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Sean Donahue

Publications and source records attributed to Sean Donahue.

6 recordsLinked to original sources
PubMed2005

Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children.

OBJECTIVE: To compare patching and atropine sulfate as treatments for moderate amblyopia in children 18 months after completion of a 6-month randomized trial. METHODS: In a randomized, multicenter (47 sites) clinical trial, 419 children younger than 7 years with amblyopia (20/40 to 20/100 in the affected eye) were assigned to receive either patching or atropine eye drops for 6 months. Between 6 months and 2 years, treatment was at the discretion of the investigator. Main Outcome Measure Visual acuity in the amblyopic eye and sound eye after 2 years. RESULTS: At 2 years, visual acuity in the amblyopic eye improved from baseline a mean of 3.7 lines in the patching group and 3.6 lines in the atropine group. The difference in visual acuity between treatment groups was small: 0.01 logMAR (95% confidence interval, -0.02 to 0.04). In both treatment groups, the mean amblyopic eye acuity was approximately 20/32, 1.8 lines worse than the mean sound eye acuity, which was approximately 20/20. CONCLUSIONS: Atropine or patching for 6 months followed by best clinical care until 2 years produced similar improvement of moderate amblyopia in children between 3 and 7 years of age at enrollment. However, on average the amblyopic eye acuity was still approximately 2 lines worse than the sound eye.

Amblyopia↗
PubMed2005

Randomized trial of treatment of amblyopia in children aged 7 to 17 years.

OBJECTIVE: To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years. METHODS: At 49 clinical sites, 507 patients with amblyopic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then randomized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (> or =2 lines) by 24 weeks were considered responders. RESULTS: In the 7- to 12-year-olds (n = 404), 53% of the treatment group were responders compared with 25% of the optical correction group (P<.001). In the 13- to 17-year-olds (n = 103), the responder rates were 25% and 23%, respectively, overall (adjusted P = .22) but 47% and 20%, respectively, among patients not previously treated with patching and/or atropine for amblyopia (adjusted P = .03). Most patients, including responders, were left with a residual visual acuity deficit. CONCLUSIONS: Amblyopia improves with optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acuity when amblyopia has not been previously treated but appears to be of little benefit if amblyopia was previously treated with patching. We do not yet know whether visual acuity improvement will be sustained once treatment is discontinued; therefore, conclusions regarding the long-term benefit of treatment and the development of treatment recommendations for amblyopia in children 7 years and older await the results of a follow-up study we are conducting on the patients who responded to treatment.

Adolescent↗
PubMed2005

Anterior chamber intraocular lens (ACIOL) placement after pars plana lensectomy in pediatric Marfan syndrome.

INTRODUCTION: The management of subluxed crystalline lenses in patients with Marfan syndrome is challenging and may require lensectomy. Options for postoperative optical correction include aphakic spectacles, aphakic contact lens, posterior chamber IOLs sutured to the ciliary sulcus, and open-loop flexible anterior chamber IOLs (ACIOL). We recently began placing ACIOLs in all patients with Marfan Syndrome who were younger than 18 years of age and required lensectomy. METHODS: We used a retrospective chart review design for this study. RESULTS: Eight eyes of 5 patients were treated with pars plana vitrectomy, pars plana lensectomy, and primary ACIOL placement. Follow-up ranged from 9 to 16 months, with a mean of 12.7 months. Ages ranged from 5 to 17 years with a mean of 9 years. Three eyes were functionally aphakic at the time of surgery. Of the 5 eyes with a portion of the lens remaining in the visual axis, none maintained accommodative function by near visual acuity testing. Best-corrected distance visual acuity preoperatively ranged from 20/50 to 20/400, with an average of 20/80 (0.65 logMAR). Postoperative acuity ranged from 20/20 to 20/50, with an average acuity of 20/32 (0.20 logMAR). One patient had an iatrogenic sector iridectomy. No patients experienced corneal decompensation, increased intraocular pressure, persistent inflammation, IOL displacement, or explantation during the follow-up period. CONCLUSIONS: Although long-term follow-up data are unavailable, our cases of primary ACIOL placement in children with Marfan syndrome indicate that this therapy should be considered.

Adolescent↗
PubMed2004

Risk of amblyopia recurrence after cessation of treatment.

BACKGROUND: Although amblyopia can be successfully treated with patching or atropine, there have been few prospective studies of amblyopia recurrence once treatment is discontinued. METHODS: We enrolled 156 children with successfully treated anisometropic or strabismic amblyopia (145 completed follow-up), who were younger than 8 years of age and who received continuous amblyopia treatment for the previous 3 months (prescribed at least 2 hours of daily patching or prescribed at least one drop of atropine per week) and who had improved at least 3 logMAR levels during the period of continuous treatment. Patients were followed off treatment for 52 weeks to assess recurrence of amblyopia, defined as a 2 or more logMAR level reduction of visual acuity from enrollment, confirmed by a second examination. Recurrence was also considered to have occurred if treatment was restarted because of a nonreplicated 2 or more logMAR level reduction of visual acuity. RESULTS: Recurrence occurred in 35 (24%) of 145 cases (95% confidence interval 17% to 32%) and was similar in patients who stopped patching (25%) and in patients who stopped atropine (21%). In patients treated with moderately intense patching (6 to 8 hours per day), recurrence was more common (11 of 26; 42%) when treatment was not reduced prior to cessation than when treatment was reduced to 2 hours per day prior to cessation (3 of 22; 14%, odds ratio 4.4, 95% confidence interval 1.0 to 18.7). CONCLUSIONS: Approximately one fourth of successfully treated amblyopic children experience a recurrence within the first year off treatment. For patients treated with 6 or more hours of daily patching, our data suggest that the risk of recurrence is greater when patching is stopped abruptly rather than when it is reduced to 2 hours per day prior to cessation. A randomized clinical trial of no weaning versus weaning in successfully-treated amblyopia is warranted to confirm these observational findings.

Amblyopia↗
PubMedDate not supplied

Severe amblyopia of the sound eye resulting from atropine therapy combined with optical penalization.

The potential amblyogenic effect to the sound eye of atropine combined with optical penalization is powerful, and frequent patient monitoring is necessary when using this therapy. We report two cases of amblyopia developing in the previously sound eye as a result of noncompliance during atropine therapy combined with optical penalization. Both cases required active treatment to correct the reverse amblyopia. Vision returned to normal in one patient, while the second patient was lost to follow-up with poor acuity.

Amblyopia↗