Search

Purpose: To evaluate the sensitivity and specificity of the PlusOptix S12C device in detecting amblyopia risk factors (ARFs) in children aged 2-7 years, in accordance with the 2020 Israeli Ministry of Health (MOH) directives and the 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines., Methods: A cross-sectional, observational study was conducted at a tertiary care hospital. Children presenting for vision testing were screened using the PlusOptix S12C device, and results were compared with the gold standard cycloplegic refraction and cover test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the overall population and subpopulations based on ARFs., Results: A total of 196 children aged 24-84 months were screened (46.4% boys, mean age: 56.94 ± 17.52 months). The PlusOptix S12C demonstrated an overall sensitivity and specificity of 85.5% and 82.3%, respectively. Sensitivity for hyperopia (>4.00 D) was lower (47.7%), while specificity was 81.7%. For strabismus (>8 Δ), sensitivity and specificity were 67.8% and 91.1%, respectively. The device failed to produce readings in 21.9% of children, primarily those with significant refractive errors or strabismus., Conclusions: The PlusOptix S12C demonstrated good overall sensitivity and specificity for detecting ARFs, making it a valuable tool for large-scale paediatric vision screening, including in very young children. However, its inherent limitations in detecting high hyperopia and strabismus, combined with the high prevalence of these conditions in the untestable group, highlight the need for supplementary evaluation. Children who receive a 'no result' or 'unable-to-read' outcome on the device should be referred for a full examination, including cycloplegic refraction, to ensure ARFs are not missed. While the device aligns well with the 2021 AAPOS and MOH guidelines, careful attention to its limitations in high-risk subpopulations is essential to optimise screening efficacy and outcomes., (© 2025 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Clinical Relevance: The visual system plays an important role in the development of the vestibular-ocular reflex (VOR). In clinical practice, the ocular vestibular evoked myogenic potential (oVEMP) test is used to assess contralateral VOR., Background: This study sought to compare the oVEMP in patients with anisometropic, strabismic, and mixed amblyopia using unilateral and bilateral (simultaneous binaural) stimulation., Methods: Forty-two amblyopic patients (20 males and 22 females) with a mean age of 10.48 ± 4.00 years (range: 5 - 20 years) were examined. The Titmus stereopsis test, alternate cover test, and best-corrected visual acuity were evaluated. Patients were divided into three groups: anisometropic, strabismic, and mixed amblyopia. The oVEMP responses including the amplitude of electrical activity (n1-p1 complex) and the latencies (n1 and p1) of the VOR responses were recorded under unilateral and bilateral stimulations., Results: In the anisometropic and strabismic group, n1 latency was significantly faster in the non-amblyopic eyes compared to amblyopic eyes (Z = -2.04, p  = 0.042, andZ = -2.54, p  = 0.024 respectively). Mean p1 latency was significantly faster in the non-amblyopic eyes compared to the amblyopic eyes of the strabismic group (Z = -2.31, p  = 0.011)In all groups, the p1 latency was faster in the non-amblyopic eye compared to bilateral stimulation (all, p  < 0.05). In all groups, the n1-p1 amplitude was not significantly different between the two eyes, and between each eye and bilateral stimulation (all, p  > 0.05). No significant correlation was found between the depth of amblyopia and n1 and p1 responses (all, p  > 0.05). In all groups there was no significant difference in the latency of n1 and p1 between the amblyopic eye and bilateral stimulation (all, p  > 0.05)., Conclusion: Regardless of its type, amblyopia affects vestibular-ocular reflex responses. Further research is warranted to clarify the effect of the disease and its treatment on the ocular-vestibular system.

Introduction: Amblyopia is two Snellen line difference between both eyes. Red filter therapy is a treatment option for amblyopia based on principle of syntonic phototherapy. The purpose of this study is to assess the stereopsis in amblyopic patient using syntonic phototherapy., Methods: A Qusai experimental study was conducted from August 2021 to December 2021 at Madina Teaching Hospital Faisalabad. A total 30 subjects of both gender and ages ranging between 8 to 18 years were included through a non-probability purposive sampling technique. The sample was considered of 15 anisometropic amblyopes and 15 strabismic amblyope. Data was collected using a Performa and pre assessments of stereopsis by Titmus fly chart were recorded without red filter. Red filter glasses were prescribed for 4 week, post assessment data was recorded after 4 weeks. Data was analyzed by using Paired sample T test and Independent Sample T test in SPSS 20 software., Results: After syntonic phototherapy significant improvement was seen, mean stereopsis was 48.00000 ( p  = 0.002) in anisometropic amblyopes while mean improvement of stereopsis 1.670.93333 ( p  = 0.00) in strabismic amblyopes. Anisometropic amblyopic patients showed significantly better improvement in stereopsis ( p  = 0.00) by syntonic phototherapy as compared to strabismic amblyopes., Conclusion: Significant improvement was seen in stereopsis, while improvement was more significant in anisometropic amblyopes as compared to strabismic amblyopes. Children were obsessed with the red filter glasses while their parents found syntonic therapy simple plus facile and gave good results. So, eye care professionals must be aware of this new therapy and they should keep syntonic phototherapy in mind whenever they are dealing with amblyopic patients.

