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PubMed2004

Objective survey of the prescription of occlusion therapy for amblyopia.

PURPOSE: To identify the variation within and consistency amongst orthoptists when prescribing occlusion therapy for amblyopia in an objective survey. METHODS: A questionnaire was designed with five case examples of amblyopic children and distributed at annual meetings of orthoptists in The Netherlands and Germany. It was filled in simultaneously within 15 min in complete silence to avoid any exchange of opinions between orthoptists that would reduce variability. For each case the orthoptists were asked to give their prescription of hours or days of occlusion. RESULTS: The questionnaire was filled in by 177 Dutch orthoptists and 227 German orthoptists. Their prescriptions of occlusion therapy were classified into five main regimens: part-time; part-time not every day; full-time; also occluding the amblyopic eye; alternating; and no occlusion therapy. The variation was large: the standard deviation was half the average prescribed hours of occlusion for each regimen in each of the five cases. All orthoptists were assigned a rank number for each of the five cases depending on whether their prescription was above or below average. These five rank numbers were not consistently above or consistently below average value per case. CONCLUSIONS: The number of prescribed hours of occlusion varied widely per regimen per case. Orthoptists were not consistently strict or lenient in their prescription of occlusion therapy.

Amblyopia↗
PubMed1998

Sensitivity of the MTI photoscreener for amblyogenic factors in infancy and early childhood.

BACKGROUND: Screening for amblyogenic factors in infancy by pediatricians is unsatisfactory, as they hardly ever detect ametropia or microstrabismus. As photoscreening seems to be a helpful method to detect even small squint angles and refractive errors, we tested the MTI photoscreener for its sensitivity with respect to amblyogenic factors. PATIENTS AND METHODS: One hundred and twelve children aged 6-48 months were first examined with the MTI photoscreener. Then each child underwent complete medical examination by an ophthalmologist and an orthoptist. The examination included the Hirschberg test (corneal reflex evaluation), the Brückner test (fundus red reflex), and, where possible, the Lang stereotest, the cover test and visual acuity assessment, as well as a motility test, biomicroscopy, ophthalmoscopy in mydriasis and refractometry in cycloplegia. Exclusion criteria were any organic pathological results, manifest strabismus, ametropia > or = 2 D and astigmatism > or = 1 D. An orthoptist, a pediatrician and two ophthalmologists independently evaluated the Polaroid pictures according to the criteria given in the handbook of the MTI photoscreener. RESULTS: For 10 children the evaluation with the MTI photoscreener was not possible despite the fact that photographs were retaken several times. Thirteen photographs showing obvious pathologic findings despite their poor quality were included. Eighty-three of the remaining 102 children failed the eye examination according to the above-mentioned criteria. The mean sensitivity of the MTI photoscreener was determined to be 82.8%. The ability to correctly identify the absence of any amblyogenic factors (specificity) was 61.8%. CONCLUSIONS: Sensitivity was high when compared to the usually low detection rate during pediatric examinations. Due to the low specificity, effectiveness was poor. Therefore an ophthalmological examination should be included in the preventive screening during infancy and early childhood.

Amblyopia↗
PubMed1979

Penalization in the treatment of amblyopia.

Penalization is a useful alternative to occlusion therapy in amblyopia of mild and moderate degrees and in preserving therapeutic gains made by previous occlusion treatment. Penalization at near, total, and alternating penalization are more valuable than penalization at distance. Because penalization does not prevent the development of visual deprivation amblyopia, unilateral atropine therapy must be used carefully in treating patients in an age group susceptible to occlusion amblyopia.

Adolescent↗