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PubMed2006

Differential changes of magnocellular and parvocellular visual function in early- and late-onset strabismic amblyopia.

PURPOSE: Studies in nonhuman primates show that monocular visual deprivation starting at different ages has different effects on cells in the parvocellular and magnocellular laminae of the lateral geniculate nucleus. The present study used color and luminance contrast sensitivity (CS) measurements to look for differences in parvocellular- and magnocellular-related visual function in human subjects with strabismic amblyopia. METHODS: Fifteen subjects with early- and 14 with late-onset strabismic amblyopia and similar ranges of visual acuity were studied, together with 15 subjects with normal vision. Contrast sensitivities were measured to an equiluminant (L-M cone-modulated) grating with slow onset and an achromatic (L+M cone-modulated) 0.8-cpd grating with rapid onset using an adaptive METHOD RESULTS: Luminance and color CS were lower in the amblyopic eyes than in the fellow eyes of all amblyopes. For luminance CS, this was due both to an increase in sensitivity of the fellow eye and to a reduction in sensitivity in the amblyopic eye. Color CS was greatly reduced in the amblyopic and fellow eyes of subjects with strabismic amblyopia of early- and late onset compared with subjects with normal vision. The reduction in color CS compared with luminance CS was significantly greater in eyes with late- rather than early-onset amblyopia. CONCLUSIONS: Parvocellular and magnocellular function are differentially affected in the amblyopic and fellow eyes of subjects with strabismic amblyopia. The difference is more marked in late-onset amblyopia than in early-onset amblyopia.

Adolescent↗
PubMed2005

[A cost analysis of therapy for amblyopia for an outpatient at a university hospital].

PURPOSE: To analyze the costs of therapy for amblyopia for an outpatient using occlusion of the normal sighted eye and its visual results. METHODS: A prospective study was performed to evaluate the costs of therapy for amblyopia at the Strabismus Sector of the Hospital São Paulo--Universidade Federal de São Paulo/Escola Paulista de Medicina. Children with amblyopia ranging in age from 3 to 7 years were included in the study. The patients were followed since the diagnosis time until three consecutive visits. At the diagnosis time we prescribed glasses when necessary and total, direct and continuous occlusion of the normal sighted eye. Information about the therapy and the cost of therapy for amblyopia was collected at the following visits. To analyze the results the costs were separated into direct (glasses and occlusors) and indirect (transport, and cost of parent's/guardian's workday). RESULTS: Fourteen patients were analyzed. The mean age was 5.21 years (from 3 to 7 years) and 7 (50%) patients were male and 7 (50%) female. The average of the monthly cost of amblyopia therapy was R$ 59.49 and the average of the annual cost was R$ 714.47. The average monthly cost of therapy for amblyopia represented 12.20% of the monthly family income. CONCLUSIONS: The therapy for amblyopia is efficient and improves visual acuity of the amblyopic eye in 71.43% of the cases. The monthly cost of this therapy is R$ 59.49 being 12.20% of the patient's family income.

Amblyopia↗
PubMedDate not supplied

Detection of amblyopia with P-VEP during chloral hydrate sedation.

A major limitation of methods presently used for detecting amblyopia in preverbal children and infants is their dependence on patient cooperation. In response to this problem, we have introduced the use of chloral hydrate sedation as a means of obtaining the pattern visual evoked potential (P-VEP) in uncooperative infants. Twenty-five infants were studied: 14 with clinically diagnosed amblyopia, four with questionable amblyopia, and seven with no clinical sign of amblyopia. In patients with known amblyopia, P-1 amplitudes from the amblyopic eye were greatly diminished when compared with responses obtained from the non-amblyopic fellow eye, with amplitude ratios ranging from 0 to 0.66 (mean 0.36). In contrast, P-1 responses from non-amblyopic infants were quite symmetrical, with amplitude ratios of 0.82 to 0.98 (mean 0.92). These results indicate that the P-VEP can be obtained during chloral hydrate sedation and that P-1 responses reflect the presence or absence of amblyopia. Performing P-VEP during chloral hydrate sedation thus holds promise as an important clinical tool for the diagnosis of amblyopia in uncooperative infants and children.