Purpose: The aim of this study was to investigate changes in the light-adapted (LA) electroretinogram (ERG) associated with paediatric amblyopia., Method: A total of 220 eyes from 81 postoperative paediatric cataract patients and 29 healthy children were enrolled in four groups, namely controls, unilaterally amblyopic eyes, non-amblyopic fellow eyes and bilaterally affected eyes. Differences in LA ERG variables (peak time and amplitude of a- and b-waves and photopic negative response [PhNR]) were compared across groups, as well as their associations with visual acuity and changes in axial length., Results: The peak time of both the a-wave (p < 0.001) and b-wave (p < 0.001), as well as the amplitude of the b-wave (p < 0.001) and the PhNR (p = 0.04) differed significantly across groups. Compared to controls, affected eyes in both unilateral and bilateral groups showed significantly lower b-wave amplitude and longer a- and b-wave peak times (p < 0.008, Bonferroni-corrected). Additionally, fellow eyes in the unilateral group exhibited significantly longer b-wave peak times (p = 0.008). For all eyes, poorer visual acuity was associated with a longer peak time for both the a- (p = 0.006) and b-waves (p = 0.003), as well as lower amplitudes of the b-wave (p = 0.006) and PhNR (p = 0.02)., Conclusions: Changes in LA ERG components suggest alteration of retinal physiology in deprivation amblyopia. Thus, the LA ERG may provide additional information to help understand the mechanisms underlying deprivation amblyopia., (© 2024 College of Optometrists.)

Purpose: To identify clinical and sociodemographic factors associated with disparities in amblyopia treatment outcomes., Design: Retrospective chart review., Participants: Children ≤ 8 years of age diagnosed and treated for unilateral refractive or strabismic amblyopia at our institution from 2012 to 2022., Methods: Children with amblyopia were categorized by outcome: resolved amblyopia (< 0.2 logarithm of the minimum angle of resolution [logMAR] interocular difference [IOD] in visual acuity [VA] or no fixation preference in nonverbal patients) or persistent amblyopia. Demographic and clinical data were recorded from the medical record. Zip codes were used to calculate Childhood Opportunity Index (COI) scores, estimated annual household income, and distance to hospital., Main Outcome Measures: Sociodemographic and clinical factors were compared between children with resolved and persistent amblyopia. Factors significant at P < 0.10 on univariate analysis were included in a multivariable regression model., Results: A total of 168 patients met inclusion criteria, and 131 patients (78%) had resolved amblyopia. Demographic factors associated with resolution of amblyopia were younger age at diagnosis (3.3 ± 1.7 years vs. 4.5 ± 1.9 years; P = 0.0009), English as the primary language (79.4% vs. 62.2%; P = 0.04), higher estimated annual income ($83 315.93 ± $29 276.64 vs. $71 623.00 ± $26 842.56; P = 0.03), higher COI scores (50.9 ± 27.3 vs. 40.0 ± 26.4; P = 0.03), and living farther from our institution (28.6 ± 37.6 miles vs. 14.9 ± 12.7 miles; P = 0.003). Patients with resolved amblyopia also had higher rates of treatment compliance (83.2% ± 25.0% vs. 75.6% ± 24.4%; P = 0.009) and shorter delays in follow-up (40.1 ± 76.8 days vs. 61.1 ± 90.4 days; P = 0.02). Amblyopia persistence was borderline associated with governmental insurance and higher presenting IOD in VA (both P = 0.06). On multivariate analysis, only younger age at amblyopia diagnosis (P = 0.0010) remained significantly associated with amblyopia resolution., Conclusions: Our findings suggest that disparities in amblyopia outcomes are related to differences in age at diagnosis. Interventions to lower the age at which amblyopia is diagnosed, such as programs to improve vision screening rates and access to pediatric eye care in at-risk groups, may directly address inequities in rates of amblyopia resolution., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To estimate the prevalence of amblyopia and refractive errors among 6-year-old children in Greenland and to assess the impact of incorporating autorefraction, stereoacuity and near visual acuity testing into vision screening., Methods: In this cross-sectional study, 517 children (238 girls and 279 boys) from 21 locations in Greenland were screened using HOTV charts for distance and near visual acuity (VA), stereoacuity test and non-cycloplegic autorefraction. Referral criteria for further ophthalmological examination included a VA of ≥0.2 logMAR on the worse-seeing eye or an interocular VA difference of ≥2 lines., Results: Initial screening identified amblyopia (defined as VA of ≥0.3 logMAR) in 7% (unilateral) and 3% (bilateral) of children. However, subsequent ophthalmological examinations confirmed amblyopia in under 40% of referrals. Significant interocular VA differences were found in 9%. The prevalence of refractive errors at the screening was 3% for myopia (≤-0.5 dioptres), 10% for hyperopia (>+2.0 dioptres) and 14% for astigmatism (≤-1.00 dioptres), while the corresponding prevalences at the ophthalmological examination were 4% for myopia, 8% for hyperopia and 6% for astigmatism. Combining screening measurements increased the positive predictive values, thereby enhancing screening accuracy. Specifically, the incorporation of autorefraction or stereoacuity with distance VA demonstrated to be the most effective combination. Six percent of the children were prescribed glasses after the screening procedure., Conclusion: This study provides the first visual profile of Greenlandic schoolchildren. Incorporating autorefraction, stereoacuity and near visual acuity in vision screenings enhanced the efficacy of detection of vision anomalies. Although this may lead to more false positives, accurate screening is crucial in regions with limited ophthalmological resources., (© 2024 The Author(s). Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

