of inter-ocular asymmetry in this particular age and ethnic group.METHODS: Study sample consisted of 37 Caucasian children and young adults aged between 12 and 23 years(spherical equivalent from -3.00D to +4.00D, anisometropia RESULTS: Statistically significant inter-ocular differences were found in mean(P=0.003and superior(P=0.008retinal nerve fiber layer(RNFLthickness, as well as in central macular thickness(P=0.039, with larger values in the left eye in all instances, and with tolerance limits of inter-ocular asymmetry of -9.00μm to 6.00μm, -28.00μm to 9μm and -39.00μm to 29.00μm, respectively. In addition, statistically significant differences were found between males and females in mean thickness of the RNFL in the right eye(P=0.020.CONCLUSION: The exploration of the normal asymmetries of the retina may be an effective approach to further understand myopia onset and progression, which is particularly relevant in this age group. Differences in instrumentation and sample characteristics compromise direct comparison with published research and warrant the need for further studies.
Langmann, A; Lindner, S
Infantile hemangiomas affect about 5% (3%-8%) of the population, showing a predilection for the face. After a phase of rapid enlargement between the 3rd and the 9th month of life, 70% regress by the age of six after a period of stability. 43%-60% of the children with eye lid hemangiomas develop strabismic, anisometropic, or deprivation amblyopia. Previous studies found the majority of cases resulting from anisometropia (especially asymmetric astigmatism) rather than strabism or occlusion of the visual axis. Several methods of treatment--surgical excision, irradiation, sclerosing agents, systemic steroids, ligation, cryotherapy--have been used but all with a risk of local or systemic complications. Local injections of steroids are a simple method of therapy with a high rate of resolution of hemangiomas, but still with a high degree of bad visual output because of persistent astigmatism. In four children with asymmetric astigmatism (axis of astigmatism towards the hemangioma) in which the injection was given at the beginning of the phase of enlargement, amblyopia could be avoided by preventing corneal steepening from becoming permanent.
Costa, Manuel F. M.; Jorge, Jorge M.
It is of utmost importance to the development of the child's visual system that she perceives clear focused retinal images. Furthermore if the refractive problems are not corrected in due time amblyopia may occur--myopia and hyperopia can only cause important problems in the future when they are significantly large, however for the astigmatism (rather frequent in infants) and anisometropia the problems tend to be more stringent. The early evaluation of the visual status of human infants is thus of critical importance. Photorefraction is a convenient technique for this kind of subjects. Essentially a light beam is delivered into the eyes. It is refracted by the ocular media, strikes the retina, focusing or not, reflects off and is collected by a camera. The photorefraction setup we established using new technological breakthroughs on the fields of imaging devices, digital image processing and fiber optics, allows a fast noninvasive evaluation of children visual status (refractive errors, accommodation, strabismus, ...). Results of the visual screening of a group of risk' child descents of blinds or amblyopes will be presented.
Caca, Ihsan; Cingu, Abdullah Kursat; Sahin, Alparslan; Ari, Seyhmus; Dursun, Mehmet Emin; Dag, Umut; Balsak, Selahattin; Alakus, Fuat; Yavuz, Abdullah; Palanci, Yilmaz
To investigate the prevalence of refractive errors and other eye diseases, incidence and types of amblyopia in school-aged children, and their relation to gender, age, parental education, and socioeconomic factors. A total of 21,062 children 6 to 14 years old were screened. The examination included visual acuity measurements and ocular motility evaluation. Autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus were performed. There were 11,118 females and 9,944 males. The average age was 10.56 ± 3.59 years. When all of the children were evaluated, 3.2% had myopia and 5.9% had hyperopia. Astigmatism 0.50 D or greater was present in 14.3% of children. Myopia was associated with older age, female gender, and higher parental education. Hyperopia was inversely proportional with older age. Spectacles were needed in 4,476 (22.7%) children with refractive errors, and 10.6% of children were unaware of their spectacle needs. Amblyopia was detected in 2.6% of all children. The most common causes of amblyopia were anisometropia (1.2%) and strabismus (0.9%). Visual impairment is a common disorder in school-aged children. Eye health screening programs are beneficial in early detection and proper treatment of refractive errors. Copyright 2013, SLACK Incorporated.
Vide-Escada, Ana; Prior Filipe, Helena
To show that Straatsma Syndrome can have a good outcome and to highlight an unusual presentation of this disease. A four-year-old boy presents with severe right eye amblyopia in association with high myopia, esotropia, heterochromia iridum and extensive myelinated retinal fibers involving both temporal arcades and the optic nerve head. Right eye initial visual acuity was less than 20/400 for distance and less than R6W10 for near. Left eye examination was unremarkable. Despite the indicators for bad prognosis, intensive occlusion therapy was prescribed. Parents were strongly involved in the treatment regimen. After four months, the patient presented an unexpected good visual recovery both for distance and near, that has persisted until present. Right eye visual acuity is 20/30 with -9.00 dioptres contact lens for distance and R2W1 for near. Esotropia also improved to 12 prism dioptres. Fundoscopic alterations and heterochromia iridum have remained stable. Spectral-domain optical coherence tomography images of the right eye showed thinner superior outer ring measurements. Straatsma Syndrome can present with heterochromia iridum . When strabismus is present, early surgery should be withheld. Intensive treatment of Straatsma Syndrome can yield an unexpected good result, despite initial high degree anisometropia and low vision acuity.
Prevenção à cegueira em crianças de 3 a 6 anos assistidas pelo programa de saúde da família (PSF do Morro do Alemão - Rio de Janeiro Blindness prevention on 3 to 6 years old children at a health family program assisted community in Morro do Alemão - Rio de Janeiro
Giancarlo Cardoso Jeveaux
Full Text Available OBJETIVO: Este trabalho visou fazer um levantamento da prevalência de ambliopia e fatores ambliopiogênicos em crianças com idade pré-escolar em áreas assistidas pelo Programa de Saúde da Família no Morro do Alemão-RJ. MÉTODOS: Crianças com idade entre 3 e 6 anos foram submetidas a exame de triagem visual. Os resultados positivos foram confirmados por exame oftalmológico realizado sob cicloplegia na própria unidade de saúde. Foram aplicados questionários semi-estruturados aos acompanhantes das crianças e aos membros de todas as equipes de saúde da unidade. RESULTADOS: De 559 crianças convocadas para triagem, 265 (47,4% compareceram e, destas, 127 (48% foram encaminhadas para exame oftalmológico completo. Tiveram o exame ocular normal 138 (52% das crianças examinadas pela triagem. Compareceram para exame especializado 81 (63,7% crianças. Destas, 9 (4,1% crianças tiveram diagnóstico de ambliopia. Quatro (1,8% por estrabismo, uma (0,46% por privação de estímulo, uma (0,46% por anisometropia e três (33,3% por erros refracionais isometrópicos. CONCLUSÃO: Os dados obtidos pela triagem seguida de exame ocular especializado executada na unidade de atenção primária à saúde (PSF do Morro do Alemão-RJ, mostraram que os exames de triagem realizados são relevantes para a detecção de ambliopia e fatores ambliopiogênicos e para a promoção da saúde ocular infantil.PURPOSE: The study objective is to determine the prevalence of amblyopia and amblyopiogenic factors in children from 3 to 6 years old at a health family program assisted community in Morro do Alemão-RJ. METHODS: A preschool children ocular evaluation cross sectional study will be submitted to an ophthalmic screening exam.The positive results were confirmed by oftalmologic examination under cicloplegia inside of the health centre. Were applied a semi-structure questionnaire to the health members of the health centre team and to all children accompanist. RESULTS
Renato Ambrósio Junior
/34 (varying between 1 and 0,1; SD = 0,21. 52 eyes (58,4% of 28 patients showed improvement in BSCDVA with the new refraction. The average improvement was 0,13 logMAR (1,3 lines on Snellen chart, varying between zero and 0,6 (6 lines, with standard deviation of 0,16. Eight patients had significant anisometropia that limited the prescription of glasses. CONCLUSION: Aberrometry facilitated the refraction, determining significant improvement in visual acuity with sphero-cylindrical lenses in keratoconus patients intolerant to contact lenses. The anisometropia was a limiting factor in the prescription of glasses.
Jabbarvand, Mahmoud; Hashemian, Hesam; Khodaparast, Mehdi; Anvari, Pasha
To evaluate the effects of photorefractive keratectomy (PRK) on the stereopsis of myopic and hyperopic patients. Farabi Eye Hospital, Tehran, Iran. Prospective case series. This study included patients having PRK to achieve emmetropia. The patients were divided into the following 3 groups: low myopia (-6.0 D), and hyperopia (<+4.0 D). Near stereoacuity was measured using the Randot test under photopic conditions (with corrective glasses) at 40 cm preoperatively (with corrective glasses) and 1, 3, and 12 months postoperatively. Repeated-measure analysis of variance was used to assess changes in stereopsis over time in the 3 groups. Each group comprised 60 patients. The mean preoperative stereoacuity was 121.16 seconds of arc (arcsec) ± 149.92 (SD), improving to 83.66 ± 75.84 arcsec 1 month postoperatively and 80.66 ± 64.31 arcsec at 3 months (both P < .001). It remained unchanged (83.33 ± 75.01 arcsec) at 12 months (P = .610). Patients with high myopia had the greatest improvement in stereopsis after PRK compared with low myopic and hyperopic patients (P < .001). The improvement in stereoacuity was significantly higher in the severe anisometropic group; the lowest improvement was in the group without anisometropia. Photorefractive keratectomy could result in an improvement in stereopsis. Patients with high myopia benefitted most from PRK in terms of improvement in stereopsis. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
Liang, Minglong; Xie, Bing; Yin, Xuntao; Wang, Jian [Third Military Medical University, Department of Radiology, Southwest Hospital, 30 Gaotanyan Street, Shapingba District, Chongqing (China); Yang, Hong; Wang, Hao [Third Military Medical University, Ophthalmology Research Center, Southwest Eye Hospital/Southwest Hospital, Chongqing (China); Yu, Longhua [Third Military Medical University, Department of Radiology, Southwest Hospital, 30 Gaotanyan Street, Shapingba District, Chongqing (China); 401st Hospital of PLA, Department of Radiology, Qingdao (China); He, Sheng [University of Minnesota Twin Cities, Department of Psychology, Minneapolis, MN (United States)
Altered brain functional connectivity has been reported in patients with amblyopia by recent neuroimaging studies. However, relatively little is known about the alterations in interhemispheric functional connectivity in amblyopia. The present study aimed to investigate the functional connectivity patterns between homotopic regions across hemispheres in patients with anisometropic and strabismic amblyopia under resting state. Nineteen monocular anisometropic amblyopia (AA), 18 strabismic amblyopia (SA), and 20 normal-sight controls (NC) were enrolled in this study. After a comprehensive ophthalmologic examination, resting-state fMRI scanning was performed in all participants. The pattern of the interhemispheric functional connectivity was measured with the voxel-mirrored homotopic connectivity (VMHC) approach. VMHC values differences within and between three groups were compared, and correlations between VMHC values and each the clinical variable were also analyzed. Altered VMHC was observed in AA and SA patients in lingual gyrus and fusiform gyrus compared with NC subjects. The altered VMHC of lingual gyrus showed a pattern of AA > SA > NC, while the altered VMHC of fusiform gyrus showed a pattern of AA > NC > SA. Moreover, the VMHC values of lingual gyrus were positively correlated with the stereoacuity both in AA and SA patients, and the VMHC values of fusiform gyrus were positively correlated with the amount of anisometropia just in AA patients. These findings suggest that interhemispheric functional coordination between several homotopic visual-related brain regions is impaired both in AA and SA patients under resting state and revealed the similarities and differences in interhemispheric functional connectivity between the anisometropic and strabismic amblyopia. (orig.)
