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PubMed1995

Update on strabismus and amblyopia.

This review analyzes progress in the field of infantile strabismus and amblyopia. Only works which are of clinical interest have been reviewed. A brief survey is provided also of subjects matter of international debate, as surgery for accommodative esotropia, the prism adaptation test and the use of sectors for amblyopia treatment. Mention is made of new developments in the field which are not yet applicable to clinical practice. Finally, progress in the approach towards ocular nystagmus is considered as well.

Amblyopia↗
PubMed1975

Follow-up results of occlusion and pleoptic treatment.

Fifty cases of amblyopia, including some cases of eccentric fixation, which had previously been successfully treated by various therapies (conventional occlusion, red filter occlusion and pleoptics) were followed up from 12 to 68 months. Fifteen cases (30%) deteriorated to pretreatment level during the follow up. Deterioration was found to be greater in cases over the age of 15 years and in cases who did not follow the instructions given to them after cessation of therapy.

Adolescent↗
PubMed1981

Effects of grating stimulation on visual acuity in amblyopia.

Thirty-one children with amblyopia were treated with CAM vision stimulation. Twenty-one of them had previously been treated with conventional methods but failed to improve further. The conventional therapy was continued during and after CAM. Grating stimulation was the first treatment attempted for the rest of the children. Most children in both groups showed improved distance visual acuity after CAM-treatment and no one suffered a loss. The average visual acuity improvement was the same in both groups of children and did not vary with age. The improvement amounted to about 50% of the visual acuity before CAM, irrespective of the pre-treatment acuity level. We conclude that CAM-stimulation can be useful in cases where occlusion or other amblyopia treatment has failed, but that some form of treatment must be continued if visual acuity is to be maintained after the CAM-treatment period.

Adolescent↗
PubMed1981

Contrast sensitivity in children with strabismic and anisometropic amblyopia. A study of the effect of treatment.

The contrast threshold of sinusoidal gratings of varying contrast and frequency was examined in children with amblyopia due to strabismus or anisometropia. In strabismic amblyopia the contrast sensitivity is depressed for only a limited band of high spatial frequencies. In anisometropic amblyopia depression of the contrast sensitivity function (CSF) was found over the whole frequency range. The CSF could not be predicted from the visual acuity measurements in amblyopic eyes due to strabismus, whereas a rough correlation was observed in anisometropia. During occlusion treatment of the dominant eye in anisometropia the visual acuity and the contrast sensitivity function of the amblyopic eye improved in parallel. The study indicates that the abnormalities in spatial vision are different in amblyopia due to strabismus or anisometropia during childhood. Determination of the contrast sensitivity function seems to be an additional tool besides acuity measurements to document changes of visual function during treatment of amblyopia.

Amblyopia↗
PubMed1981

A pilot study of contrast sensitivity assessment of the CAM treatment of amblyopia.

Contrast thresholds of varying spatial frequencies were obtained on 3 amblyopic patients before and after the CAM treatment of amblyopia. Results of this study confirm previous findings that in the absence of change of visual acuity, contrast sensitivity function can be changed with the use of this technique. Improvement of contrast sensitivity can occur in older patients and that the sensitivity sometimes can deteriorate when treatment is stopped.

Amblyopia↗
PubMed1983

Effects of amblyopia therapy on contrast sensitivity as reflected in the visuogram.

A quantitative evaluation of the Cambridge amblyopia treatment on contrast sensitivity was performed for 2 groups, one comprising 11 children with strabismic amblyopia (S) and another of 10 children with combined strabismic and anisometropic amblyopia (S & A). Contrast sensitivity deficits were expressed in dB CSL (Contrast Seeing Level) in relation to normal sensitivity of the same age group and represented in the form of visuograms. Mean contrast sensitivity losses in dB CSL were estimated within the low, medium and high spatial frequency ranges, as well as over the total frequency band. On an average S & A amblyopia was found to affect contrast sensitivity of all spatial frequencies, while S amblyopia affected mainly the higher frequency band, but to a smaller extent. After therapy average contrast sensitivity improved for both S and S & A groups, and reached the same, subnormal levels. The relation between highest resolvable spatial frequency (according to our method) and Snellen acuity was different for the 2 amblyopia groups. No correlation was found between improvements in contrast sensitivity and Snellen acuity, which is why both parameters should be estimated.