Amblyopia↗
PubMedDate not supplied

Evaluation of the functions of the parvocellular and magnocellular pathways in strabismic amblyopia.

PURPOSE: To evaluate the functions of the magnocellular and parvocellular pathways in strabismic amblyopia. METHODS: Visual evoked potentials produced by achromatic and chromatic stimuli in 14 children with strabismic amblyopia were compared with those in 14 age-matched control subjects. The achromatic sine-wave grating with low spatial frequency was used to stimulate the magnocellular pathway, whereas the parvocellular pathway was stimulated by the chromatic sine-wave grating (isoluminant red-green) with low and high spatial frequencies. RESULTS: When the achromatic stimuli with low spatial frequency were used, the latencies of the N1 and P1 components and the amplitude of the N1-P1 complex were similar in the children with strabismic amblyopia and the control subjects. There also were no differences between the amblyopic and non-amblyopic eyes of the children with strabismic amblyopia. When chromatic stimuli with low and high spatial frequencies were used, the latencies of the N1 and P1 components were significantly longer and the amplitude of the N1-P1 complex was significantly smaller in the children with strabismic amblyopia than in the control group. When the amblyopic and non-amblyopic eyes of the children with strabismic amblyopia were compared, the latencies of the N1 and P1 components were longer and the amplitude of the N1-P1 complex was smaller in the amblyopic eyes. CONCLUSION: In strabismic amblyopia, the cells in the parvocellular pathway may be more involved, whereas the magnocellular pathway may be relatively spared.

Amblyopia↗
PubMedDate not supplied

Comparison of the HOTV and Lea symbols visual acuity tests in patients with amblyopia.

PURPOSE: To determine whether the Lea symbols visual acuity test, compared with the HOTV visual acuity test, overestimates visual acuity in patients with amblyopia. PATIENTS AND METHODS: Fifty-nine patients with amblyopia or a history of amblyopia treatment had visual acuity measurements in both eyes with the HOTV and Lea symbols tests. Crowding bars, separated by a width of 1 optotype, and the original pilot-testing protocol in the Amblyopia Treatment Study were used to quantify visual acuity. RESULTS: The patients' ages ranged from 4 to 35 years (mean age, 10.1 years). Visual acuity in the amblyopic eyes ranged from 20/20 to 20/250. The mean visual acuity difference (HOTV scores vs Lea symbols scores) was -0.056 logMAR units (P < .001), slightly more than half of a line. The negative value indicates that patients performed better on the HOTV test. In nonamblyopic eyes, the mean difference was -0.05 logMAR units (P < .001). Patients with strabismic amblyopia had a mean difference of -0.05 logMAR units (P = .08); those with anisometropic amblyopia had a mean difference of -0.07 logMAR units (P = .002). Patients 8 years and younger had a mean difference of -0.04 logMAR units (P = .05); those older than 8 years had a mean difference of -0.06 logMAR units (P = .002). CONCLUSIONS: In both amblyopic and nonamblyopic eyes, visual acuity measurements were better on HOTV testing compared with Lea symbols testing. The differences persisted regardless of patient age and the cause and severity of amblyopia. Overestimation of visual acuity by the Lea symbols test was not found.

Adolescent↗
PubMed2006

Evaluation of relationship of ocular parameters and depth of anisometropic amblyopia with the degree of anisometropia.

PURPOSE: (1) To find out the relationship of the depth of amblyopia with the degree of anisometropia, in untreated cases of anisometropic amblyopia without strabismus, for both myopic and hypermetropic individuals. (2) To find out the relationship between various ocular parameters, such as axial length and corneal curvature, with the degree of anisometropia between the two eyes. MATERIALS AND METHODS: This prospective study was conducted between January 2001 and March 2003, in 85 cases of untreated anisometropic amblyopia, who attended the author's out patient department. All these patients were subjected to a meticulous ocular examination, with special emphasis on (1) refraction under cycloplegia (2) best corrected visual acuity (3) measurement of axial length by A Scan (4) keratometry . The depth of amblyopia was calculated in two ways: (1) By finding out decimal visual acuity for each eye and subsequently calculating their difference. (2) By converting the Snellen acuity into Log MAR units, which was calculated by finding the Logarithm of the reciprocal of the decimal visual acuity for the two eyes, followed by calculating the difference between the two. The difference in refraction between the two eyes as a measure of anisometropia, was determined by the difference in spherical equivalent between the refraction for each eye. RESULTS: On comparing hypermetropic and myopic cases, a significant correlation was found between depth of amblyopia and the degree of anisometropia, in both myopic and hypermetropic patients. The correlation coefficients were however, found to be greater for hypermetropic than myopic individuals. It was observed that the difference between the axial length of the two eyes contributed to a major part of anisometropia, more so in myopic cases. CONCLUSIONS: The depth of amblyopia correlates with the degree of anisometropia in previously untreated anisometropic amblyopia patients.