Liang, Minglong; Xie, Bing; Yin, Xuntao; Wang, Jian; Yang, Hong; Wang, Hao; Yu, Longhua; He, Sheng
Altered brain functional connectivity has been reported in patients with amblyopia by recent neuroimaging studies. However, relatively little is known about the alterations in interhemispheric functional connectivity in amblyopia. The present study aimed to investigate the functional connectivity patterns between homotopic regions across hemispheres in patients with anisometropic and strabismic amblyopia under resting state. Nineteen monocular anisometropic amblyopia (AA), 18 strabismic amblyopia (SA), and 20 normal-sight controls (NC) were enrolled in this study. After a comprehensive ophthalmologic examination, resting-state fMRI scanning was performed in all participants. The pattern of the interhemispheric functional connectivity was measured with the voxel-mirrored homotopic connectivity (VMHC) approach. VMHC values differences within and between three groups were compared, and correlations between VMHC values and each the clinical variable were also analyzed. Altered VMHC was observed in AA and SA patients in lingual gyrus and fusiform gyrus compared with NC subjects. The altered VMHC of lingual gyrus showed a pattern of AA > SA > NC, while the altered VMHC of fusiform gyrus showed a pattern of AA > NC > SA. Moreover, the VMHC values of lingual gyrus were positively correlated with the stereoacuity both in AA and SA patients, and the VMHC values of fusiform gyrus were positively correlated with the amount of anisometropia just in AA patients. These findings suggest that interhemispheric functional coordination between several homotopic visual-related brain regions is impaired both in AA and SA patients under resting state and revealed the similarities and differences in interhemispheric functional connectivity between the anisometropic and strabismic amblyopia. (orig.)
Full Text Available Purpose: Strabismus and anisometropia are the most common causes of amblyopia. It can be easily prevented or treated if detected early. With the changing socio-cultural-economic milieu of the society, the perspectives of strabismus in society are gradually changing but still adequate knowledge, awareness, and attitude of parents toward strabismus will help in preventing amblyopia and aid in the proper psychosocial adaptation of such children. This study aimed to assess knowledge and attitude of parents toward children suffering from strabismus. Methods: A prospective study was carried out from January 1 to February 29, 2016, through a structured questionnaire to assess the level of knowledge and attitude of parents of children suffering from strabismus. Results: One hundred and twenty parents of children with strabismus were interviewed through a questionnaire. Education level of 78 parents was less than graduation (60% and of 42 parents (40% was graduation or higher. The majority of the parents, i.e., 116 (96.67% were bothered due to strabismus. One hundred and one (84.17% parents felt that their child's strabismus was noticed by others during interaction. Seventy-four (61.67% parents felt that their children will have difficulty in making friends. Ninety (75% parents felt uncomfortable if someone asked something about their child's strabismus. One hundred and ten (91.67% parents considered strabismus as cosmetic stigma. Conclusion: Some parents, especially from the lower educated segment, had poor understanding of strabismus, thus resulting in late presentation and ineffective countermeasures. The key to prevent strabismic amblyopia and its psychosocial impacts is to provide health education regarding strabismus.
Full Text Available AIM: To document common ocular abnormalities in children with spastic subtype of cerebral palsy (CP and to find out whether any correlation exists between their occurance and etiologic factors. METHODS: Totally 194 patients with the diagnosis of spastic type CP were enrolled in this retrospective study. Detailed ophthalmic examinations were performed. Demographic data and neuroradiological findings were documented. Kruskal-Wallis, Mann Whitney U, Pearson Chi-square tests and Student’s t tests were used in the statistical analysis. RESULTS: The mean age was 64.7±44.2 months on the first ophthalmic examination. Prevalences of diplegia (47.4% and tetraplegia (36.1% were found to be higher than the frequency of hemiplegia (16.5% in our study population. Etiologic factor was asphyxia in 60.8% of the patients. Abnormal ocular findings were present in 78.9% of the patients. Statistically significant poor vision was detected in tetraplegia group among all the spastic ubtypes of CP (P=0.000. Anisometropia and significant refractive error were found in 14.4% and 70.1% of the patients, respectively. Thirty-six children (18.6% had nystagmus and 107 children (55.2% had strabismus. Lower gestational age and birth weight were statistically higher in patients with esotropia than exotropia (P=0.009 and P=0.024, respectively. Abnormal morphology of the optic disc was present in 152 eyes (39.2%. Severe periventricular leukomalacia (PVL was found in 48 patients and statistically significant poor vision was detected in the presence of PVL (P=0.000. CONCLUSION: Spastic diplegic or tetraplegic CP patients with positive neuroradiological symptoms, younger gestational age and lower birth weight ought to have detailed ophthalmic examinations as early as possible to provide best visual rehabilitation.
Cotter, Susan; Varma, Rohit; Tarczy-Hornoch, Kristina; McKean-Cowdin, Roberta; Lin, Jesse; Wen, Ge; Wei, Jolyn; Borchert, Mark; Azen, Stan; Torres, Mina; Tielsch, James M.; Friedman, David S.; Repka, Michael X.; Ibironke, Joanne Katz Josephine; Giordano, Lydia
Objective To investigate risk factors associated with esotropia or exotropia in infants and young children. Design Population-based cross-sectional prevalence study. Participants Population-based samples of 9970 children ages 6 to 72 months from California and Maryland. Methods Participants were preschool African-American, Hispanic, and non-Hispanic white children participating in the Multiethnic Pediatric Eye Disease Study and the Baltimore Eye Disease Study. Data were obtained by parental interview and ocular examination. Odd ratios and 95% confidence intervals were calculated to evaluate the association of demographic, behavioral, and clinical risk factors with esotropia and exotropia. Main Outcome Measures Odds ratios (ORs) for various risk factors associated with esotropia or exotropia diagnosis based on cover testing. Results In multivariate logistic regression analysis, esotropia was independently associated with prematurity, maternal smoking during pregnancy, older preschool age (48–72 months), anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 Diopters (D) to strabismus, female sex, astigmatism (OR 2.5 for 1.50 to <2.50 D, and 5.9 for ≥ 2.5 D of astigmatism), and aniso-astigmatism in the J0 component (OR ≥ 2 for J0 aniso-astigmatism ≥ 0.25 D). Conclusions Prematurity and maternal smoking during pregnancy are associated with a higher risk of having esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Because refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in infants and young children children. PMID:21856012
Full Text Available Deborah KL Tan,1,2 Gillian H Teh,2,3 Ching Lin Ho,2,4 Boon Long Quah1,2 1Department of Paediatric Ophthalmology and Adult Strabismus, Singapore National Eye Centre, 2Singapore Eye Research Institute, 3Department of General Cataract and Comprehensive Ophthalmology, 4Department of Glaucoma, Singapore National Eye Centre, Singapore Abstract: Childhood glaucoma poses a diagnostic and therapeutic challenge to ophthalmologists. Difficulty in examination and limitations on ability to perform structural and functional testing of optic nerve make diagnosis and verification of glaucoma control difficult in children. It is well known that an excessive loss of hyperopia is a useful sign in alerting the examining ophthalmologist to the possible diagnosis of glaucoma. We present an interesting case of juvenile onset glaucoma presenting with anisohypermetropic amblyopia in one eye and normal vision in the fellow eye that has glaucoma. It is an unusual case as the left eye with abnormal vision from hypermetropic amblyopia, though by itself requiring treatment, was a red herring for a potentially blinding condition in the fellow eye with normal vision and lower and less amblyogenic hyperopia on examination. We believe that glaucomatous enlargement of the right eye resulted in significant loss of hyperopia in that eye and in turn contributed to anisohypermetropic amblyopia in the left eye. To the best of our knowledge, this is the first reported case of juvenile onset glaucoma presenting with anisohypermetropic amblyopia in one eye and normal vision in the fellow eye that has glaucoma. Keywords: childhood glaucoma, anisometropia, anisohypermetropia, amblyopia, myopic shift
Arneja, Jugpal S; Mulliken, John B
Periocular hemangiomas can induce irreversible amblyopia by multiple mechanisms: visual deprivation, refractive error (astigmatism and/or anisometropia), or strabismus. There is a subset of complicated periocular hemangiomas most effectively managed by resection. The authors reviewed all patients from 1999 to 2008 with a periocular hemangioma that was either completely resected or debulked; whenever necessary, the levator apparatus was reinserted. Infants were included in the study if they had complete preoperative and postoperative ophthalmic assessments and there was more than a 6-month follow-up interval. Thirty-three children were treated with a mean operative age of 6.2 months and a mean follow-up interval of 48.2 months. The majority of hemangiomas were well-localized and caused corneal deformation with astigmatism or blepharoptosis. Intralesional or oral corticosteroid administration was attempted in almost one-half of patients. Postoperatively, the degree of astigmatism was statistically improved: from 3.0 diopters to 1.11 diopters (p correction was slightly greater postoperatively (from 2.76 diopters to 0.80 diopters). Resection performed after 3 months (14 patients) of age also resulted in improvement of astigmatism (from 3.39 diopters to 1.38 diopters). Reinsertion of the levator expansion was required in 34 percent of patients. The authors advocate early resection of a well-localized periocular hemangioma to prevent potentially irreversible amblyopia caused by either corneal deformation or blepharoptosis. The longer a complicated periocular hemangioma is observed, the greater the astigmatism and the less amenable it will be to correction following tumor removal.
Harvey, Erin M; Miller, Joseph M; Twelker, J Daniel; Davis, Amy L
To compare oral reading fluency (ORF) in students with no/low astigmatism and moderate/high astigmatism and to assess the impact of spectacle correction on ORF in moderate and high astigmats. Subjects were third- to eighth-grade students from a highly astigmatic population. Refractive error was determined through subjectively refined cycloplegic autorefraction. Data from students with ocular abnormalities, anisometropia, symptomatic binocular vision disorders, or refractive error that did not meet study criteria (no/low [cylinder Oral reading fluency was tested with a modified version of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) Next test of ORF. No/low astigmats were tested without spectacles; astigmats were tested with and without spectacles. Mean ORF was compared in no/low astigmats and astigmats (with and without correction). Improvement in ORF with spectacles was compared between moderate and high astigmats. The sample included 130 no/low, 67 moderate, and 76 high astigmats. ORF was lower in uncorrected astigmats than in no/low astigmats (p = 0.011). ORF did not significantly differ in no/low astigmats and corrected astigmats (p = 0.10). ORF significantly improved with spectacle correction in high astigmats (p = 0.001; mean improvement, 6.55 words per minute) but not in moderate astigmats (p = 0.193; mean improvement, 1.87 words per minute). Effects of spectacle wear were observed in students who read smaller text stimuli (older grades). ORF is significantly reduced in students with bilateral astigmatism (≥1.00D) when uncorrected but not when best-corrected compared with their nonastigmatic peers. Improvement in ORF with spectacle correction is seen in high astigmats but not in moderate astigmats. These data support the recommendation for full-time spectacle wear in astigmatic students, particularly those with high astigmatism.
Mollazadegan, Kaziwe; Lundström, Mats
To analyse the relationship between patient-reported outcome measures and clinical outcome measures in 42 individual Swedish cataract surgery settings. The study material consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008-2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analysed together with clinical data. The analyses were performed for each clinic. For almost all clinics, a factor related to a poor patient-reported outcome after surgery was a good preoperative self-assessed visual function. For some clinics, up to 50% of the patients stated that they were very satisfied with their vision before surgery. For single clinics, different factors such as large anisometropia (≥3D), capsule complications, biometry prediction error (≥3D) and ocular comorbidity were related to a poor patient-reported outcome. In situations where the clinical outcome was good and the patient-reported outcome was poor, problems with near-vision activities after surgery was the main factor noted. Analysing factors related to a poor patient-reported outcome for each clinic showed large variation. Weak indication for surgery, refractive problems after surgery, surgical complications and a poor chance of visual recovery due to ocular comorbidity were among the reasons for a poor patient-reported outcome. Post-operative care in terms of establishing a good near vision seemed to be another problem for some clinics. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.
Suttle, Catherine M.; Melmoth, Dean R.; Finlay, Alison L.; Sloper, John J.