Adolescent↗
PubMed1986

Contrast sensitivity in amblyopia. III. Effect of occlusion.

Contrast sensitivity of 26 children (mean age 9 years) was measured using vertical gratings during the course of pleoptic treatment. A statistically highly significant improvement in the vision of amblyopic eyes occurred during intensive treatment in the hospital. Occlusion of the amblyopic eye (inverse occlusion) before the pleoptic treatment did not effect the function of the amblyopic eyes. During 8-week occlusion of the dominant eye (direct occlusion) after pleoptic treatment changes in the vision of the amblyopic eyes were statistically insignificant. In some patients there was change in contrast sensitivity without a corresponding change in visual acuity. The contrast sensitivity of the dominant eye decreased markedly during occlusion in 12 patients. After a continuous occlusion of only 2 weeks there was a statistically significant decrease at spatial frequency 6 c/deg. There was no simultaneous decrease of visual acuity; thus the change can be called 'hidden occlusion amblyopia'. An additional 8-week occlusion did not cause any statistically significant decrease in contrast sensitivity, but visual acuity of 2 patients decreased slightly, a sign of beginning occlusion amblyopia. The changes disappeared during 'Einschleich'-occlusion or penalization except in one child whose previously dominant eye became non-dominant and slightly amblyopic.

Adolescent↗
PubMed1986

Effects of surgery on the dominant eye in exodeviations.

It has been suggested that operating the dominant eye is a more effective way of treatment for exodeviations than the conventional non-dominant eye surgery. We have tested this idea in groups of children and adults with intermittent and constant exotropia. In a first group of 30 patients where the non-dominant eye was operated on, we found that our initial technique resulted in an undercorrection averaging 11 prism diopters. Modification of the technique, by increasing the relative amount of surgery on the non-dominant eye in another group of 41 patients, improved the results significantly in adult patients, but not in children. Operations on the dominant eye in a third group of 26 patients were no more successful than non-dominant eye surgery with the initial technique. Thus, we did not obtain better results in operations on the dominant eye with our technique than we did with surgery on the non-dominant eye.

Adolescent↗
PubMed2006

Why is compliance with occlusion therapy for amblyopia so hard? A qualitative study.

OBJECTIVE: To explore parents' perceptions and experiences of occlusion (patching) therapy for treatment of amblyopia in children. METHODS: Qualitative study involving semistructured interviews with 25 families of a child with amblyopia being treated at a specialist clinic. Interviews were tape recorded and transcribed verbatim. Data analysis was based on the constant comparative method, assisted by qualitative analysis software. RESULTS: Parents of children prescribed patching treatment found themselves obliged to manage the treatment. This involved dilemmas and tensions, with many parents describing children's distress, particularly in the early stages of patching treatment. Parents were highly sensitive to the credibility of the treatment, but were sometimes confused by information given in the clinic or did not see clinic staff as authoritative. There was evidence that parents were likely to abandon or modify treatment if no improvement could be detected or if the child continued to suffer socially or educationally. Parents described a range of strategies for facilitating patching, including explanation; normalisation; rewards; customising the patch; establishing a routine; and enlisting the help of others. Whatever their practices in relation to patching, parents were keen to defend their behaviour as that of a "good parent". CONCLUSIONS: Interventions that aim to improve compliance should take account of the difficulties and tensions experienced by parents, rather than simply treating non-compliance as resulting from information deficits. Practical support that builds on strategies described by parents is likely to be of benefit.

Adaptation, Psychological↗
PubMed1991

Preschool vision screening in Cornwall: performance indicators of community orthoptists.

The performance of community orthoptists was retrospectively assessed in a primary preschool screening programme that has been established in Cornwall since 1982. The outcome of screening was compared between random samples of two birth year cohorts corresponding to the second and fourth years of existence of the screening programme (1980, n = 298 and 1982, n = 300). The mean age at screening was significantly later for the second cohort (4.3 years compared with 4.4 years) but otherwise performance indicators improved in the second cohort. Community orthoptists achieved a sensitivity of about 90% and specificity of 99% during the study. It is unlikely that the more commonly used two tier system of health visitors referring to a community orthoptist could achieve this degree of accuracy.

Child, Preschool↗