To evaluate the effectiveness of syntonic phototherapy and compare it with partial time occlusion to improve visual acuity in cases of refractive amblyopia. This study is a prospective, comparative, and randomized study. It included 40 patients. Their mean age ± SD was 14.45 ± 10.03 years (Range: 6-45 years). Twenty patients were subjected to partial time occlusion of the sound eye, and 20 received syntonic phototherapy treatment.The study revealed that there was statistically significant improvement in visual functions, UCVA, BCVA, AOP, and functional visual field in patients who were subjected to syntonic phototherapy, whereas the improvement of UCVA and BCVA in patients who were subjected to conventional treatment was satisfactory but less than that reported by syntonic therapy. Visual acuity increased significantly in patients with amblyopia after syntonic phototherapy as compared to partial occlusion therapy., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: To analyze the clinical characteristics of patients with abnormal head posture (AHP) due to ocular causes and investigate the effect of treatment on the change in AHP., Materials and Methods: Patients with AHP admitted to the strabismus unit of our clinic between 2011 and 2022 were retrospectively analyzed. The patients' clinical and demographic data and change in AHP after treatment were recorded., Results: A total of 172 patients, 86 females (50%) and 86 males (50%), with a mean age of 14.1±13.9 years were included in the study. The most common ocular causes of AHP were fourth cranial nerve palsy (50%), Duane retraction syndrome (16.9%), and A-V pattern strabismus (15.1%). Sixth cranial nerve palsy, third cranial nerve palsy, nystagmus blockade syndrome, extraocular muscle fibrosis, Brown syndrome, oculocutaneous albinism, and heavy eye syndrome were diagnosed less frequently. The most common AHP type was head tilted position (52.3%), followed by head turned (40.1%), chin down/up (3.5%), and combined form (4.1%). There was a significant relationship between AHP type and diagnosis (p<0.001). Amblyopia was present in 55 (35.7%) and absent in 99 (64.3%) patients. There was a significant relationship between amblyopia and both diagnosis (p<0.001) and AHP type (p=0.003). Of 172 patients, 100 (58.1%) underwent strabismus surgery, 10 (5.8%) had botulinum toxin injection, and 2 (1.2%) were prescribed prism glasses. Sixty patients (34.9%) were only followed up. Among 94 patients who continued follow-up, AHP was reduced in 77.3% and completely resolved in 16.7% of patients treated surgically, and was reduced in 50% and completely resolved in 25% of those treated with botulinum toxin., Conclusion: The causes of AHP are varied. Ophthalmological and orthoptic examinations should be performed in patients presenting with AHP, and strabismus surgery or botulinum toxin administration may reduce or completely correct AHP in eligible patients., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2025 by the Turkish Ophthalmological Association / Turkish Journal of Ophthalmology published by Galenos Publishing House.)

Purpose: To estimate the prevalence of uncorrectable visual impairment and to identify sociodemographic factors associated with such impairment among US adolescents., Design: Cross-sectional study., Methods: Setting: 1999-2008 National Health and Nutrition Examination Survey (NHANES) STUDY POPULATION: Adolescents (age 12-19 years) OBSERVATION: Best-corrected visual acuity OUTCOME MEASURES: Prevalence of unilateral uncorrectable visual impairment, defined as best-corrected visual acuity of 20/40 or better in one eye with greater than 2 lines of visual acuity asymmetry, and of bilateral uncorrectable visual impairment, defined as best-corrected visual acuity worse than 20/40 in both eyes. Multivariable logistic regression was used to identify sociodemographic factors (race and ethnicity, caregiver education, household income, food security, citizenship status, health insurance type, and healthcare access) associated with uncorrectable visual impairment, adjusting for age and sex., Results: The survey identified 9949 participants (mean [SD] age, 15.86 [2.27] years; 4914 female participants [49%]).The prevalence estimate of uncorrectable visual impairment was 4.0% (491 participants, 95% CI 3.4-4.7%). After adjusting for age and sex, there were increased odds of uncorrectable visual impairment among those with family income below poverty level (OR, 1.59; 95% CI, 1.14-2.22) compared to poverty level and above, those with Mexican-American ethnicity (OR, 1.64; 95% CI, 1.18-2.29) or Non-Hispanic Black race (OR, 1.43; 95% CI, 1.03-1.99) compared to non-Hispanic White race, those with food insecurity (OR, 1.67; 95% CI, 1.21-2.32), those with caregiver education below high school (OR, 1.68; 95% CI, 1.24-2.28), those with public insurance (OR, 1.67; 95% CI, 1.21-2.30), and those with no insurance (OR, 1.71; 95% CI, 1.12-2.59) compared to those with private insurance., Conclusions: Socioeconomic disparities in the prevalence of uncorrectable visual impairment are evident by adolescence. Interventions to treat amblyopia, the most common cause of uncorrectable vision loss, have limited efficacy in late childhood. Efforts are needed to identify and treat amblyopia in socioeconomically disadvantaged populations at an earlier age to prevent permanent vision loss., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Isdin Oke reports financial support was provided by Knights Templar Eye Foundation. Isdin Oke reports financial support was provided by Harvard University Harvard Catalyst. Isdin Oke reports financial support was provided by Research to Prevent Blindness. Eric D. Gaier reports financial support was provided by National Institutes of Health. David G. Hunter reports a relationship with Luminopia, Inc. that includes: consulting or advisory and equity or stocks. Eric D. Gaier reports a relationship with Luminopia, Inc. that includes: consulting or advisory and equity or stocks. David G. Hunter reports a relationship with Rebion that includes: board membership and equity or stocks. Eric D. Gaier reports a relationship with Stoke Therapeutics Inc that includes: consulting or advisory. Eric D. Gaier reports a relationship with NeuroField Inc that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025. Published by Elsevier Inc.)