Purpose. To investigate whether binocular information provides benefits for programming and guidance of reach-to-grasp movements in normal children and whether these eye–hand coordination skills are impaired in children with amblyopia and abnormal binocularity. Methods. Reach-to-grasp performance of the preferred hand in binocular versus monocular (dominant or nondominant eye occluded) conditions to different objects (two sizes, three locations, and two to three repetitions) was quantified by using a 3D motion-capture system. The participants were 36 children (age, 5–11 years) and 11 adults who were normally sighted and 21 children (age, 4–8 years) who had strabismus and/or anisometropia. Movement kinematics and error rates were compared for each viewing condition within and between subject groups. Results. The youngest control subjects used a mainly programmed (ballistic) strategy and collided with the objects more often when viewing with only one eye, while older children progressively incorporated visual feedback to guide their reach and, eventually, their grasp, resulting in binocular advantages for both movement components resembling those of adult performance. Amblyopic children were the worst performers under all viewing conditions, even when using the dominant eye. They spent almost twice as long in the final approach to the objects and made many (1.5–3 times) more errors in reach direction and grip positioning than their normal counterparts, these impairments being most marked in those with the poorest binocularity, regardless of the severity or cause of their amblyopia. Conclusions. The importance of binocular vision for eye–hand coordination normally increases with age and use of online movement guidance. Restoring binocularity in children with amblyopia may improve their poor hand action control. PMID:21212188
Suttle, Catherine M; Melmoth, Dean R; Finlay, Alison L; Sloper, John J; Grant, Simon
To investigate whether binocular information provides benefits for programming and guidance of reach-to-grasp movements in normal children and whether these eye-hand coordination skills are impaired in children with amblyopia and abnormal binocularity. Reach-to-grasp performance of the preferred hand in binocular versus monocular (dominant or nondominant eye occluded) conditions to different objects (two sizes, three locations, and two to three repetitions) was quantified by using a 3D motion-capture system. The participants were 36 children (age, 5-11 years) and 11 adults who were normally sighted and 21 children (age, 4-8 years) who had strabismus and/or anisometropia. Movement kinematics and error rates were compared for each viewing condition within and between subject groups. The youngest control subjects used a mainly programmed (ballistic) strategy and collided with the objects more often when viewing with only one eye, while older children progressively incorporated visual feedback to guide their reach and, eventually, their grasp, resulting in binocular advantages for both movement components resembling those of adult performance. Amblyopic children were the worst performers under all viewing conditions, even when using the dominant eye. They spent almost twice as long in the final approach to the objects and made many (1.5-3 times) more errors in reach direction and grip positioning than their normal counterparts, these impairments being most marked in those with the poorest binocularity, regardless of the severity or cause of their amblyopia. The importance of binocular vision for eye-hand coordination normally increases with age and use of online movement guidance. Restoring binocularity in children with amblyopia may improve their poor hand action control.
Fu, Jing; Li, Shi Ming; Liu, Luo Ru; Li, Jin Ling; Li, Si Yuan; Zhu, Bi Dan; Li, He; Yang, Zhou; Li, Lei; Wang, Ning Li
To determine the prevalence of amblyopia and strabismus in 7th-grade junior high school students in central China. Using stratified cluster sampling, 2363 7th-grade students were recruited from four junior high schools in Anyang city into the cross-sectional Anyang Childhood Eye Study (ACES). All students underwent visual acuity (VA), cycloplegic autorefraction, cover test, and ocular movement examinations. Uncorrected VA and best-corrected VA (BCVA) were measured with a logarithm of the minimum angle of resolution (logMAR) chart. Cycloplegic autorefraction was performed after administration of 1.0% cyclopentolate and Mydrin-P. Strabismus was defined as heterotropia at near or distance fixation. Amblyopia was defined as BCVA ≤ 0.1 logMAR units in one or both eyes, without ocular pathology in either eye. Of the 2363 eligible students, 2260 (95.6%) completed all examinations. The mean age of the students was 12.4 ± 0.6 years. Amblyopia was present in 52 students (2.5%), of whom 33 (63.5%) had unilateral and 19 (36.6%) had bilateral amblyopia. Of those with unilateral amblyopia, 18 (54.5 %) had anisometropia and 7 (21.2%) had strabismus. Of those with bilateral amblyopia, 6 (31.6%) had significant refractive error. Strabismus was present in 108 students (5.0%), of whom 2 (1.9%) had esotropia, 102 (94.4%) had exotropia, 3 (2.8%) had vertical strabismus, and 1 (0.9%) had microstrabismus. Of the 108 students with strabismus, 9 (8.3%) had amblyopia. The cross-sectional ACES which examined the prevalence of amblyopia and strabismus in 7th-grade students in central China revealed the prevalence of strabismus, particularly the proportion of exotropia, to be higher than previously reported.
Faghihi, Mohammad; Ostadimoghaddam, Hadi; Yekta, Abbas Ali
To determine the prevalence of amblyopia and strabismus among the population of schoolchildren Mashhad, Iran. In a cross-sectional study with cluster sampling, 2510 schoolchildren were selected from schools of district 1 in Mashhad. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Of the 2510 selected schoolchildren, 2150 participated (response rate, 85.6%). The mean (± standard deviation) age of the participants was 13.2 ± 3.2 (range, 6-21) years. The prevalence of amblyopia was 1.9% (95% CI: 0.94-2.90); 2.1% (95% CI: 0.10-3.16) in girls and 1.7% (95% CI: 0.30-3.12) in boys (P = 0.6). Among myopic, hyperopic, and astigmatic students, 3.7%, 27.8%, and 6.5% had amblyopia, respectively (Pamblyopia were anisometropia in 65.9%, strabismus in 24.4%, and isoametropia in 9.8%. The prevalence of strabismus was 3.1% (95% CI, 1.3% to 4.3%); 4.2% (95% CI, 3.05 to 5.7%) in girls, and 2.0% (1.3% to 2.9%) in boys (P = 0.0011). Strabismus was significantly more prevalent among hyperopic students (7.9%) compared with myopic ones (3.7%). Results of the present study indicate that the prevalence rate of amblyopia was in the mid-range of other studies, and the prevalence of strabismus was relatively high. Since refractive errors, especially hyperopia, are responsible for some cases of strabismus.
Karki, K J D
To find out prevalence of amblyopia in ametropias in a clinical set-up. In this retrospective clinical study children from 4-5 years age group to the young adults who attended the eye clinic in one year period were included after taking history, VA test by Snellen's Vision Chart, cycloplegic refraction by streak retinoscope in children and wet or dry retinospcopy in young adults; and a thorough anterior and posterior segment eye examinations by slit lamp biomicroscope and ophthalmoscope to exclude structural abnormality of the eye or the posterior visual pathway defects. A total of 970 eye patients having diminution of vision with ametropias were identified and patients having reduction of visual acuity of greater than two lines between the eyes or an absolute reduction in acuity below 6/9 either eye in snellen's vision chart which cannot be corrected by refraction were enrolled to find out prevalence of amblyopia. Out of 970 ametropic eye patients amblyopia was present in 56 patients (5.97%) with anisometropias and high bilateral ametropias. The prevalence of amblyopia according to types of ametropias are: hyperopia 6 (10.71%), myopia 2 (3.57%), myopic astigmatism 31 (55.36%), hyperopic astigmatism 11 (19.64%) and mixed astigmatism 6 (10.71%). Sex distribution of amblyopia is male 32 (57.14%) and female 24 (42.86%). Laterality of amblyopia shows: monocular 40 (71.43%) and binocular 16 (28.57%). Out of 970 ametropic eye patients a total of 56 (5.97%) patients have amblyopia. A preschool and school screening program in children in critical period of development of amblyopia must be conducted to find out the ametropias and amblyopia in time; and treat them earlier, by optical correction and amblyopia therapy, effectively and adequately.
V Akila Ramkumar
Full Text Available Purpose: To report the prevalence of amblyopia risk factors in children with congenital nasolacrimal duct obstruction. Methods: A retrospective review of records of children with the diagnosis of congenital nasolacrimal duct obstruction (NLDO, who underwent probing from January 2009 to October 2011, was done. All of them underwent a complete ophthalmic evaluation including cycloplegic refraction and strabismus evaluation before probing. Results: A total of 142 children were included in this study. The mean age at presentation was 22.38 months (sample standard deviation (SSD - 15.88. Amblyopia risk factors were defined according to two sets of guidelines: The American Association for Pediatric Ophthalmology and Strabismus (AAPOS referral criteria guidelines and the new AAPOS Vision Screening Committee guidelines. Twenty-eight (20% children were found to have some form of amblyopia risk factor based on the referral criteria prescribed by AAPOS. However, on applying modified guidelines described by Donahue et al., to analyze the same cohort, 21 children were found to have amblyogenic risk factors. Of these 28 children, 13 had significant astigmatism (>1.50 D, 8 children had hypermetropia (>3.50 D, and six children had anisometropia (>1.50 D. One child had significant cataract (media opacity >1 mm. None of the children in this series had either myopia or strabismus. Conclusion: Prevalence of amblyopia risk factor was found to be 20% in our study based on the older guidelines; however, it reduces to 14.78% by applying the modified guidelines. Despite this reduction, importance of a comprehensive ophthalmic examination including cycloplegic refraction in all children presenting with NLDO cannot be overstated. A close follow-up of these children is also essential to prevent the development of amblyopia.
Ramkumar, V Akila; Agarkar, Sumita; Mukherjee, Bipasha
To report the prevalence of amblyopia risk factors in children with congenital nasolacrimal duct obstruction. A retrospective review of records of children with the diagnosis of congenital nasolacrimal duct obstruction (NLDO), who underwent probing from January 2009 to October 2011, was done. All of them underwent a complete ophthalmic evaluation including cycloplegic refraction and strabismus evaluation before probing. A total of 142 children were included in this study. The mean age at presentation was 22.38 months (sample standard deviation (SSD) - 15.88). Amblyopia risk factors were defined according to two sets of guidelines: The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines and the new AAPOS Vision Screening Committee guidelines. Twenty-eight (20%) children were found to have some form of amblyopia risk factor based on the referral criteria prescribed by AAPOS. However, on applying modified guidelines described by Donahue et al., to analyze the same cohort, 21 children were found to have amblyogenic risk factors. Of these 28 children, 13 had significant astigmatism (>1.50 D), 8 children had hypermetropia (>3.50 D), and six children had anisometropia (>1.50 D). One child had significant cataract (media opacity >1 mm). None of the children in this series had either myopia or strabismus. Prevalence of amblyopia risk factor was found to be 20% in our study based on the older guidelines; however, it reduces to 14.78% by applying the modified guidelines. Despite this reduction, importance of a comprehensive ophthalmic examination including cycloplegic refraction in all children presenting with NLDO cannot be overstated. A close follow-up of these children is also essential to prevent the development of amblyopia.
Wajuihian, Samuel Otabor; Hansraj, Rekha
This study focused on a cohort that has not been studied and who currently have limited access to eye care services. The findings, while improving the understanding of the distribution of refractive errors, also enabled identification of children requiring intervention and provided a guide for future resource allocation. The aim of conducting the study was to determine the prevalence and distribution of refractive error and its association with gender, age, and school grade level. Using a multistage random cluster sampling, 1586 children, 632 males (40%) and 954 females (60%), were selected. Their ages ranged between 13 and 18 years with a mean of 15.81 ± 1.56 years. The visual functions evaluated included visual acuity using the logarithm of minimum angle of resolution chart and refractive error measured using the autorefractor and then refined subjectively. Axis astigmatism was presented in the vector method where positive values of J0 indicated with-the-rule astigmatism, negative values indicated against-the-rule astigmatism, whereas J45 represented oblique astigmatism. Overall, patients were myopic with a mean spherical power for right eye of -0.02 ± 0.47; mean astigmatic cylinder power was -0.09 ± 0.27 with mainly with-the-rule astigmatism (J0 = 0.01 ± 0.11). The prevalence estimates were as follows: myopia (at least -0.50) 7% (95% confidence interval [CI], 6 to 9%), hyperopia (at least 0.5) 5% (95% CI, 4 to 6%), astigmatism (at least -0.75 cylinder) 3% (95% CI, 2 to 4%), and anisometropia 3% (95% CI, 2 to 4%). There was no significant association between refractive error and any of the categories (gender, age, and grade levels). The prevalence of refractive error in the sample of high school children was relatively low. Myopia was the most prevalent, and findings on its association with age suggest that the prevalence of myopia may be stabilizing at late teenage years.
