Long-term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia

Department of Clinical Vision Sciences, La Trobe University, Victoria, Australia.
Binocular vision & strabismus quarterly 02/2007; 22(1):49-56.
Source: PubMed


To investigate the long-term vision outcomes of amblyopia treatment in "successfully" compared with "unsuccessfully" treated patients.
Forty-two participants (n=42, mean age 14.8 years, range 10-25 years) were enrolled in the study. Individuals with strabismic or mixed (strabismic and anisometropic) amblyopia were examined at a mean of 6.6 years (range 1-18 years) after cessation of amblyopia treatment. Participants were classified as being "successfully" treated (Group 1) if visual acuity of 6/7.5 or better was achieved at cessation of treatment, or "unsuccessfully" treated (Group 2) if visual acuity of 6/9 or less was achieved at cessation of treatment. Visual acuity was analyzed by calculating an interocular score or difference in visual acuity between the amblyopic and non amblyopic normal (control) eye.
A deterioration of visual acuity occurred in 62% of the participants in both Groups 1 and 2. The mean deterioration of visual acuity over time for either group was less than one LogMAR chart line and was not "statistically significant" by convention (F [1,39]=3.361, p=0.074). The outcomes achieved at cessation of treatment did not "statistically significantly" affect the mean deterioration that occurred over time (F [1,49]=0.031, p=0.860).
Visual acuity was relatively stable over a mean followup period of 6.6 years. The treatment outcome and the success of amblyopia treatment were found to be irrelevant to long term stability of visual acuity. These findings suggest that amblyopia treatment mostly results in a lasting improvement in visual acuity, and that both unsuccessfully and successfully treated individuals maintain their visual acuity improvement achieved during treatment.

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    ABSTRACT: To investigate the impact of fixation on vision outcomes in patients with amblyopia undergoing atropine treatment and the validity of the "cyclo-swap test" (CST) as a method of predicting atropine efficacy. Sixteen children with amblyopia were included. The initial examination included a vision assessment and CST, in which fixation was assessed at 1/3 m, 6 m, and at distances less than 1/3 m. Children were treated for 10 weeks and reviewed at 5-week intervals with cessation of atropine 4 days prior. Vision and fixation were assessed at the follow-up visits. Children demonstrating no fixation swap initially were additionally observed after 1 week of atropine treatment under maximum cycloplegia. Eight children demonstrated a fixation swap (FS group) to the amblyopic eye during the CST at either 1/3 or 6 m, and 8 demonstrated no fixation swap (NFS group). By the end of the 10-week treatment period, both groups demonstrated a mean visual acuity improvement of between 2 and 3 lines (FS = 0.22 log units; NFS = 0.27 log units). Six of the 8 children in the NFS group demonstrated improvement in vision, all of whom also demonstrated a fixation swap at some stage. Vision improvement in patients using atropine is likely to be attributable to a fixation swap that occurs during the treatment phase. The CST performed at 1/3 and 6 m has little value in predicting improvements in vision; however, when performed at distances of less than 1/3 m, it may provide valuable clinical information about atropine efficacy.
    No preview · Article · Nov 2009 · Journal of Pediatric Ophthalmology & Strabismus