Background: High anisometropia is often accompanied by amblyopia. One percent atropine penalization is an important treatment for anisometropic amblyopia and is as effective as occlusion therapy. On the other hand, 1% atropine had the strongest effect on controlling refractive error and axial length (AL) changes in myopic patients., Case Presentation: A female child was diagnosed with anisometropia at the age of two. Cycloplegic retinoscopy examination revealed refraction of + 2.5 diopters the right eye and -8.5/-1.5 × 120 diopters the left eye, and full correction spectacles and patching therapy were prescribed for the child. Anisometropic amblyopia was then diagnosed because the best corrected vision acuity in highly myopic eyes is 20/100. Owing to poor compliance, visual acuity recovery in the amblyopic eye was unsatisfactory, and 1% atropine was applied two times per week for the fellow (right) eye. Since then, the fellow eye has experienced rapid myopization, with the refractive error increasing to -7.5/-1.25 × 15 diopterswithin five years. In addition, the visual acuity of the amblyopic (left) eye has improved gradually to 20/20, although the refraction status has remained stable., Conclusions: In this report, a high anisometropic amblyopia patient underwent rapid myopization in the fellow eye with constant use of 1% atropine, in contrast to the stable refraction status of the amblyopic eye., Competing Interests: Declarations. Ethics approval and consent to participate: This prospective study was approved by the Lixiang Eye Hospital of Soochow University Institutional Review Board and adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from the patient’s parents. Consent for publication: Written informed consent was obtained from the patient’s parents for the publication of clinical details and clinical images. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Amblyopia is associated with structural differences in ocular biometrics, but existing studies often lack long-term follow-ups. This study compares three-year changes in ocular biometric components in amblyopic and non-amblyopic eyes., Methods: In this prospective cohort, study data were collected in 2015 and 2018 in Shahroud, northeast Iran. The sample comprised 4968 primary students (9935 eyes), including 4931 non-amblyopic students (9893 eyes) and 37 students with amblyopia (42 eyes). Axial length, keratometry, central corneal thickness, lens thickness, pupil diameter, anterior chamber depth, lens power and vitreous chamber depth were measured using Lenstar LS900. Multilevel mixed-effects regression models were used to determine any association between variables., Results: The mean age of children without and with amblyopia at baseline were 9.7 ± 1.7 and 9.9 ± 1.5 years, respectively. The mean axial elongation in amblyopic and non-amblyopic groups over three years was 0.37 (95% CI: 0.34-0.40) and 0.33 mm (95% CI: 0.31-0.34), respectively (p < 0.001). Amblyopic eyes showed greater axial elongation than non-amblyopic eyes (p < 0.001). Anterior chamber depth was constant in amblyopic eyes while it decreased in non-amblyopic eyes by 0.13 mm. Vitreous chamber depth increased significantly in both groups, with a greater increase observed in the amblyopic eyes (0.36 vs. 0.28 mm) (p < 0.001). Flat and steep keratometry increased significantly in amblyopic eyes (p < 0.001), while it was constant in non-amblyopic eyes. Lens power decreased significantly in both groups (p < 0.001). The increase in the axial length and vitreous chamber depth in the amblyopic eye was greater than in the non-amblyopic eyes (p < 0.001). The spherical equivalent change in both groups was - 0.31 D., Conclusions: Amblyopia was associated with significant changes in key biometric parameters, offering valuable insight into the structural alterations underlying the condition., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Helsinki Declaration. The Ethics Committee of Shahroud University of Medical Sciences approved all procedures involving students. We obtained written informed consent from all parents or students’ legal guardians and oral consent from all the students in both phases of SSCECS (Ethical code: IR.SHMU.REC.1396.195). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

We employed high-resolution fMRI to distinguish the impacts of anisometropia and strabismus amblyopia on the evoked ocular dominance (OD) response. Sixteen amblyopic participants (eight females) plus eight individuals with normal vision (one female), participated in this study for whom we measured the difference between the response to stimulation of the two eyes, across areas V1-V4. In controls, the evoked OD response formed the expected striped pattern within V1. Compared to controls, the OD response in amblyopic participants formed larger fused patches that extended into downstream visual areas. Moreover, both anisometropic and strabismic participants showed elevated OD responses across V1-V4. Beyond these common effects, and despite similar densities of amblyopia between the two groups, strabismus, and anisometropia had differential impacts on the OD bias, binocular response, and correlation between V1 depth levels. Specifically, we found a greater increase in the size of the V1 portion that responded preferentially to fellow eye stimulation in anisometropic compared with strabismic individuals. We also found a greater difference between the amplitudes of the response to binocular stimulation, in those regions that responded preferentially to the fellow versus amblyopic eye, in anisometropic compared with strabismic participants. In contrast, strabismic participants demonstrated an increased correlation between the OD responses evoked within V1 superficial and deep depths, whereas anisometropic individuals did not. These results provide the primary direct functional evidence for distinct impacts of strabismus and anisometropia on the mesoscale functional organization of the human visual system, thus extending what was inferred previously about amblyopia from animal models., Competing Interests: The authors declare no competing financial interests., (Copyright © 2025 the authors.)