Hashemi, Hassan; Rezvan, Farhad; Beiranvand, Asghar; Papi, Omid-Ali; Hoseini Yazdi, Hosein; Ostadimoghaddam, Hadi; Yekta, Abbas Ali; Norouzirad, Reza; Khabazkhoob, Mehdi
Purpose To determine the prevalence of refractive errors among high school students. Methods In a cross-sectional study, we applied stratified cluster sampling on high school students of Aligoudarz, Western Iran. Examinations included visual acuity, non-cycloplegic refraction by autorefraction and fine tuning with retinoscopy. Myopia and hyperopia were defined as spherical equivalent of -0.5/+0.5 diopter (D) or worse, respectively; astigmatism was defined as cylindrical error >0.5 D and anisometropia as an interocular difference in spherical equivalent exceeding 1 D. Results Of 451 selected students, 438 participated in the study (response rate, 97.0%). Data from 434 subjects with mean age of 16±1.3 (range, 14 to 21) years including 212 (48.8%) male subjects was analyzed. The prevalence of myopia, hyperopia and astigmatism was 29.3% [95% confidence interval (CI), 25-33.6%], 21.7% (95%CI, 17.8-25.5%), and 20.7% (95%CI, 16.9-24.6%), respectively. The prevalence of myopia increased significantly with age [odds ratio (OR)=1.30, P=0.003] and was higher among boys (OR=3.10, Pprevalence of hyperopia was significantly higher in girls (OR=0.49, P=0.003). The prevalence of astigmatism was 25.9% in boys and 15.8% in girls (OR=2.13, P=0.002). The overall prevalence of high myopia and high hyperopia were 0.5% and 1.2%, respectively. The prevalence of with-the-rule, against-the-rule, and oblique astigmatism was 14.5%, 4.8% and 1.4%, respectively. Overall, 4.6% (95%CI, 2.6-6.6%) of subjects were anisometropic. Conclusion More than half of high school students in Aligoudarz had at least one type of refractive error. Compared to similar studies, the prevalence of refractive errors was high in this age group. PMID:25279126
Smith, Earl L.; Hung, Li-Fang; Arumugam, Baskar; Holden, Brien A.; Neitz, Maureen; Neitz, Jay
Purpose Differences in the spectral composition of lighting between indoor and outdoor scenes may contribute to the higher prevalence of myopia in children who spend low amounts of time outdoors. Our goal was to determine whether environments dominated by long-wavelength light promote the development of myopia. Methods Beginning at 25 ± 2 days of age, infant monkeys were reared with long-wavelength-pass (red) filters in front of one (MRL, n = 6) or both eyes (BRL, n = 7). The filters were worn continuously until 146 ± 7 days of age. Refractive development, corneal power, and vitreous chamber depth were assessed by retinoscopy, keratometry, and ultrasonography, respectively. Control data were obtained from 6 monkeys reared with binocular neutral density (ND) filters and 33 normal monkeys reared with unrestricted vision under typical indoor lighting. Results At the end of the filter-rearing period, the median refractive error for the BRL monkeys (+4.25 diopters [D]) was significantly more hyperopic than that for the ND (+2.22 D; P = 0.003) and normal monkeys (+2.38 D; P = 0.0001). Similarly, the MRL monkeys exhibited hyperopic anisometropias that were larger than those in normal monkeys (+1.70 ± 1.55 vs. −0.013 ± 0.33 D, P monkeys recovered from the induced hyperopic errors. Conclusions The observed hyperopic shifts indicate that emmetropization does not necessarily target the focal plane that maximizes luminance contrast and that reducing potential chromatic cues can interfere with emmetropization. There was no evidence that environments dominated by long wavelengths necessarily promote myopia development. PMID:26447984
Alió, Jorge L; Wolter, Nathaly V; Piñero, David P; Amparo, Fransisco; Sari, Esin Sogutlu; Cankaya, Cem; Laria, Carlos
To provide an overview of the visual outcomes after pediatric refractive surgery in anisometropic amblyopia and to analyze the relationship of these outcomes with age and type of refractive surgery. Systematic searches in PubMed, Embase, and Web of Science databases without data restrictions and a search by surveillance of the literature regarding pediatric refractive surgery were performed. Only studies reporting individual data of pediatric cases (age 1 to 17 years) undergoing photorefractive keratectomy (PRK), laser epithelial keratomileusis (LASEK), and LASIK were included. A total of 15 articles including data from a total of 213 amblyopic eyes were considered: LASIK in 95 eyes and surface ablation in 118 eyes. Changes in uncorrected (UDVA) and corrected distance visual acuity (CDVA) were investigated as well as their relation with age and ablation type. A significant increase in logMAR UDVA and CDVA was found in the overall sample of amblyopic eyes after surgery (P<.001). A significant correlation was found between age and preoperative CDVA (r=0.34, P<.001) as well as between age and the change in CDVA after surgery (r=-0.38, P<.001). The change in UDVA was significantly superior for eyes undergoing surface ablation compared to those undergoing LASIK (P=.04). Corneal haze was the predominant complication, which was reported in 5.3% of LASIK cases and 8.5% of surface ablation cases. Laser refractive surgery is an effective option for improving the visual acuity in children with an amblyopic eye in association with anisometropia. Copyright 2011, SLACK Incorporated.
Bilgihan, K; Ozdek, S C; Akata, F; Hasanreisoğlu, B
To determine the safety, effectiveness, and predictability of photorefractive keratectomy (PRK) for the correction of myopia and astigmatism after penetrating keratoplasty. Gazi University, Medical School, Department of Ophthalmology, Ankara, Turkey. Photorefractive keratectomy was performed in 16 eyes of 16 patients with postkeratoplasty myopia and astigmatism who were unable to wear glasses due to anisometropia and were contact lens intolerant. They were examined for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and corneal transplant integrity before and after surgery. The mean follow-up after PRK was 26.0 months +/- 15.7 (SD) (range 12 to 63 months). The mean preoperative spherical equivalent refraction of -4.47 +/- 1.39 diopters (D) was -3.39 +/- 1.84 D (P >.05) at the last postoperative visit and the mean preoperative cylinder of -5.62 +/- 2.88 D was -3.23 +/- 1.70 D (P <.05); refractive regression correlated with the amount of ablation performed. The BSCVA decreased in 3 eyes (18.8%), and the UCVA decreased in 2 (12.5%). Six eyes (37.5%) had grade 2 to 3 haze, which resolved spontaneously in 4 eyes within a relatively long time but caused a decrease in BSCVA in 2 (12.5%). Two of the eyes (12.5%) had a rejection episode after PRK and were successfully treated with topical steroids. Photorefractive keratectomy to correct postkeratoplasty myopia and astigmatism appears to be less effective and less predictable than PRK for naturally occurring myopia and astigmatism. Corneal haze and refractive regression are more prevalent, and patient satisfaction is not good.
de Souza Lima LCS
Full Text Available Luiz Cláudio Santos de Souza Lima,1 Adalmir Morterá Dantas,2 Guilherme Herzog Neto,1 Eduardo França Damasceno,1 Helena Parente Solari,1 Marcelo Palis Ventura1 1Department of General Surgery, Federal Fluminense University, Niteroi, 2Department of Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Purpose: To compare anisometropic hypermetropic amblyopic and strabismic amblyopic responses to pattern electroretinogram (PERG and pattern visual evocated potential (PVEP. Materials and methods: Fifty-six patients – 18 hypermetropic anisometropic amblyopic children (mean age 9.70±2.5 years, 19 strabismic amblyopic children (mean age 10.30±2.6 years and 19 normal emetropic subjects (mean age 10.10±2.2 years – were enrolled in this study. After routine ophthalmic examination, PERG and PVEP were recorded in response to checks reversed at the rate of two reversals/second stimulating macular area. Results: The difference between hypermetropic anisometropic amblyopia and strabismus amblyopia with respect to P100/P50/N95 wave latencies (P=0.055/0.855/0.132 and P100/P50/N95 amplitudes (P=0.980/0.095/0.045 was not statistically significant. However, there was a significant statistical difference between strabismic amblyopia group and controls for P100/P50/N95 latencies (P=0.000/0.006/0.004. Conclusion: Our findings indicated that despite clinical differences between anisometropic amblyopic and strabismic amblyopic patients, no differences were found in the responses of PVEP and PERG. The abnormal components of the PVEP and PERG in amblyopic subjects could reflect a retinal dysfunction in the visual pathway. Keywords: amblyopia, strabismus, pattern electroretinogram, pattern visual evocated potential, anisometropia
Mori, Takafumi; Sugano, Yukinori; Maruko, Ichiro; Sekiryu, Tetsuju
To investigate the relationship between subfoveal choroidal thickness and axial length in Japanese preschool children with hyperopic anisometropic amblyopia. Twenty-four children between the age of 3 and 6 years exhibiting hyperopic anisometropic amblyopia were examined. Differences in spherical equivalent between the two eyes were over 1.5 D in all children. Twenty-four eyes in 12 children without anisometropia and amblyopia were examined as age-matched normal controls. Subfoveal choroidal thickness was measured by using enhanced depth imaging optical coherence tomography. Axial length was measured with noncontact optical biometer. The spherical equivalent ranged from +3.50 to +7.25 D in amblyopic eyes and from +0.75 to +3.50 D in fellow eyes. The subfoveal choroidal thickness was significantly greater in the amblyopic eyes than that in the fellow eyes (407.3 ± 54.2 μm versus 357.7 ± 54.3 μm, Paired t-test, p amblyopia was greater than that in age matched normal children, although this difference did not reach statistical significance (326.0 ± 62.1 μm, p = 0.07). The subfoveal choroidal thickness in amblyopic children was negatively correlated with their axial length (r = -0.50, p < 0.01). The subfoveal choroidal thickness of amblyopic children abnormally increased and the thicker subfoveal choroid is mildly correlated with their shorter axial length. The anomalous subfoveal choroidal thicknesses in our amblyopic children may reflect a delay in emmetropization.
Pascual, Maisie; Huang, Jiayan; Maguire, Maureen G; Kulp, Marjean Taylor; Quinn, Graham E; Ciner, Elise; Cyert, Lynn A; Orel-Bixler, Deborah; Moore, Bruce; Ying, Gui-shuang
Objective To evaluate risk factors for unilateral amblyopia and for bilateral amblyopia in the Vision In Preschoolers (VIP) Study. Design Multicenter, cross-sectional Study. Participants Three- to 5-year old Head Start preschoolers from 5 clinical centers, over-representing children with vision disorders. Methods All children underwent comprehensive eye exams including threshold visual acuity (VA), cover testing, and cycloplegic retinoscopy, performed by VIP-certified optometrists and ophthalmologists who were experienced in providing care to children. Monocular threshold VA was tested using single-surround HOTV letter protocol without correction, and retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as an inter-ocular difference in best-corrected VA ≥2 lines. Bilateral amblyopia was defined as best-corrected VA in each eye worse than 20/50 for 3-year-olds and worse than 20/40 for 4- to 5-year-olds. Main Outcome Measures Risk of amblyopia was summarized by The odds ratios (ORs) and their 95% confidence intervals (95% CIs) estimated from logistic regression models. Results In this enriched sample of Head Start children (N=3869), 296 (7.7%) children had unilateral amblyopia, and 144 (3.7%) children had bilateral amblyopia. Presence of strabismus (pamblyopia. Presence of strabismus, hyperopia ≥2.0 D, astigmatism ≥1.0 D, or anisometropia ≥0.5 D were present in 91% of children with unilateral amblyopia. Greater magnitude of astigmatism (pamblyopia. Bilateral hyperopia ≥3.0 diopters (D) or astigmatism ≥1.0 D were present in 76% of children with bilateral amblyopia. Conclusion Strabismus and significant refractive errors were risk factors for unilateral amblyopia. Bilateral astigmatism and bilateral hyperopia were risk factors for bilateral amblyopia. Despite differences in selection of study population, these results validated the findings from the Multi-ethnic Pediatric Eye Disease Study and Baltimore
Wallace, Michael P; Stewart, Catherine E; Moseley, Merrick J; Stephens, David A; Fielder, Alistair R
Explore compliance with occlusion treatment of amblyopia in the Monitored and Randomized Occlusion Treatment of Amblyopia Studies (MOTAS and ROTAS), using objective monitoring. Both studies had a three-phase protocol: initial assessment, refractive adaptation, and occlusion. In the occlusion phase, participants were instructed to dose for 6 hours/day (MOTAS) or randomized to 6 or 12 hour/day (ROTAS). Dose was monitored continuously using an occlusion dose monitor (ODM). One hundred and fifty-two patients (71 male, 81 female; 122 Caucasian, 30 non-Caucasian) of mean ± SD age 68 ± 18 months participated. Amblyopia was defined as an interocular acuity difference of at least 0.1 logMAR and was associated with anisometropia in 50, strabismus in 44, and both (mixed) in 58. Median duration of occlusion was 99 days (interquartile range 72 days). Mean compliance was 44%, mean proportion of days with no patch worn was 42%. Compliance was lower (39%) on weekends compared with weekdays (46%, P = 0.04), as was the likelihood of dosing at all (52% vs. 60%, P = 0.028). Compliance was lower when attendance was less frequent (P amblyopia type, and severity were not associated with compliance. Mixture modeling suggested three subpopulations of patch day doses: less than 30 minutes; doses that achieve 30% to 80% compliance; and doses that achieve around 100% compliance. This study shows that compliance with patching treatment averages less than 50% and is influenced by several factors. A greater understanding of these influences should improve treatment outcome. (ClinicalTrials.gov number, NCT00274664).