Adolescent↗
PubMed2002

The clinical profile of moderate amblyopia in children younger than 7 years.

OBJECTIVE: To describe the demographic and clinical characteristics of a cohort of children with moderate amblyopia participating in the Amblyopia Treatment Study 1, a randomized trial comparing atropine and patching. METHODS: The children enrolled were younger than 7 years and had strabismic, anisometropic, or combined strabismic and anisometropic amblyopia. Visual acuity, measured with a standardized testing protocol using single-surround HOTV optotypes, was 20/40 to 20/100 in the amblyopic eye, with an intereye acuity difference of 3 or more logMAR lines. There were 419 children enrolled, 409 of whom met these criteria and were included in the analyses. RESULTS: The mean age of the 409 children was 5.3 years. The cause of the amblyopia was strabismus in 38%, anisometropia in 37%, and both strabismus and anisometropia in 24%. The mean visual acuity of the amblyopic eyes (approximately 20/60) was similar among the strabismic, anisometropic, and combined groups (P =.24), but visual acuity of the sound eyes was worse in the strabismic group compared with the anisometropic group (P<.001). For the patients randomized into the patching group, 43% were initially treated for 6 hours per day, whereas 17% underwent full-time patching. Patients with poorer visual acuity in the amblyopic eye were prescribed more hours of patching than patients with better acuity (P =.003). CONCLUSIONS: In the Amblyopia Treatment Study 1, there were nearly equal proportions of patients with strabismic and anisometropic amblyopia. A similar level of visual impairment was found irrespective of the cause of amblyopia. There was considerable variation in treatment practices with regard to the number of hours of initial patching prescribed.

Age Distribution↗
PubMed2004

Photorefractive keratectomy for anisometropic amblyopia in children.

PURPOSE: To assess the safety and efficacy of photorefractive keratectomy (PRK) in children with anisometropic amblyopia and to define the characteristics of children who may be candidates for PRK. METHODS: This thesis comprises four parts: (1) a retrospective analysis of risk factors predictive of amblyopia treatment failure in 104 children, (2) a prospective study of pachymetry in 198 eyes of 108 children, (3) development and implementation of a protocol to perform PRK under general anesthesia, and (4) a prospective interventional case-comparison study of PRK in 11 noncompliant children with anisometropic amblyopia to evaluate safety and long-term outcomes. Compliant and noncompliant children with anisometropic amblyopia were analyzed as controls. RESULTS: Factors associated with conventional anisometropic amblyopia treatment failure were poor compliance (P = .004), age 6 years or older (P = .01), astigmatism > or = 1.5 diopters (P = .0002), and initial visual acuity of 20/200 or worse (P = .02). Central and paracentral pachymetry measurements were similar to published adult values. The general anesthesia protocol was efficient, and the laser functioned properly in all cases. All children did well with no anesthesia-related or treatment-related complications. Two years following PRK, the mean reduction in refractive error was 9.7 +/- 2.6 diopters for myopes (P = .0001) and 3.4 +/- 1.3 diopters for hyperopes (P = .001). The cycloplegic refractive error in 9 of 11 treated eyes was within 3 diopters of that in the fellow eye. Uncorrected visual acuity in the amblyopic eye improved by > or = 2 lines in seven of nine children; best-corrected visual acuity improved by > or = 2 lines in six of nine children. Stereopsis improved in five of nine children. The mean visual acuity of the PRK patients at last follow-up was significantly better than that of noncompliant controls (P = .003). The safety and efficacy indices for PRK in this study were 1.24 and 1.12, respectively. CONCLUSIONS: Photorefractive keratectomy can be safely performed in children with anisometropic amblyopia. Visual acuity and stereopsis improved in most eyes, even in older children. Photorefractive keratectomy may have an important role in the management of anisometropic amblyopia in noncompliant children.