Purpose: The relationship between refractive error at age 1 and the risk of developing amblyopia or accommodative esotropia, and the protection offered by early glasses, is unknown. These are determined in the Early Glasses Study, a prospective, population-based, longitudinal, randomized controlled study. We report baseline findings., Methods: Healthy children aged 12-18 months were recruited at Children's Healthcare Centres (CHCs) and received an entry orthoptic examination followed by cycloplegic retinoscopy. Children with amblyopia, strabismus, ophthalmic disease or very high refractive error were excluded. Those exceeding the AAPOS 2003 Criteria (> + 3.5D spherical equivalent (SE), > 1.5D astigmatism, > 1.5D anisometropia) were randomized into wearing glasses or not, and are followed-up by research orthoptists. Other children are followed-up by regular vision screening at CHCs and visual acuity is measured in all children at age 4., Results: Parents of 865 children were called, 123 were excluded. Of 742 children enrolled, 601 underwent the entry orthoptic examination at age 14.5 ± 1.7 months. Mean SE was + 1.73 ± 1.18D, astigmatism -0.70 ± 0.44D, anisometropia 0.21D (IQR: 0-0.25). Of 62 (10.3%) children exceeding the Criteria, 52 were randomized into wearing glasses or not. Of 539 other children, 522 are followed up at CHCs. In total, 31 were excluded: 2 had strabismus and amblyopia, 7 strabismus, 2 amblyopia suspect, 1 strabismus suspect, 1 squinting during sinusitis, 4 excessive refractive error, 9 myopia, 2 ptosis, 1 oculomotor apraxia, 1 Duane syndrome, 1 congenital nystagmus., Conclusion: Prevalence of strabismus (10/601) was as expected, but prevalence of amblyopia (2/601) was low, suggesting that common amblyopia develops later than generally thought., Key Messages: What is known High refractive errors cause amblyopia, but no study has determined the exact relationship between the kind and size of refractive error at age 1 and the risk to develop amblyopia, and assessed the protective effect of glasses in a controlled, population-based, longitudinal study. What is new At baseline, 601 children received a full orthoptic examination followed by retinoscopy in cycloplegia at the age of 14.5 ± 1.7 months; 10.3% had high refractive error exceeding spherical equivalent > + 3.5D, > 1.5D astigmatism, > 1D oblique astigmatism or > 1.5D anisometropia. The prevalence of amblyopia was lower (0.3%) than expected, suggesting that most amblyopia develops after the first year of life. The prevalence of anisometropia, associated with amblyopia in older children, was low (0.8%)., Competing Interests: Declarations. Ethics approval: The study was approved by the Medical Ethics Review Committee (MERC) of the Erasmus University Medical Center on April 30th, 2021, and was carried out in accordance with the ethical conduct and juridical laws laid down in the Declaration of Helsinki, version 2013. Consent to participate: All parents of enrolled children were required to provide written consent by both parents or legal representative or guardian prior to the Entry Orthoptic Examination. Consent for publication: Not applicable, all data is presented anonymously. Conflict of interest: The authors have no relevant financial or non-financial interest to disclose., (© 2024. The Author(s).)

Objective: To evaluate the retinal microvascular changes in strabismic amblyopia and compare them to the strabismic cases without amblyopia and controls., Design: Cross-sectional study., Participants: Three groups of patients, including 25 amblyopic cases with exotropia (XT), 25 constant XT cases without amblyopia, and 25 healthy subjects as controls, are included in the study. Both eyes of the included participants are evaluated., Methods: All the patients underwent a thorough ophthalmic examination, BCVA assessment, and macular and optic nerve head OCTA with the AngioVue™ Imaging System., Main Outcome Measures: The vascular density (VD) of various layers (Deep and superficial capillary plexus (DCP and SCP) in different regions of the macula, optic nerve head, and FAZ area were evaluated as the target variables., Results: 42 females and 33 males with a mean age of 32.2 (95%CI:29.8-34.6) entered our study. The median exotropia in both groups was 35 PD. The parafoveal DCP VD was significantly lower in both eyes of amblyopic cases than in controls (53.56 and 52.31 vs. 56.13%, p:0.021, <0.001). The parafoveal SCP VD was only lower in the dominant eye of the amblyopic cases than in the controls (50.53 vs. 53.54%, p:0.002). The foveal and peripapillary VD showed no significant difference between the groups. The FAZ area was significantly larger in amblyopic eyes than the fellow eyes (0.250 vs. 0.194 mm 2 , p:0.025) and correlated with worse BCVA (Correlation Coefficient: 0.358, p: 0.011)., Conclusions: The amblyopia could be accompanied by a lower parafoveal DCP VD and a larger FAZ area in strabismic amblyopia., Competing Interests: Declaration of competing interest Authors of this manuscript have no competing interest in the contents of this paper., (Copyright © 2025. Published by Elsevier B.V.)