Liang, Minglong; Xie, Bing; Yang, Hong; Yin, Xuntao; Wang, Hao; Yu, Longhua; He, Sheng; Wang, Jian
Altered brain functional connectivity has been reported in patients with amblyopia by recent neuroimaging studies. However, relatively little is known about the alterations in interhemispheric functional connectivity in amblyopia. The present study aimed to investigate the functional connectivity patterns between homotopic regions across hemispheres in patients with anisometropic and strabismic amblyopia under resting state. Nineteen monocular anisometropic amblyopia (AA), 18 strabismic amblyopia (SA), and 20 normal-sight controls (NC) were enrolled in this study. After a comprehensive ophthalmologic examination, resting-state fMRI scanning was performed in all participants. The pattern of the interhemispheric functional connectivity was measured with the voxel-mirrored homotopic connectivity (VMHC) approach. VMHC values differences within and between three groups were compared, and correlations between VMHC values and each the clinical variable were also analyzed. Altered VMHC was observed in AA and SA patients in lingual gyrus and fusiform gyrus compared with NC subjects. The altered VMHC of lingual gyrus showed a pattern of AA > SA > NC, while the altered VMHC of fusiform gyrus showed a pattern of AA > NC > SA. Moreover, the VMHC values of lingual gyrus were positively correlated with the stereoacuity both in AA and SA patients, and the VMHC values of fusiform gyrus were positively correlated with the amount of anisometropia just in AA patients. These findings suggest that interhemispheric functional coordination between several homotopic visual-related brain regions is impaired both in AA and SA patients under resting state and revealed the similarities and differences in interhemispheric functional connectivity between the anisometropic and strabismic amblyopia.
Araki, Syunsuke; Miki, Atsushi; Goto, Katsutoshi; Yamashita, Tsutomu; Takizawa, Go; Haruishi, Kazuko; Ieki, Yoshiaki; Kiryu, Junichi; Yaoeda, Kiyoshi
To investigate macular retinal and choroidal thickness in amblyopic eyes compared to that in fellow and normal eyes using swept-source optical coherence tomography (SS-OCT). This study examined 31 patients with hyperopic anisometropic amblyopia (6.9 ± 3.8 years, mean ± standard deviation), 15 patients with strabismic amblyopia without anisometropia (7.9 ± 4.2 years), and 24 age-matched controls (7.8 ± 3.3 years). Retinal and choroidal thickness was measured by 3D scans using SS-OCT. A 6-mm area around the fovea was automatically analyzed using the Early Treatment Diabetic Retinopathy Study map. The thickness from SS-OCT was corrected for magnification error using individual axial length, spherical refraction, cylinder refraction, and corneal radius. Retinal thickness was divided into the macular retinal nerve fiber layer (mRNFL), ganglion cell layer + inner plexiform layer (GCL+IPL), ganglion cell complex (GCC), and the inner limiting membrane to the retinal pigment epithelium (ILM-RPE) thickness. Retinal and choroidal thickness was compared among amblyopic, fellow, and normal eyes. In both amblyopia groups, there was no significant difference in the mRNFL, GCL+IPL, and GCC thicknesses among the amblyopic, fellow, and control eyes. In the anisometropic amblyopia group, choroidal thickness (subfovea, center 1 mm, nasal and inferior of the inner ring, nasal of the outer ring, and center 6 mm) of amblyopic eyes were significantly greater than that of fellow and normal eyes. In contrast, none of the choroidal thicknesses were significantly different among the investigated eyes in the strabismic amblyopia group. We found no significant difference in inner retinal thickness in patients with unilateral amblyopia. Although there were significant differences in choroidal thickness with hyperopic anisometropic amblyopia, there was no significant difference for the strabismic amblyopia. The discrepancy in choroidal thickness between the two types of amblyopia may be due
Full Text Available AIM:To provide a proper assessment of the clinical use of orthokeratology by observing and analyzing the ocular biometric changes of the eyes and the stereopsis of the myopia.METHODS:Sixty eyes from 30 myopia(from 8 to 17 years oldwere fitted with orthokeratology. Stereopsis, visual acuity, near visual acuity, central corneal thickness, anterior chamber depth, average anterior corneal refractive power(K value, and intraocular pressure were measured before the orthokeratology treatment and 3mo after it. Refraction was expressed as spherical equivalent(SE, and the subjects were divided into 3 groups according to refraction: low myopia group(SE-6.00D, and high myopia group(SE≥-6.00D.RESULTS: All subjects had significant improvements in visual acuity and near visual acuity 3mo after the orthokeratology treatment(PP>0.05. Three months after the orthokeratology treatment, Naked eye near stereoacuity values of all subjects were decreased(PP>0.05. There was significant correlation in stereopsis and anisometropia(Pearson coefficient r=0.778, PK values than before 3mo after the orthokeratology treatment(PP>0.05.CONCLUSION: Orthokeratology could lower K value in a short time and change the corneal curvature to correct myopia, to improve visual acuity and near visual acuity. It also has an influence on improving stereopsis. There are no obviously changes in patients' central corneal thickness, anterior chamber depth or intraocular pressure after the orthokeratology treatment, making it a safe and effective treatment for adolescent.
Juan M. Bueno
Full Text Available The purpose of this study was to describe the ocular refractive state (ORS of fighting bulls. The study consisted of 90 ophthalmological healthy animals (85 in post-mortem and 5 in living conditions, resp.. The ORS of the eyes (2 per animal was determined using streak retinoscopy. In vivo animals were assessed at a fighting bull farm facility. Post-mortem measurements were carried out at a local arena. The ORS along the horizontal meridian ranged between −1.00 and +2.50 diopters (D, with a mean of +0.66±0.85 D in post-mortem animals. Values for in vivo conditions were similar (+0.75±0.46 D. Left and right eyes were highly correlated in both sets (p<0.001. A fairly good correlation was also observed when comparing living and post-mortem eyes in the same animals. Anisometropia ≥ 1.00 D was diagnosed in 3 animals. Astigmatism (≥+0.5 D was detected in 93% of the eyes. To our knowledge, the ORS of the fighting bull has been reported for the first time. Although values vary among individuals, all eyes presented a marked astigmatism. Whereas the horizontal meridian was slightly hyperopic, the vertical meridian was always closer to emmetropia. These results represent a starting point to understand the ocular optics of this kind of animals, which might benefit the selection of animals at the farm before being sent to the bullfighting arena.
Gazzola, R; Piozzi, E; Lanfranchi, A L; Baruffaldi Preis, F W
treatment of congenital ptoses and blepharophimoses relies on levator resections and frontalis suspensions. Several techniques of levator resection have been described in literature, some of them include tarsal resections and resections of the Müller muscle. Nevertheless a gold treatment have not been detected yet. Frontalis suspension is performed when levator muscle is not functional or when ptosis is severe. The suspension could be carried out with several materials: ePTFE, silicon rods, poly-propylene, nylon, braided poliester, but the preferable material is considered the autologous fascia lata. this study was designate to determine retrospectively if the indications of surgery are correct, considering age, severity of pathology, relapses and complications. An analysis of demographic data and outcomes for each technique is performed. in this study we analyze case series of 33 pediatric patients affected by congenital ptosis and blepharophimosis congenital syndrome, surgically treated from 2000 to 2008 in the ophtalmic pediatric surgery department at the Niguarda Hospital of Milan. A literature review was also performed. the mean age at presentation was 4.13. The diagnosis was precocious in most cases and often helped by some recognizable clinical signs: compensatory head posture (48.5%), anisometropia (36.4%), astigmatism (48.5%), strabismus (36.4%) and amblyopia (15.2%). Most of patients was treated with frontalis suspension (57.6%) and their age was significatively lower than patients treated with levator resection. No difference about complications and recurrence was reported between the two techniques. Complications and recurrence amount to 39.4%. these results are in line with other studies in literature. A precociuos treatment is able to reduce the incidence of amblyopia from 34% to 8%. The choice of the treatment (resection Vs suspension) has to consider the age of the patient, the severity of ptosis and avaibility of fascia lata. Nevertheless no
Full Text Available Aditi Gupta, Rajiv Raman, Tarun SharmaShri Bhagwan Mahavir Department of Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, IndiaWe read with great interest the recent article by Kashima et al,1 in which the authors report a case of asymmetric severity of diabetic retinopathy in Waardenburg syndrome. We want to highlight some concerns regarding this report. Previous reports have described many systemic and local factors associated with the development of asymmetric diabetic retinopathy.2,3 These include myopia ≥5 D, anisometropia >1 D, amblyopia, unilateral elevated intraocular pressure, complete posterior vitreous detachment, unilateral carotid artery stenosis, ocular ischemic syndrome, and chorioretinal scarring.2,3 In any suspected case of asymmetric diabetic retinopathy, it is prudent to rule out the abovementioned factors first. In the present case, although the authors clearly mention the absence of internal carotid and ophthalmic artery obstruction on magnetic resonance angiography, it would have been more informative if the authors had also provided the refractive error, intraocular pressure, and posterior vitreous detachment status of both the eyes.Likewise, it would have been useful to note the arm-retina time and retinal arteriovenous filling time in both the eyes on fundus fluorescein angiography, which is usually used to diagnose ocular ischemic syndrome by monitoring extension of the retinal circulation time, including time of blood circulation from the arm to the retina and the retinal arteriovenous filling time.4,5 The mere absence of internal carotid obstruction on magnetic resonance angiography cannot rule out the presence of ocular ischemic syndrome because, rarely, ocular ischemic syndrome can also occur secondary to other causes, such as arteritis.6,7 Comparing the arm-retina time and retinal arteriovenous filling time on fundus fluorescein angiography in both the eyes would be more helpful to rule out ocular
Singh, Anirudh; Rana, Vipin; Patyal, Sagarika; Kumar, Santosh; Mishra, Sanjay K; Sharma, Vijay K
Strabismus and anisometropia are the most common causes of amblyopia. It can be easily prevented or treated if detected early. With the changing socio-cultural-economic milieu of the society, the perspectives of strabismus in society are gradually changing but still adequate knowledge, awareness, and attitude of parents toward strabismus will help in preventing amblyopia and aid in the proper psychosocial adaptation of such children. This study aimed to assess knowledge and attitude of parents toward children suffering from strabismus. A prospective study was carried out from January 1 to February 29, 2016, through a structured questionnaire to assess the level of knowledge and attitude of parents of children suffering from strabismus. One hundred and twenty parents of children with strabismus were interviewed through a questionnaire. Education level of 78 parents was less than graduation (60%) and of 42 parents (40%) was graduation or higher. The majority of the parents, i.e., 116 (96.67%) were bothered due to strabismus. One hundred and one (84.17%) parents felt that their child's strabismus was noticed by others during interaction. Seventy-four (61.67%) parents felt that their children will have difficulty in making friends. Ninety (75%) parents felt uncomfortable if someone asked something about their child's strabismus. One hundred and ten (91.67%) parents considered strabismus as cosmetic stigma. Some parents, especially from the lower educated segment, had poor understanding of strabismus, thus resulting in late presentation and ineffective countermeasures. The key to prevent strabismic amblyopia and its psychosocial impacts is to provide health education regarding strabismus.
Full Text Available Amblyopia is a developmental abnormality of visual cortex. Although amblyopes experience perceptual deficits in spatial vision tasks, they have less temporal sensitivity loss. We investigated whether their temporal synchrony sensitivity is impaired. In experiment 1, four Gaussian blobs, located at the top, bottom, left, and right of a presentation screen, were flickering in 3 Hz and one of them was flickering in out-of-phase fashion in time. Participants needed to tell which blob was different from the other three and contrast threshold of the blobs was measured to determine the synchrony detection threshold. We found the thresholds were not correlated with the contrast thresholds for detecting the flickering blobs, suggesting synchrony detection and temporal detection threshold are processed by different mechanisms. In experiment 2, synchrony thresholds were measured as participants' ability to tell if one of the four high contrast Gaussian blobs was flickering asynchronously in time. Three temporal frequencies (1, 2, and 3 Hz and two element separations (1.25 and 5 deg were compared. We found that the amblyopic group exhibited a deficit only for the 1.25 deg element separation in amblyopic eye but was normal for the other configurations compared to controlled participants. It suggests amblyopes have deficits in temporal processing but only for foveal vision. We also found the sensitivity for the non-strabismic anismetropia group is reduced for all three temporal frequencies whereas for the strabismic anisometropia group it was reduced at 3Hz only, suggesting the impairment in temporal synchrony might be different for different types of amblyopia.