Amblyopia↗
PubMed1992

Defective processing of motion-defined form in the fellow eye of patients with unilateral amblyopia.

The following three measurements were made on a group of 20 pediatric and 5 adult patients with unilateral amblyopia: (1) speed threshold for recognizing motion-defined dotted letters; (2) recognition acuity for isolated solid letters of 4% contrast; and (3) Snellen line acuity for high-contrast letters. Normal limits were established with a group of 30 pediatric and 10 adult control subjects. The main finding was that, in amblyopic children, a high percentage (83%, 15 of 18) of fellow eyes showed a degraded ability to recognize motion-defined letters, even though Snellen acuity and 4% letter acuity were normal for age. The fellow eyes of all nine patients with strabismic amblyopia showed this pattern of loss, as did four of six fellow eyes of patients with anisometropic amblyopia and two of three fellow eyes of patients with anisometropic plus strabismic amblyopia. Only two clinically unaffected eyes were normal for motion-defined letters. These eyes belonged to patients with anisometropic amblyopia. Eighteen of the 19 previously amblyopic eyes tested were abnormal for motion-defined letters even though Snellen acuity was within normal limits for 6 of these eyes. In adults, only one of five fellow eyes failed the motion-defined letter test. It was concluded that the degradation of form perception associated with amblyopia can be different for luminance-defined and motion-defined form and that defective processing of motion-defined form is common in the fellow eyes of children with unilateral amblyopia.

Adolescent↗
PubMed1991

Factors associated with delay in diagnosis of childhood amblyopia.

The prevention of permanent visual impairment from amblyopia is an important goal of pediatric vision screening. Unfortunately, many cases of amblyopia are not diagnosed until the child is too old to benefit maximally from treatment. A review of patient records from the practice of a private pediatric ophthalmologist confirmed that late detection is a frequent occurrence among children with amblyopia who have had good access to health care. A case-control study was then used to identify factors associated with delayed diagnosis, in which children with an adverse outcome (diagnosed at or after 5 years of age) were compared with those with an optimal outcome (diagnosed before 5 years of age). The chart review identified 161 children with amblyopia who participated in this study; 75 had late diagnoses (case patients) and 86 served as control patients. Children with early diagnoses more often had the following characteristics: a positive family history of strabismus, greater degrees of strabismus (when strabismus was present), higher maternal educational level, greater parental suspicion that an eye problem existed, and an increased chance that the parents requested the eye examination that led to the diagnosis. The parents of children with late diagnoses expressed less concern over the seriousness of amblyopia but were more likely to report that their children had suffered adverse consequences of amblyopia. When diagnosed early, amblyopia was more often detected by the child's primary health care provider. Physicians of the children with early diagnoses more often reported compliance with both the American Academy of Pediatrics guidelines for vision screening in infancy and referral for vision problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Amblyopia↗
PubMed1995

[The application of the pattern visual-evoked potential in the diagnosis and treatment of amblyopia].

PURPOSE: To research into the value of the application in the diagnosis and treatment of amblyopia, and to discuss the mechanism of amblyopia. METHODS: The subjects were divided into three groups: 108 amblyopia eyes; 180 normal eyes and 26 amblyopia eyes during the treatment with Madopar. PVEP was observed with black-white checks pattern-reversal stimulation at several spatial frequencies (30', 60', 90'). RESULTS: P1 latency of the amblyopia eyes prolongs at the high frequency (30' angle of view), in which the occurrence rate of abnormal PVEP is 68.5%. Through detecting PVEP during the treatment of amblyopia with Madopar, we found P1 latency shortened and amplitude increased (P < 0.05). CONCLUSION: It is better to use P1 latency to observe the visual function of patients with amslyopia with stimulation at 30' angle of view. PVEP is an important objective index in diagnosis and evaluating the curative effect of amblyopia.

Adolescent↗
PubMed2005

Clinical profile of amblyopia in Pakistani children age 3 to 14 years.