Background: Uncorrected refractive error is reported to be the most common cause globally of vision impairment in school age children. However, little is known about the extent of uncorrected refractive error in Israel. The purpose of this study was to investigate the prevalence of vision impairment in schoolchildren recruited for the Israel Refraction, Environment, And Devices (iREAD) Study., Methods: Healthy boys, ages 5-13 years, were recruited to participate in the iREAD Study. Parents first answered a questionnaire to exclude children with a known history of amblyopia, strabismus, or hyperopia. A comprehensive eye exam was then performed. Presenting visual acuity < 6/12 was defined as vision impairment. Myopia and hyperopia were defined as cycloplegic spherical equivalent refraction  ≤ - 0.50 D, and ≥  + 0.50 D, respectively, and astigmatism as ≤ - 0.75 D. Amblyopia was defined as best corrected visual acuity ≤ 6/12 in at least one eye in the absence of any ocular pathology. Descriptive statistics were used to calculate the prevalence of each refractive error and amblyopia., Results: Two hundred five boys (average age 8.8 ± 1.7 years) presented for a comprehensive eye exam. The prevalence of vision impairment at initial presentation was 22.9% (N = 47), with 16.1% (N = 33) and 6.8% (N = 14) for both eyes and one eye, respectively. Of the children with vision impairment, 36.2% (N = 17) were wearing habitual correction. Of the children with vision impairment, 97.9% (N = 46) had refractive error, with 85.1% (N = 40) being myopic and 12.8% (N = 6) being hyperopic. In addition, 36.2% (N = 17) with vision impairment had astigmatism. Most children with vision impairment (N = 43) achieved good vision with refractive correction. However, amblyopia was observed in 2.0% (N = 4) of the children., Conclusions: A high prevalence of vision impairment was observed, primarily due to uncorrected or undercorrected refractive error. Children with amblyopia and/or hyperopia presented despite a parent questionnaire to exclude children with these conditions. Findings suggest that many parents are unaware of their children's visual and refractive status, even for children who already have glasses. In conclusion, improvements to the current system in Israel of vision screenings in first grade should be made to help insure children in need receive adequate follow-up throughout their education., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent was obtained from all subjects and/or their legal guardian(s). The study was approved by the ethics committee of Hadassah College and followed the tenets of the Declaration of Helsinki (approval #387). Consent for publication: Not applicable. Competing interests: All Authors declare that there is no conflict of interest., (© 2025. The Author(s).)

People with amblyopia show deficits in global motion perception, especially at slow speeds. These observers are also known to have unstable fixation when viewing stationary fixation targets, relative to healthy controls. It is possible that poor fixation stability during motion viewing interferes with the fidelity of the input to motion-sensitive neurons in visual cortex. To probe these mechanisms at a behavioral level, we assessed motion coherence thresholds in adults with amblyopia while measuring fixation stability. Consistent with prior work, participants with amblyopia had elevated coherence thresholds for the slow speed stimuli, but not the fast speed stimuli, using either the amblyopic or the fellow eye. Fixation stability was elevated in the amblyopic eye relative to controls across all motion stimuli, and not selective for conditions on which perceptual deficits were observed. Fixation stability was not related to visual acuity, nor did it predict coherence thresholds. These results suggest that motion perception deficits might not be a result of poor input to the motion processing system due to unstable fixation, but rather due to processing deficits in motion-sensitive visual areas., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: Amblyopia is characterized by decreased visual acuity due to abnormal visual experience during development. It affects approximately 3% of the population and is associated with abnormal development of the visual cortex. Despite treatment, many patients have residual visual acuity deficits. This study aimed to explore the genetic contributions to amblyopia., Design: Case-control., Participants: The All of Us Research Program includes genotypic and phenotypic data from a diverse population of adults (age ≥ 18 years) across the United States. A total of 764 subjects with amblyopia (based on International Classification of Diseases and Systematized Nomenclature of Medicine codes) and 122 305 controls with no record of amblyopia and with whole genome sequencing data were compared. Only participants of European genetic ancestry were included because of small numbers of affected participants in other ancestral groups., Methods: Genome-wide association study (GWAS) of common variants (minor allele frequency > 1%) and rare variant association study (RVAS) at the gene level for amblyopia of participants in the All of Us Research Program., Main Outcome Measures: Individual single nucleotide polymorphisms (SNPs) significantly associated with amblyopia and genes with significant burden of rare variants in amblyopia., Results: The GWAS revealed 4 loci that approached statistical significance defined as P < 5e-8: rs56105618, rs1349660, rs7958343, and rs138693522. Each of the variants is an expression quantitative trait locus (eQTL) for a gene expressed in the brain or related to neural development. This RVAS revealed 15 genes with a statistically significant (P < 5e-05) different burden of variants: DCP1B, OR12D2, PCDHA4, ALKBH8, NMUR2, OR52P1P, NEU1, CACNB2, PSMA7, LRR1, ZNF831, FSIP2, ZNF654, CES5A, and MPV17, several of which have known roles in neurodevelopment., Conclusions: The identification of genes linked to amblyopia with roles in neurodevelopment suggests that the neurodevelopmental changes in amblyopia are not only secondary to abnormal visual experience but also may result from the interaction of primary neurodevelopmental deficits with abnormal experience. This potentially explains why some children develop amblyopia and others do not with the same ocular risk factors, may explain differences in treatment outcomes, and suggests new avenues for amblyopia treatment., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2025 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Aim: The aim of this literature review was to determine if a consensus could be reached on whether amblyopia treatment causes distress to patients and/or their guardians, and if so, establish the impact of this reported psychological distress upon paediatric patients and/or their parents/guardians., Methods: A systematic review of the literature was conducted of all publications written in English. Search terms included both MeSH terms and alternatives related to amblyopia and psychological distress. Evidence quality was assessed using an adapted Newcastle-Ottawa Score (NOS) and evaluation of the literature was used to form a narrative synthesis of the findings., Results: Initial searches yielded 7,838 titles in total, with 25 peer reviewed papers published between 1999 and 2021 meeting the study inclusion criteria. Factors such as the presence of strabismus, moderate and severe amblyopic density, occlusive patch treatment and patching during school age increase the likelihood of experiencing distress as a result of amblyopia treatment., Conclusions: Both parents/guardians and patients can experience psychological distress as a result of undertaking amblyopia treatment. School-aged children and those receiving occlusion therapy in the form of patching report higher distress than infants and young-children, and those receiving atropine occlusion therapy or refractive correction only. Further study measuring the physiological markers of distress such as Cortisol and BDNF, is recommended., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2025 The Author(s).)