Vincent, Stephen J
Ocular pathology that manifests at an early age has the potential to alter the vision-dependent emmetropisation mechanism, which co-ordinates ocular growth throughout childhood. The disruption of this feedback mechanism in children with congenital or early-onset visual impairment often results in the development of significant ametropia, including high levels of spherical refractive error, astigmatism and anisometropia. This review examines the use of contact lenses as a refractive correction, low vision aid and therapeutic intervention in the rehabilitation of patients with bilateral, irreversible visual loss due to congenital ocular disease. The advantages and disadvantages of the use of contact lenses for increased magnification (telescopes and microscopes) or field expansion (reverse telescopes) are discussed, along with the benefits and practical considerations for the correction of pathological high myopia. The historical and present use of therapeutic tinted contact lenses to reduce photosensitivity and nystagmus in achromatopsia, albinism and aniridia are also presented, including clinical considerations for the contact lens practitioner. In addition to the known optical benefits in comparison to spectacles for high levels of ametropia (an improved field of view for myopes and fewer inherent oblique aberrations), contact lenses may be of significant psycho-social benefit for patients with low vision, due to enhanced cosmesis and reduced conspicuity and potential related effects of improved self-esteem and peer acceptance. The contact lens correction of patients with congenital vision impairment can be challenging for both practitioner and patient but should be considered as a potential optical or therapeutic solution in modern low vision rehabilitation. © 2017 Optometry Australia.
Macias, E P; Lee, D A; Oelrich, F O
Occurrence of refractive errors and uncorrected visual acuity impairment among self-selected, indigent, medically underserved Hispanic, white, and black adults examined by the staff of the UCLA Mobile Eye Clinic (MEC) are described in this study and compared to population-based studies. The study sample consisted of all 2,970 Hispanic, 1,228 white, and 1,028 black participants, for a total of 5,226 self-selected adults, ages 25 to 74 years, who received vision screenings and eye examinations by the staff of the UCLA MEC from 1987 to 1997. Tests consisted of visual acuity, refractive error, intraocular pressure, retinoscopy, slit-lamp biomicroscopy, direct ophthalmoscopic examination, and indirect ophthalmoloscopy with pupillary dilation. Levels of visual acuity impairment were defined as mild (20/50-20/80), moderate (20/100), or severe (20/200 or worse) in either eye. Self-selected whites in this study had higher rates of astigmatism, anisometropia, and hyperopia, while myopia was higher among self-selected blacks. Myopia and hyperopia occurred more frequently among younger age groups for all ethnic groups. Whites had a higher occurrence of mild, moderate, and severe visual acuity impairment, as compared with Hispanics and blacks. Both refractive errors and impaired visual acuity of this self-selected sample are similar to those of adults from the National Health and Nutrition Examination Survey, Hispanic Health and Nutrition Examination Survey, and the Baltimore Eye Survey. The data presented in this study provide a crude estimate of the occurrence of refractive errors and impaired visual acuity among self-selected, medically underserved, indigent Hispanic, white, and black adults in the Los Angeles area.
Rull-Cotrina, Jorge; Molleda, Jose M; Gallardo, José; Martín-Suárez, Eva
To assess the refractive state of the equine eye utilizing retinoscopy. To compare the refractive state of Spanish Thoroughbred horses with the refractive state of Crossbred horses. The refractive state of 135 horses (264 eyes) was assessed utilizing streak retinoscopy. Two perpendicular meridians were examined in order to assess astigmatism at a working distance of approximately 67 cm. A group of 81 Spanish Thoroughbred horses was compared with a group of 54 Crossbred horses. Cyclopentolate ophthalmic solution was instilled in the eyes of a group of 18 horses to determine if accommodation has any influence on the assessment of the refractive state. Mean ± SE refractive state of all horses examined was -0.17 ± 0.04 D. The mean refractive state of the Spanish Thoroughbred was -0.28 ± 0.06 D while that of the Crossbred was -0.01 ± 0.05 D. The refractive state of the Spanish Thoroughbred was found to be statistically different to that of the Crossbred. The most prevalent refractive state was emmetropia in all cases, followed by hyperopia for the Crossbred, and myopia for the Spanish Thoroughbred. Astigmatism ≥0.50 D present in both eyes from the same individual was found in 21.7% of all horses examined. Anisometropia ≥1.00 D was diagnosed in 4 out of 129 horses with both visual eyes. Cycloplegia did not statistically affect the refractive state of the evaluated eyes. The equine eye has a refractive state close to emmetropia. Myopia is higher among Spanish Thoroughbred horses than among Crossbred horses. © 2012 American College of Veterinary Ophthalmologists.
Hargadon, Deborah D; Wood, Jeffrey; Twelker, J Daniel; Harvey, Erin M; Dobson, Velma
To measure monocular distance visual acuity (VA), grating VA, contrast sensitivity, and visual field extent in full-term, 6-year-old children. Subjects were 59 healthy full-term children aged 5.8 to 6.3 years who had no ocular abnormalities and no myopia of 1.00 diopter (D) or greater, hyperopia of 4.00 D or greater, astigmatism of 1.50 D or greater, or anisometropia of 1.50 D or greater spherical equivalent or cylinder, as evaluated by a standard eye examination with cycloplegic refraction. All were tested monocularly for recognition acuity (Early Treatment Diabetic Retinopathy Study VA charts), grating acuity (Teller acuity cards), contrast sensitivity (Pelli-Robson contrast sensitivity charts), and visual field extent (white-sphere kinetic perimetry). Right and left eye values did not differ significantly. Mean values for the right eye were 0.040 logMAR (SD, 0.075 log units) for Early Treatment Diabetic Retinopathy Study VA, 24.5 cycles per degree (SD, 0.3 octaves) for grating acuity, and 1.63 (SD, 0.12 log units) for contrast sensitivity. Mean visual field extent for the inferonasal, superonasal, superotemporal, and inferotemporal meridians was 59.1 degrees (SD, 9.7 degrees), 57.8 degrees (SD, 9.6 degrees), 71.2 degrees (SD, 12.3 degrees), and 100.4 degrees (SD, 6.6 degrees), respectively. The results provide additional normative monocular data on visual function in 6-year-old children and indicate that their thresholds are less than those of adults for distance recognition VA, grating VA, and contrast sensitivity, but similar to those of adults for white-sphere kinetic perimetry.
Schroth, V; Jaschinski, W
For prism correction of associated phoria (at 5-6 m viewing distance), Hans-Joachim Haase developed--among other tests--the prevalence test, which consists of a central fixation target and two triangles that appear stereoscopically about 1.5 m in front of or behind the fixation target; the vertex of each triangle is directed towards the centre of the fixation target. Only when both eyes contribute equally to the perception of visual directions do the triangles appear centred (equivalence), while any perceived horizontal offset between the triangles and fixation target indicates a prevalence of one eye. Provided that monocular vision is equal in both eyes, Haase interpreted ocular prevalence as being due to a small vergence error (fixation disparity with a shift of retinal correspondence). This vergence error indicates, according to Haase, a (not yet fully corrected) heterophoria. From practical experience, Haase developed rules for transferring ocular prevalence into equivalence with prisms (MKH). If equivalence has been reached, Haase assumed that the heterophoria was fully corrected. In 19 subjects we examined whether spherical and prismatic corrections reduce ocular prevalence. The perception of the subjects was ascertained with three methods: they were asked 1. to describe their perception orally--as proposed by H.-J. Haase--, 2. to make a drawing of their perception, and 3. to align the position of the stereo images to the central fusion target with a computer-controlled device. Based on the group mean, the three methods did not reveal a consistent reduction of prevalence. Only in two individuals did the drawing and the computer-controlled alignment showed reductions of prevalence that were confirmed statistically on the individual level. However, it has to be noted that these two individuals not only received prisms but also a correction of their hyperopia and anisometropia. The prevalence of one eye is a common phenomenon in normal binocular vision (with the
Full Text Available AIM: To study the factors affecting residual exotropia (>10 PD at 4-6wk postoperative visit following two rectus muscle surgery for intermittent exotropia [bilateral lateral rectus (LR recession or unilateral recess resect procedure]. METHODS: A retrospective chart review of patients with intermittent exotropia ≤50 PD who underwent two rectus muscle surgery in between Jan. 2011 to Dec. 2013 was performed. Possible factors were compared between patients with residual exotropia (>10 PD and successful outcome (within 10 PD of orthotropia at the 4-6wk postoperative visit. Effect/dose ratio was calculated by dividing the effect of surgery by the total amount (mm of muscle surgery done. RESULTS: One hundred and fifty-seven patients with mean age of 14y (range 3-53y were included. Twenty-seven patients (17.2% had residual exotropia at 4-6wk postoperative follow up. Age at surgery (P=0.009 and preoperative deviation for distance (P≤0.001 and near (P=0.001 were identified as important predictors of unsuccessful outcome. The occurrence of residual exotropia was not affected by amblyopia, anisometropia, lateral incomitance, pattern deviation, vertical deviation, type of exotropia or type of surgery done (recess-resect or bilateral LR recession. The effect/dose ratio was more in deviations >40 PD in the both recess-resect and bilateral LR recession type of surgery. The effect/dose ratio was less in patients with residual exotropia as compared to the successful outcome group (1.36 PD/mm vs 2.05 PD/mm in the bilateral LR recession surgery and 1.93 PD/mm vs 2.63 PD/mm in the unilateral recess-resect surgery. CONCLUSION: Residual exotropia is seen in 17% of patients after two muscle surgery for intermittent exotropia. Patients with older age and larger preoperative deviation have greater chances of developing failure of two muscle strabismus surgery for intermittent exotropia.