OBJECTIVE: To study the clinical profile of amblyopia in children age 3 to 14 years. DESIGN: A cohort study. PLACE AND DURATION OF STUDY: The study was conducted over a period of two years from June 2001 to June 2003 at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan. PATIENTS AND METHODS: This study included 316 children. Visual acuity was tested with Snellen type and Lea symbols chart according to the level of cooperation of the children. Cycloplegic refraction and orthoptic assessment was performed on all children. RESULTS: One hundred and eighty-two children were between 3 to 8 years age and 134 were between 8 to 14 years. Mean age was 8 years. One hundred and twenty children had strabismic amblyopia, 136 children had anisometropic amblyopia, while 60 children had combined mechanism amblyopia (strabismus and anisometropia both). CONCLUSION: The results indicate the importance of screening school-going children for refractive error and amblyopia and the importance of a future prospective study on the magnitude, cause and treatment of amblyopia at more treatable age.

Adolescent↗
PubMed2006

Detection of abnormal visual cortex in children with amblyopia by voxel-based morphometry.

PURPOSE: To detect the abnormalities of gray matter in children with amblyopia by voxel-based morphometry (VBM). DESIGN: Prospective, nonrandomized clinical trial. METHODS: Thirteen children with amblyopia and 14 normally sighted children underwent magnetic resonance (MR) examination. The two groups were age-matched with a mean age of 5.8 years. In the amblyopia group, five children had strabismus amblyopia, and eight had anisometropic amblyopia. We analyzed the original 3-dimensional T1 brain images using the VBM module within the widely used analysis software package SPM2 (Welcome Department of Cognitive Neurology, London, United Kingdom). After normalization, segmentation, and smoothing of the images, comparison between amblyopic and control groups was derived for the gray matter of the entire brain using parametric statistics. RESULTS: The results of VBM analysis indicated that the amblyopic group had decreased gray matter density in the middle frontal gyrus, parahippocampal gyrus, fusiform gyrus, inferior temporal gyrus of the left hemisphere, and the bilateral calcarine cortices. The radii of these regions ranged from 12 to 36 voxels. These abnormalities were consistent with morphologic changes in brain regions related to visual function. CONCLUSIONS: Using MR and VBM analysis, we detected morphologic changes in the visual cortex of children with amblyopia, which may indicate developmental abnormalities of visual cortex during the critical growth period.

Amblyopia↗
PubMed2005

A randomized pilot study of near activities versus non-near activities during patching therapy for amblyopia.

BACKGROUND: To plan a future randomized clinical trial, we conducted a pilot study to determine whether children randomized to near or non-near activities would perform prescribed activities. A secondary aim was to obtain a preliminary estimate of the effect of near versus non-near activities on amblyopic eye visual acuity, when combined with 2 hours of daily patching. METHODS: Sixty-four children, 3 to less than 7 years of age, with anisometropic, strabismic, or combined amblyopia (20/40 to 20/400) were randomly assigned to receive either 2 hours of daily patching with near activities or 2 hours of daily patching without near activities. Parents completed daily calendars for 4 weeks recording the activities performed while patched and received a weekly telephone call in which they were asked to describe the activities performed during the previous 2 hours of patching. Visual acuity was assessed at 4 weeks. RESULTS: The children assigned to near visual activities performed more near activities than those assigned to non-near activities (by calendars, mean 1.6 +/- 0.5 hours versus 0.2 +/- 0.2 hours daily, P < 0.001; by telephone interviews, 1.6 +/- 0.4 hours versus 0.4 +/- 0.5 hours daily, P < 0.001). After 4 weeks of treatment, there was a suggestion of greater improvement in amblyopic eye visual acuity in those assigned to near visual activities (mean 2.6 lines versus 1.6 lines, P = 0.07). The treatment group difference in visual acuity was present for patients with severe amblyopia but not moderate amblyopia. CONCLUSIONS: Children patched and instructed to perform near activities for amblyopia spent more time performing those near activities than children who were instructed to perform non-near activities. Our results suggest that performing near activities while patched may be beneficial in treating amblyopia. Based on our data, a formal randomized amblyopia treatment trial of patching with and without near activities is both feasible and desirable.

Activities of Daily Living↗
PubMed1992

Asymmetric inferior oblique overaction and its association with amblyopia in esotropia.