Background: Amblyopia is a common cause of visual impairment in children. Compliance with traditional treatments for amblyopia is challenging due to negative psychosocial impacts. Recent shifts in amblyopia treatment have moved from suppressing the dominant eye to enhancing binocular visual function. Binocular digital therapy has become a promising approach., Objective: The aim of this study was to evaluate the effects of binocular gamified digital therapy on visual acuity and stereoacuity (SA) in children with unilateral amblyopia., Methods: This pilot prospective study enrolled 11 children aged 4-6 years with unilateral amblyopia. Following at least 8 weeks of refractive correction, participants underwent binocular gamified digital therapy for 60 minutes per day, 5 days a week. The therapy used a roguelike shooting game delivered under binocular conditions through two independent channels with a real-time artificial intelligence visual engine. Assessments of distance visual acuity (DVA), near visual acuity (NVA), and SA were conducted at baseline and again at 4, 8, and 12 weeks., Results: At 12 weeks, the following significant improvements were noted: amblyopic eye DVA improved by 1.0 line (P=.01; d=0.77), binocular DVA improved by 0.7 lines (P=.006; d=1.00), and SA improved by 0.3 logarithm (log) arcseconds (P=.01; d=0.97). At 8 weeks, improvements included amblyopic eye DVA by 0.9 lines (P=.046; d=1.00) and SA by 0.28 log arcseconds (P=.02; d=0.90). No significant adverse events were observed, although one participant developed progressive esotropia., Conclusions: Binocular gamified digital therapy is effective and safe for improving visual outcomes in children aged 4-6 years with unilateral amblyopia., (© Wenqing Zhu, Shuneng Gu, Jian Li, Jin Lin, Chanling Hu, Rui Liu. Originally published in JMIR Serious Games (https://games.jmir.org).)

Purpose: To evaluate the impact of daily digital therapeutics (DTx) on the risk of rapid axial elongation (RAE) in children with amblyopia using data from clinical settings., Design: Retrospective cohort study., Participants: One thousand three hundred ninety-four children 3-to-12 years of age with amblyopia, 477 of whom received DTx., Methods: Children in the DTx group underwent 30 minutes of daily vision therapy, with axial length (AL) measured at baseline and during follow-up. Cox proportional hazards models were used to assess the risk of RAE, defined as an annual axial elongation exceeding safety thresholds based on age and myopia status., Main Outcome Measures: The primary outcome was the hazard ratio (HR) for RAE associated with DTx, adjusted for age, sex, best-corrected visual acuity, cycloplegic spherical equivalent refraction, amblyopic eye, type of amblyopia, and baseline AL., Results: Six hundred forty-one children (45.98%) experienced RAE. Use of DTx increased the risk of RAE by 65% (HR, 1.65; 95% confidence interval, 1.40-1.96; P < 0.001), with consistent findings across all subgroups (P > 0.05 for interaction). The increased risk was noted particularly in children with hyperopia, suggesting the potential for DTx to influence axial growth in this population., Conclusions: Digital therapeutics are associated with an increased risk of RAE in children with amblyopia, highlighting the need for careful monitoring of AL during therapy. Although DTx offers visual acuity improvements, its potential impact on ocular growth should be balanced, particularly in children with hyperopia and premyopia., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article., (Copyright © 2025 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

This study investigates colour vision deficits in children with amblyopia by employing a computerized colour vision test with varying stimulus sizes (1°, 2°, and 3°). The aim is to delineate the impact of amblyopia on colour discrimination in children and to determine the effectiveness of the computerized colour vision test in detecting these deficits. The study involved 40 participants, divided into 20 children with amblyopia and 20 without amblyopia (control group). Our findings reveal that, during binocular viewing, children with amblyopia exhibit significant impairments in colour vision both for red-green and blue-yellow axes, primarily for 1° chromatic stimuli, but not for larger stimuli (2° and 3°). These findings offer valuable insight into the functional visual limitations in pediatric amblyopia, potentially guiding more targeted clinical assessments and interventions.

