Elsevier

Ophthalmology

Volume 113, Issue 6, June 2006, Pages 895-903
Ophthalmology

Original Article
Treatment of Anisometropic Amblyopia in Children with Refractive Correction

https://doi.org/10.1016/j.ophtha.2006.01.068Get rights and content

Objective

To evaluate the effectiveness of refractive correction alone for the treatment of untreated anisometropic amblyopia in children 3 to <7 years old.

Design

Prospective, multicenter, noncomparative intervention.

Participants

Eighty-four children 3 to <7 years old with untreated anisometropic amblyopia ranging from 20/40 to 20/250.

Methods

Optimal refractive correction was provided, and visual acuity (VA) was measured with the new spectacle correction at baseline and at 5-week intervals until VA stabilized or amblyopia resolved.

Main Outcome Measures

Maximum improvement in best-corrected VA in the amblyopic eye and proportion of children whose amblyopia resolved (interocular difference of ≤1 line) with refractive correction alone.

Results

Amblyopia improved with optical correction by ≥2 lines in 77% of the patients and resolved in 27%. Improvement took up to 30 weeks for stabilization criteria to be met. After stabilization, additional improvement occurred with spectacles alone in 21 of 34 patients observed in a control group of a subsequent randomized trial, with amblyopia resolving in 6. Treatment outcome was not related to age, but was related to better baseline VA and lesser amounts of anisometropia.

Conclusion

Refractive correction alone improves VA in many cases and results in resolution of amblyopia in at least one third of 3- to <7-year-old children with untreated anisometropic amblyopia. Although most cases of resolution occur with moderate (20/40–20/100) amblyopia, the average 3-line improvement in VA resulting from treatment with spectacles may lessen the burden of subsequent amblyopia therapy for those with denser levels of amblyopia.

Section snippets

Materials and Methods

This study, supported through a cooperative agreement with the National Eye Institute of the National Institutes of Health, was conducted by the Pediatric Eye Disease Investigator Group at 34 clinical sites. The protocol and Health Insurance Portability and Accountability Act–compliant informed consent forms were approved by the respective institutional review boards. The parent or guardian of each study patient gave written informed consent. Study oversight was provided by an independent data

Results

Between February 2004 and December 2004, 84 patients with untreated anisometropic amblyopia ranging from 20/40 to 20/250 were enrolled in this study at 34 sites. The number of patients enrolled per site ranged from 1 to 9 (median = 2). The mean age of the patients at study entry was 5.2±0.9 years; 46% were female and 75% were white. Mean VA measurements at study entry were 0.60 logMAR (approximately 20/80) in the amblyopic eye and 0.04 logMAR (approximately 20/20−2) in the sound eye. Table 1

Discussion

In this prospective observational study of 84 untreated anisometropic amblyopic children 3 to <7 years old, we found that refractive correction with spectacles alone improved amblyopic eye VA an average of 2.9 lines. Visual acuity improved from baseline by ≥2 lines in 77% of the patients and by ≥3 lines in 60%. Resolution of amblyopia occurred in 27% of the cohort during the study. Additionally, amblyopia resolved in 6 of 34 (18%) patients with residual amblyopia who continued to be treated

Acknowledgment

LensCrafters provided spectacles to some patients at a reduced cost.

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Manuscript no. 2005-1116.

Supported through a cooperative agreement from the National Eye Institute, Bethesda, Maryland (grant no.: EY11751).

There are no conflicts of interest.

The writing committee and a list of the members of the Group participating in the trial appear in “Appendix.”

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