To evaluate the frequency of asymmetric inferior oblique overaction and its relationship to amblyopia, the authors reviewed the records of all patients who presented to Children's Hospital of Dallas with esotropia over a 2-year period. A total of 368 patients were identified and classified as infantile esotropia, acquired accommodative or partially accommodative esotropia, or acquired nonaccommodative esotropia. Two hundred forty-two patients (66%) had no amblyopia, of which 90% had symmetric inferior oblique activity. One hundred twenty-six patients (34%) had amblyopia; of these patients, 93 (74%) had symmetric inferior oblique action. Amblyopia was strongly associated with increased inferior oblique overaction in the amblyopic eye (P less than 0.001). This finding was consistent for all subgroups. The relative risk for having amblyopia as opposed to normal vision in an eye with increased inferior oblique activity relative to the contralateral eye was 5.6 to 8.6 depending on the eye. Amblyopia should be strongly suspected in patients with esotropia and asymmetric inferior oblique activity, specifically in the eye with more inferior oblique overaction.

Amblyopia↗
PubMed1997

Poverty predicts amblyopia treatment failure.

OBJECTIVE: Clinical impressions suggested a hypothesis that poverty is associated with poorer results in amblyopia therapy. To test this hypothesis, we compared patients with amblyopia who had Medicaid assistance with those who did not. METHODS: Of 1272 patients recorded to have amblyopia in the eye center computer, 280 met inclusion criteria of first visit under age 10 years and had treatment instituted and visual acuities recorded then and at follow-up visits. Seventy-one had Medicaid assistance, and 209 did not. Age at first visit, age at final visit, severity of amblyopia as measured by visual acuity at the first visit, and number of visits were all statistically indistinguishable. A large difference in final visual acuity, number of missed visits, and the parent's estimate of compliance was found. RESULTS: The likelihood of good final visual acuity of 20/30 or better was 26.8% in the Medicaid group and 58% in the non-Medicaid group. The likelihood of a poor final visual acuity of 20/70 or worse was 33.8% in the Medicaid group versus 11.5% in the non-Medicaid group. CONCLUSION: These results established socioeconomic status, measured by qualification for Medicaid assistance, to be an important predictor for success for amblyopia therapy. Work is in progress to better understand more specific factors and to meet the therapeutic challenge of amblyopia therapy for children.

Amblyopia↗
PubMed1997

Positron-emission tomographic study of human amblyopia with use of defined visual stimuli.

PURPOSE: The purpose of this study was to use positron emission tomography (PET) to evaluate effects of amblyopia on cerebral blood flow and glucose metabolism in humans viewing defined visual stimuli and to correlate these effects with specific behavioral and electrophysiologic measures of visual function. METHODS: One subject with normal vision and five patients with amblyopia were prospectively studied. During monocular viewing of a checkerboard reversal stimulus by each subject, we performed PET imaging of relative cerebral glucose metabolism with use of [18F]fluorodeoxyglucose, PET imaging of relative cerebral blood flow with use of H2(15)O, and visual evoked potentials. Control studies were also performed with use of binocular occlusion and during presentation of stationary and horizontally drifting checkerboards. These data were correlated with letter acuities and contrast sensitivity functions for each eye. RESULTS: Although spatial resolution was superior for glucose metabolic imaging, PET readily demonstrated activation of calcarine cortex with use of both metabolic and blood flow tracers. Even in patients with mild amblyopia, functional activation of calcarine cortex was reduced in amblyopic eyes compared with sound eyes to a degree more closely correlated with visual acuity than were visual evoked potential amplitudes to the same stimulus. When responses to drifting versus stationary stimuli were compared, a putative motion processing center was identified in the right temporoparietal region. Activity in this motion center was relatively preserved during viewing of drifting stimuli by the affected eye of an anisometropic amblyopic subject, but was attenuated during viewing of the same stimulus by the affected eye of a strabismic amblyopic subject. CONCLUSIONS: PET imaging of blood flow and metabolism can quantitatively evaluate functional deficits resulting from amblyopia in striate as well as extrastriate visual areas. Calcarine cortical function correlates closely with severity of amblyopia, but function in a putative motion processing area may vary according to the type of amblyopia present.

Adult↗
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↗