Full Text Available AIM:To discuss the clinical features and operation methods on small-diopter intermittent exotropia. METHODS:Totally 206 in-patients with small-diopter intermittent exotropia(IXTin different operation groups, from September 2013 to September 2014,were observed for the eyesight, refraction, dominant eye, exotropia degree, synoptophore and near stereopsis before and after operation. Three types were divided in 206 cases. One hundred and thirty-two cases of basic IXT were the first type, in which 52 cases underwent nondominant eye unilateral recess-resection(nondominant eye unilateral recess-resection, ndR& R, 40 cases underwent dominant eye unilateral recess-resection(dominant eye unilateral recess-resection, dR& R, 40 cases underwent bilateral lateral rectus recession(bilateral lateral rectus recession, BLR-rec. Sixty-one cases of convergence insufficiency IXT were the second type, in which 40 cases underwent ndR& R, 21 cases underwent bilateral medial rectus amputation. Thirteen cases of divergence excess IXT were the third type, in which 7 cases underwent ndR& R, 6 cases underwent BLR-rec. The rates of the orthophoria, undercorrection, overcorrection and the recovery of synoptophore and near stereopsis after surgery in 1, 6, 12, 24mo were compared in 3 types. RESULTS: The clinical features of 206 cases with small-diopter IXT were: in the most cases, between 5 and 12 years old; nondominant eye was left eye; the eyesight of nondominant eye was lower than another eye; refraction status were myopia, astigmatism and anisometropia; basic IXT was the most common type; exotropia degree was between 40△ and 60△; some cases owned binocular function and near stereopsis. Comparison of operation methods in 3 groups: orthophoria comparisons in basic IXT among ndR& R group, d R& R group and BLR-rec group were significant difference(PP>0.05after operation. The operation of divergence excess IXT was effective. Orthophoria comparison in ndR& R group between
S. O. Wajuihian
Full Text Available Background: Reading difficulties constitute an impediment to the learning process and in the educational achievement of a child. Consequently, several studies examined the visual status of dyslexic children in the Caucasian populations. Such studies are lacking in the African populations. Aim: To determine the prevalence of vision defects and investigate if there is an association between dyslexia and vision in a South African population of dyslexic school children. Methods: This comparative study assessed the visual function of 62 children (31 dyslexic and 31 normally-reading children, mean age 13 ± 1.42 years and 11.90 ± 0.93 years respectively. The participants were matched for gender, race and socio-economic status. The visual functions evaluated and the techniques used were: visual acuity (LogMAR acuity chart, refraction (static retinos-copy, ocular alignment (cover test near point of convergence (RAF rule, accommodation facility (± 2 D flipper lenses, amplitude of accommodation (push-up method relative accommodation (trial lenses accommodation posture (monocular estimation technique and vergence reserves (prism bars. Results: In the following, results are provided for the dyslexic versus control: Refractive errors: (hyperopia 6.5% vs 3%, (myopia 6.5% vs 6.5%, (astigmatism 10% vs 13%, (anisometropia 6.5% vs 6.5% (amblyopia 6.5% vs 0%, (remote NPC 33% vs 48% (esophoria at near 3% vs 0% (exophoria at near 9.5% vs 0%, (accommodative infacility at near 54% vs 33%, lag of accommodation 39.28% vs 41,93%, (poor positive fusional amplitude at near, 25% vs 16%. Only the binocular accommodative facility at near was significantly associated with dyslexia (p=0.027. Conclusion: The prevalence of vision defects was similar between the dyslexic and non-dyslexic participants, which suggest that an association between dyslexia and vision variables investigated, cannot be inferred. This study provides a research perspective on the
Fu, Jing; Li, Shi Ming; Li, Si Yuan; Li, Jin Ling; Li, He; Zhu, Bi Dan; Yang, Zhou; Li, Lei; Wang, Ning Li
Earlier diagnosis and treatment of amblyopia are associated with improved visual outcomes. This study reports the prevalence of amblyopia and associated factors in year 1 primary school students in central China. The school-based, cross-sectional study involved 3,112 year 1 primary school students . All the participants underwent a comprehensive eye examinations including cycloplegic refraction, cover test and ocular movement examinations. The unaided and best corrected visual acuity (BCVA) was recorded. Unilateral amblyopia was defined as a 2-line interocular difference with BCVA ≤ 20/32 (≥ logMar 0.2) in the worse eye and with coexisting anisometropia (≥ 1.00 D SE for hyperopia, ≥ 3.00 D SE for myopia, or ≥ 1.50 D for astigmatism), strabismus or past or present visual axis obstruction. Bilateral amblyopia was defined as BCVA in both eyes logMar 0.3), with coexisting hyperopia ≥ 4 D SE, myopia ≤ -6 D SE, or astigmatism ≥ 2.5 D, or past or present visual axis obstruction. Out of the 3,112 eligible students, 2,893 (93.0 %) students completed the examinations. The average age of the students was 7.1 ± 0.4 (mean ± standard deviation SD) years old. The prevalence of amblyopia was 1.0 % (95 % confidence interval [CI], 0.6 %-1.3 %) with no difference between the sexes (P = 0.88). Of the 27 amblyopic students, unilateral amblyopia was found in 18 (66.7 %) students, and bilateral amblyopia in 9 (33.3 %) students. Of 18 unilateral amblyopia, 13 were anisometropic amblyopia, 4 were strabismus amblyopia, 1 was mixed amblyopia. Of 9 bilateral amblyopia, 7 were isoametropic amblyopia, 2 were stimulus deprivation. The mean corrected VA of the amblyopic eyes was 30.50 logMAR letters (Snellen VA equivalent 4/12.6), and the range was 5 to 45 logMAR letters (Snellen VA equivalent 4/40-4/6.3). Most amblyopic eyes (38.9 %) were significantly hyperopic (spherical equivalent ≥ +3.00 D); 25.0 % were myopic. In addition, 58
Elflein, Heike M; Fresenius, Susanne; Lamparter, Julia; Pitz, Susanne; Pfeiffer, Norbert; Binder, Harald; Wild, Philipp; Mirshahi, Alireza
Amblyopia is due to insufficient development of the visual system in early childhood and is a major source of lifelong impairment of visual acuity. Too little is known about the prevalence of amblyopia in Germany and the frequency of its various causes. The Gutenberg Health Study of the University of Mainz Faculty of Medicine is an ongoing population-based, prospective, monocentric cohort study with 15 010 participants aged 35 to 74. All participants are examined for the presence of ocular, cardiovascular, neoplastic, metabolic, immunologic, and mental diseases. 3227 participants aged 35 to 44 underwent ophthalmological examination from 2007 to 2012. Amblyopia was defined as impaired visual acuity in the absence of any organic pathology capable of explaining the condition, and in the presence of a known risk factor for amblyopia. Amblyopia, when defined as a visual acuity less than or equal to 0.63, was present in 182 participants (5.6%, 95% confidence interval [CI] 4.9-6.5%), 120 of whom had a visual acuity less than or equal to 0.5 (3.7%, 95% CI 3.3-5.2%). A narrower definition of amblyopia requiring, in addition, an interocular difference in acuity of at least two lines yielded slightly lower prevalence figures: 5.0% (95% CI 4.2-5.8%) and 3.7% (95% CI 3.1-4.4%), respectively. The causes of amblyopia (visual acuity ≤ 0.63) were anisometropia (different refractive strengths of the two eyes) in 49% of participants, strabismus (a squint) in 23%, both of these factors in 17%, and visual deprivation in 2%. 3 patients (2%) had relative amblyopia due to a traumatic cataract sustained in early childhood. 7% of the participants with amblyopia had binocular amblyopia. This study yielded a prevalence figure of 5.6% for amblyopia in Germany-a higher figure than in other, comparable population-based studies, which have generally yielded figures of ca. 3% for visual acuity ≤ 0.63. The distribution of the causes of amblyopia is similar across studies.
Black, Joanna M; Hess, Robert F; Cooperstock, Jeremy R; To, Long; Thompson, Benjamin
Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%(1-3), the majority of cases being monocular(2). Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation. Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself(4,5) . Amblyopia is characterized by both monocular and binocular deficits(6,7) which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions(8). Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia(9,10) . Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device(11,12) . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which
Full Text Available Purpose: To determine the prevalence of refractive errors among high school students. Methods: In a cross-sectional study, we applied stratified cluster sampling on high school students of Aligoudarz, Western Iran. Examinations included visual acuity, non-cycloplegic refraction by autorefraction and fine tuning with retinoscopy. Myopia and hyperopia were defined as spherical equivalent of -0.5/+0.5 diopter (D or worse, respectively; astigmatism was defined as cylindrical error >0.5 D and anisometropia as an interocular difference in spherical equivalent exceeding 1 D. Results: Of 451 selected students, 438 participated in the study (response rate, 97.0%. Data from 434 subjects with mean age of 161.3 (range, 14 to 21 years including 212 (48.8% male subjects was analyzed. The prevalence of myopia, hyperopia and astigmatism was 29.3% [95% confidence interval (CI, 25-33.6%], 21.7% (95%CI, 17.8-25.5%, and 20.7% (95%CI, 16.9-24.6%, respectively. The prevalence of myopia increased significantly with age [odds ratio (OR=1.30, P=0.003] and was higher among boys (OR=3.10, P<0.001. The prevalence of hyperopia was significantly higher in girls (OR=0.49, P=0.003. The prevalence of astigmatism was 25.9% in boys and 15.8% in girls (OR=2.13, P=0.002. The overall prevalence of high myopia and high hyperopia were 0.5% and 1.2%, respectively. The prevalence of with-the-rule, against-the-rule, and oblique astigmatism was 14.5%, 4.8% and 1.4%, respectively. Overall, 4.6% (95%CI, 2.6-6.6% of subjects were anisometropic. Conclusion: More than half of high school students in Aligoudarz had at least one type of refractive error. Compared to similar studies, the prevalence of refractive errors was high in this age group.
Samuel Otabor Wajuihian
Full Text Available Background: Refractive errors and convergence insufficiency play major roles in reading efficiency. Uncorrected refractive errors are a primary cause of binocular anomalies, including convergence insufficiency. Symptoms of asthenopia in both refractive and binocular vision anomalies are similar. Despite the relationships that exist between them, the extent of association between refractive errors and convergence insufficiency has not been studied extensively. Aim: The aim of this study was to determine the prevalence of convergence insufficiency and refractive errors and investigate their associations with gender and age in a sample of high school children. Methods: The study design was cross-sectional and comprised data from 1056 African high school students aged 13–18 years, who were randomly selected from 13 high schools in uMhlathuze municipality in the province of KwaZulu-Natal, South Africa. In the final sample, 403 (38% were males and 653 (62% were females. The participants’ mean age and standard deviation were 15.89 ± 1.58 years and median age was 16 years. Refractive errors, heterophoria, near point of convergence, fusional vergences and accommodative functions were evaluated. Results: Prevalences for convergence insufficiency were as follows: low suspect 12.4% (confidence interval, [CI] 10.2–14.4, high suspect 6.3% (CI, 5.0–7.9, definite 4.6% (CI, 3.4–5.9, and pseudo-convergence insufficiency 2.1% (CI, 1.2–3.0. Refractive errors were: hyperopia 6.8% (CI, 5.3–8.4, myopia 6.0% (CI, 4.6–7.5, astigmatism 2.3% (CI, 1.8–3.2, anisometropia 1.3% (CI, 0.7–2.0 and emmetropia 86.2% (CI, 85.1–89.1. There were no significant associations between convergence insufficiency and gender (p = 0.32, age (p = 0.38, grade levels (p = 0.99 or refractive errors (p = 0.08. Conclusion: The prevalence of clinically significant convergence insufficiency and refractive errors was low in this sample of black high school students in South
Holmes, Jonathan M; Manh, Vivian M; Lazar, Elizabeth L; Beck, Roy W; Birch, Eileen E; Kraker, Raymond T; Crouch, Eric R; Erzurum, S Ayse; Khuddus, Nausheen; Summers, Allison I; Wallace, David K
A binocular approach to treating anisometropic and strabismic amblyopia has recently been advocated. Initial studies have yielded promising results, suggesting that a larger randomized clinical trial is warranted. To compare visual acuity (VA) improvement in children with amblyopia treated with a binocular iPad game vs part-time patching. A multicenter, noninferiority randomized clinical trial was conducted in community and institutional practices from September 16, 2014, to August 28, 2015. Participants included 385 children aged 5 years to younger than 13 years with amblyopia (20/40 to 20/200, mean 20/63) resulting from strabismus, anisometropia, or both. Participants were randomly assigned to either 16 weeks of a binocular iPad game prescribed for 1 hour a day (190 participants; binocular group) or patching of the fellow eye prescribed for 2 hours a day (195 participants; patching group). Study follow-up visits were scheduled at 4, 8, 12, and 16 weeks. A modified intent-to-treat analysis was performed on participants who completed the 16-week trial. Binocular iPad game or patching of the fellow eye. Change in amblyopic-eye VA from baseline to 16 weeks. Of the 385 participants, 187 were female (48.6%); mean (SD) age was 8.5 (1.9) years. At 16 weeks, mean amblyopic-eye VA improved 1.05 lines (2-sided 95% CI, 0.85-1.24 lines) in the binocular group and 1.35 lines (2-sided 95% CI, 1.17-1.54 lines) in the patching group, with an adjusted treatment group difference of 0.31 lines favoring patching (upper limit of the 1-sided 95% CI, 0.53 lines). This upper limit exceeded the prespecified noninferiority limit of 0.5 lines. Only 39 of the 176 participants (22.2%) randomized to the binocular game and with log file data available performed more than 75% of the prescribed treatment (median, 46%; interquartile range, 20%-72%). In younger participants (aged 5 to iPad treatment was not as good as with 2 hours of prescribed daily patching. http
Whatham, Andrew R; Judge, Stuart J
To determine whether a disruption of binocular vision that has been previously shown to be amblyogenic disturbs visually guided growth, and in particular to follow-up the observation by Kiorpes and Wallman [Kiorpes, L., & Wallman, J. (1995). Does experimentally-induced amblyopia cause hyperopia in monkeys? Vision Research, 35(9), 1289-1297] that monkeys in whom strabismus had been induced some years earlier were hyperopic in eyes that had become amblyopic, we induced unilateral fixation in five infant New World monkeys (marmosets) through the wearing of a Fresnel prism (of 15 or 30 prism dioptres power) in front of one eye for four weeks. The prism was rotated every three hours during the prism-wear period to encourage a preference for fixating with the contralateral eye. Refractive error and intraocular axial dimensions were measured before, and at intervals after the prism-wearing period. Fixation preference was measured behaviourally, during and after the prism-wear period. Cortical visual function was subsequently assessed through recording of pattern-reversal VEPs in each marmoset between 11 and 14 months of age to assess whether amblyopia had developed in the non-fixing eye. All marmosets used the untreated eye almost exclusively for a monocular visual task by the end of the prism-rearing period. This preference was still present up to at least 7 months after prism-wear had ceased. VEP measures showed a loss of sensitivity at low spatial frequencies (the only ones we were able to test), compatible with amblyopia having developed in the non-fixating eyes of the prism-reared marmosets. Eyes that wore prisms were not significantly different from their fellow eyes in mean refractive error or mean vitreous chamber depth (repeated measures ANOVA; P>0.05) before or at any time after prism-wear had ceased. Two marmosets developed 2-3D of anisometropia (one hyperopic and one myopic) at the end of prism-wear, that was attributable to interocular differences in vitreous
Grossman, David C; Curry, Susan J; Owens, Douglas K; Barry, Michael J; Davidson, Karina W; Doubeni, Chyke A; Epling, John W; Kemper, Alex R; Krist, Alex H; Kurth, Ann E; Landefeld, C Seth; Mangione, Carol M; Phipps, Maureen G; Silverstein, Michael; Simon, Melissa A; Tseng, Chien-Wen
One of the most important causes of vision abnormalities in children is amblyopia (also known as "lazy eye"). Amblyopia is an alteration in the visual neural pathway in a child's developing brain that can lead to permanent vision loss in the affected eye. Among children younger than 6 years, 1% to 6% have amblyopia or its risk factors (strabismus, anisometropia, or both). Early identification of vision abnormalities could prevent the development of amblyopia. Studies show that screening rates among children vary by race/ethnicity and family income. Data based on parent reports from 2009-2010 indicated identical screening rates among black non-Hispanic children and white non-Hispanic children (80.7%); however, Hispanic children were less likely than non-Hispanic children to report vision screening (69.8%). Children whose families earned 200% or more above the federal poverty level were more likely to report vision screening than families with lower incomes. To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for amblyopia and its risk factors in children. The USPSTF reviewed the evidence on the accuracy of vision screening tests and the benefits and harms of vision screening and treatment. Surgical interventions were considered to be out of scope for this review. Treatment of amblyopia is associated with moderate improvements in visual acuity in children aged 3 to 5 years, which are likely to result in permanent improvements in vision throughout life. The USPSTF concluded that the benefits are moderate because untreated amblyopia results in permanent, uncorrectable vision loss, and the benefits of screening and treatment potentially can be experienced over a child's lifetime. The USPSTF found adequate evidence to bound the potential harms of treatment (ie, higher false-positive rates in low-prevalence populations) as small. Therefore, the USPSTF concluded with moderate certainty that the overall net benefit is moderate for
Vujanović Milena S.
Full Text Available Background/Aim. Retinopathy of prematurity (ROP is a vasoproliferative retinopathy which affects the blood vessels of the retina during its development. The aim of this study was to evaluate the incidence and the degree of refractive errors in premature infants with severe ROP treated with antivascular endothelial growth factor (anti-VEGF (bevacizumab. Methods. This prospective study included 21 patients (42 eyes nine months old who received intravitreal injection of anti-VEGF therapy. The control group consisted of 45 patients (90 eyes who were subjected to laser treatment. In cycloplegia each patient underwent retinoscopy, keratorefractometry, and A-scan ultrasonography. Results. Myopia was present in 47.62% of the eyes in the study group and in 33.33% of the eyes in the control group, but there were no statistically significant differences between these groups. Seven (16.67% eyes in the study group and 17 (18.89% eyes in the control group were discovered to have high myopia (SE– spherical equivalents < -3.0 D – dioptre. Clinically significant hypermetropia was higher in the study group (47.62% than in the control group (34.44%, but with no statistically significant difference. In addition, high hypermetropia was significantly greater in the control group (15.56% than in the study group (11.90% (p < 0.001. Astigmatism was more common in the control group than in the study group (81.11% vs 71.43%, respectively, especially high astigmatism (56% vs 43%, respectively. Also the more common form of astigmatism was with the rule (WTR both in the study and the control group (42.86% vs 55.56%, respectively. Anisometropia was significantly greater in the control group (24.44% than in the study group (9.52% (p < 0.05. The children from the study group had significantly greater lens thickness, and a shorter anterior chamber depth than children from the control group (p < 0.01. There was no significant difference in the axial length of the eye between
Detecção de ambliopia, ametropias e fatores ambliogênicos em comunidade assistida por Programa da Saúde da Família no Rio de Janeiro, Brasil Amblyopia, ametropia and amblyogenic factors detection in a community assisted by Health Family Program in Rio de Janeiro, Brazil
Arlette Machado Oliveira
Full Text Available OBJETIVO: Estimar a prevalência dos fatores ambliogênicos e ambliopia na área adscrita do Programa Saúde da Família (PSF da Lapa (RJ e estimar na mesma área a sensibilidade/especificidade entre os métodos de medida da acuidade visual (tabelas ETDRS e LEA para triagem em crianças pré-escolares (três a seis anos. MÉTODOS: Estudo transversal de 93 crianças entre três e seis anos da área adscrita do PSF Lapa, RJ. Todas as crianças foram submetidas a avaliação oftalmológica completa que incluiu: anamnese dirigida, ectoscopia, medida da acuidade visual com tabela de ETDRS e LEA de forma duplo cega, reflexo vermelho, teste de Titmus, refração objetiva sob cicloplegia, refração subjetiva, avaliação da motilidade ocular, biomicroscopia do segmento anterior, fundoscopia sob midríase.Os dados foram coletados na Policlínica Ronaldo Gazolla, da Universidade Estácio de Sá. RESULTADOS: A prevalência dos fatores ambliogênicos foi encontrada e distribuída em: 8,4% de estrabismo, 11,86% de anisometropia e 15,2 % de ametropia. O teste de acuidade visual ETDRS apresentou sensibilidade de 100 % e especificidade de 18% para detecção de ambliopia. O teste de acuidade visual LEA apresentou sensibilidade de 100% e especificidade de 30,9 % para detecção de ambliopia. CONCLUSÃO: Ambas tabelas ETDRS e LEA podem ser usadas para a triagem de ambliopia porque tiveram 100% de sensibilidade. A especificidade foi maior para a tabela LEA. Porém, ainda em nível baixo. Portanto, há necessidade da complementação com o exame oftalmológico completo para confirmar e ratificar a presença de fatores ambliogênicos em pacientes triados positivamente. A triagem visual feita pelos agentes comunitários de saúde pode identificar crianças com distúrbios visuais, referenciando para exame oftalmológico completo; em um grupo etário onde a resolução dos problemas visuais se apresenta como prioridade. O Programa de Saúde da Família pode ser
Detecção de ambliopia, ametropias e fatores ambliogênicos em comunidade assistida por Programa da Saúde da Família no Rio de Janeiro, Brasil Amblyopia, ametropia and amblyogenic factors detection in a community assisted by Health Family Program in Rio de Janeiro, Brazil
Arlette Machado Oliveira
Full Text Available OBJETIVOS: Determinar a prevalência dos fatores ambliogênicos e ambliopia na área adscrita do Programa Saúde da Família (PSF da Lapa (RJ e, estimar na mesma área a sensibilidade e especificidade entre métodos de medida de acuidade visual (tabelas ETDRS e LEA em crianças pré-escolares. MÉTODOS: Estudo transversal de 93 crianças entre três a seis anos da área adscrita do PSF Lapa, RJ. Todas as crianças foram submetidas à avaliação oftalmológica completa que incluiu: anamnese dirigida, ectoscopia, medida da acuidade visual com tabela de ETDRS e LEA de forma duplo cega, reflexo vermelho, teste de Titmus, refração objetiva sob cicloplegia, refração subjetiva, avaliação da motilidade ocular, biomicroscopia do segmento anterior, fundoscopia sob midríase. Os dados foram coletados na Policlínica Ronaldo Gazolla, da Universidade Estácio de Sá. RESULTADOS: A prevalência dos fatores ambliogênicos foi encontrada e distribuída em: 8,4 % de estrabismo; 11,86% de anisometropia e 15,2% de ametropia. O teste de acuidade visual ETDRS apresentou sensibilidade de 100% e especificidade de 18% para detecção de ambliopia. O teste de acuidade visual LEA apresentou sensibilidade de 100% e especificidade de 30,9% para detecção de ambliopia. CONCLUSÃO: Ambas tabelas ETDRS e LEA podem ser usadas para a triagem de ambliopia porque tiveram 100% de sensibilidade. A especificidade foi maior para a tabela LEA. Porém ainda em nível baixo. Portanto, há necessidade da complementação com o exame oftalmológico completo para confirmar e ratificar a presença de fatores ambliogênicos em pacientes triados positivamente. A triagem visual feita pelos Agentes Comunitários de Saúde pode identificar crianças com distúrbios visuais, referenciando para exame oftalmológico completo; em um grupo etário onde a resolução dos problemas visuais se apresenta como prioridade. O Programa de Saúde da Família pode ser utilizado para avaliar o estado de
Full Text Available AIM: To evaluate the effects of femtosecond laser-assisted in situ keratomileusis (FS-LASIK and small-incision lenticule extraction (SMILE to correct high myopic anisometropic amblyopia in juvenile patients. METHODS: From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK (30 eyes or SMILE (3 eyes was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed follow-up examinations at 3d, 1mo, 3mo and the last follow-up time (mean 8.17±3.23mo after surgery. RESULTS: The mean age at surgery was 9.04±3.04y (range 6-16y. The mean spherical equivalent in the amblyopic eyes was significantly decreased from -10.00±2.39 D preoperatively to -0.06±1.06 D at 1mo, -0.19±1.33 D at 3mo and -0.60±1.43 D at approximately 8mo postoperatively (P<0.05 for all. The mean myopic anisometropia was significantly decreased from -9.45±2.33 D preoperatively to +0.37±1.48 D at 1mo, -0.46±1.47 D at 3mo and -0.09±1.83 D at approximately 8mo (P<0.05 for all. The logarithm of the minimum angle of resolution (logMAR for uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8mo after surgery, respectively. The logMAR CDVA at 3d, 1, 3 and 8mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles per degree was significantly improved postoperatively (P<0.05 for all. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients (21.2% recovered near stereopsis (400″ to 60″ at approximately 8mo after surgery. No intraoperative or
Gao, Tina Y; Guo, Cindy X; Babu, Raiju J; Black, Joanna M; Bobier, William R; Chakraborty, Arijit; Dai, Shuan; Hess, Robert F; Jenkins, Michelle; Jiang, Yannan; Kearns, Lisa S; Kowal, Lionel; Lam, Carly S Y; Pang, Peter C K; Parag, Varsha; Pieri, Roberto; Raveendren, Rajkumar Nallour; South, Jayshree; Staffieri, Sandra Elfride; Wadham, Angela; Walker, Natalie; Thompson, Benjamin
Binocular amblyopia treatment using contrast-rebalanced stimuli showed promise in laboratory studies and requires clinical trial investigation in a home-based setting. To compare the effectiveness of a binocular video game with a placebo video game for improving visual functions in older children and adults. The Binocular Treatment of Amblyopia Using Videogames clinical trial was a multicenter, double-masked, randomized clinical trial. Between March 2014 and June 2016, 115 participants 7 years and older with unilateral amblyopia (amblyopic eye visual acuity, 0.30-1.00 logMAR; Snellen equivalent, 20/40-20/200) due to anisometropia, strabismus, or both were recruited. Eligible participants were allocated with equal chance to receive either the active or the placebo video game, with minimization stratified by age group (child, age 7 to 12 years; teenager, age 13 to 17 years; and adult, 18 years and older). Falling-blocks video games played at home on an iPod Touch for 1 hour per day for 6 weeks. The active video game had game elements split between eyes with a dichoptic contrast offset (mean [SD] initial fellow eye contrast, 0.23 [0.14]). The placebo video game presented identical images to both eyes. Change in amblyopic eye visual acuity at 6 weeks. Secondary outcomes included compliance, stereoacuity, and interocular suppression. Participants and clinicians who measured outcomes were masked to treatment allocation. Of the 115 included participants, 65 (56.5%) were male and 83 (72.2%) were white, and the mean (SD) age at randomization was 21.5 (13.6) years. There were 89 participants (77.4%) who had prior occlusion. The mean (SD) amblyopic eye visual acuity improved 0.06 (0.12) logMAR from baseline in the active group (n = 56) and 0.07 (0.10) logMAR in the placebo group (n = 59). The mean treatment difference between groups, adjusted for baseline visual acuity and age group, was -0.02 logMAR (95% CI, -0.06 to 0.02; P = .25). Compliance with more than 25