Background and Objectives : Amblyopia is a condition where children undergo unilateral or bilateral vision loss due to a variety of disorders that impact the visual pathway. The assessment of retinal nerve fiber layer (RNFL) thickness in amblyopia has made optical coherence tomography (OCT) a useful technique for studying the pathophysiology of this condition. This study was conducted to assess OCT results for various forms of amblyopia, including macular thickness and peripapillary RNFL thickness. It is the first of its kind in Jordan. Materials and Methods : Sixty-one individuals, aged 14 to 67, who had been diagnosed with unilateral amblyopia participated in a prospective study. Both eyes underwent spectral-domain OCT imaging, and clinical and demographic information was gathered. Relationships between different types of amblyopia and OCT measurements were investigated. Results : Compared to the contralateral fellow eyes, the amblyopic eyes showed thicker fovea, and there were differences in foveal and macular thickness observed between the sexes. Individuals with anisometropic amblyopia exhibited a greater central macular thickness. While nasal optic nerve thickness was adversely correlated with age, inferior optic nerve thickness was considerably lower in amblyopia. Conclusions : This research indicates unique OCT traits in amblyopic eyes, which may have a role in amblyopia diagnosis and treatment. The prevention of long-term visual impairment depends heavily on early detection and care. More studies using larger cohorts and longitudinal designs are necessary to improve our knowledge of the pathogenesis of amblyopia and to provide the best possible clinical management approaches.

Purpose: To evaluate the cost-utility of Luminopia (Luminopia, Inc) and CureSight (NovaSight, Ltd) as therapy for amblyopia compared with current common amblyopic treatments such as glasses, atropine drops, and patching., Design: Cost analysis based on data from published randomized control trials (RCTs)., Subjects: Data from Luminopia, CureSight, and atropine RCTs., Methods: A cost-utility analysis was performed using patient preference-based time trade-off utility values from previous literature. Costs for eye examinations were calculated using reimbursement data; device costs for duration of treatment were provided by sales representatives of Luminopia and CureSight. All treatments were inclusive of the cost of eyeglasses. Visual acuity (VA) and stereoacuity outcomes were extrapolated from the RCTs for atropine, Luminopia, and CureSight. A quality-adjusted life-year (QALY) was calculated by multiplying utility gain, a value correlated with VA gain, by length of time of benefit., Main Outcome Measures: Cost, cost per QALY, and cost per stereoacuity gain., Results: The cost to treat amblyopia with glasses alone for 12 weeks was $514. The cost of treating with patching for 12 weeks was $540 and with atropine for 16 weeks was $652, whereas the cost of treating with Luminopia or CureSight for 12 weeks was $1951 and $1564 or $1814, respectively. Treatment with glasses alone or patching for 12 weeks resulted in a cost per QALY gained of $427 and $101, respectively. Atropine treatment for 16 weeks resulted in a cost per QALY gained of $151. The cost per QALY for 12-week Luminopia treatment was $618 versus $368 or $427 for 12-week CureSight treatment and $314 or $354 for 16-week CureSight treatment (P < 0.05). Cost per stereoacuity gain for 12-week treatment duration was $6421/log arcsec (glasses), $1801/log arcsec (patching), and $3007/log arcsec or $3488/log arcsec (CureSight)., Conclusions: Treatment of amblyopia with Luminopia or CureSight is cost-effective in comparison with established willingness-to-pay thresholds and can provide a viable treatment option, especially for those who are unable to tolerate patching or atropine penalization. Cost-effectiveness values based on VA gain of Luminopia and CureSight were comparable., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2025 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Vision screening programs can provide epidemiological information regarding visual impairment in children. This study aims to report the characteristics of visual abnormalities diagnosed through the Primary School Nurse Health Readiness Program (PSNHRP) in Queensland, Australia., Methods: A retrospective review of vision screening records from the PSNHRP between January 2017 and December 2020 was undertaken. Children aged between 4 and 7 who underwent vision screening were included for review. Children with a visual acuity of worse than 6/9-1 using the Parr 4 m letter-matching chart or those who failed the SPOT Vision Screener were referred to an optometrist or ophthalmologist for review., Results: 164 890 children underwent vision screening. 12148 children failed visual screening (7.4%) and were referred for an eye assessment. 6011 (69.4%) of the 8659 children who attended ophthalmic review had a confirmed visual abnormality. Of 164 890 screened children, 1187 (0.72%) were confirmed to have anisometropia, 3843 (2.33%) had refractive error, 194 (0.12%) had strabismus, 755 (0.46%) had anisometropic amblyopia, 136 (0.08%) had strabismic amblyopia, and 1356 (0.82%) had an unspecific abnormality. There was no statistically significant difference in the age at screening between any visual abnormality (p = 0.94). Anisometropia, refractive error, and strabismus were significantly more common in females than males (p = 0.03, p < 0.01, and p = 0.03 respectively), whereas anisometropic amblyopia was more common in males (p < 0.01)., Conclusions: We report the prevalence of visual abnormalities detected through the PSNHRP vision screening program. Identification of medical or socioeconomic risk factors that are likely to be associated with visual abnormalities can help to optimise vision screening programs., (© 2024 The Author(s). Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: Isolated acquired superior rectus palsy (ASRP) is extremely rare. The goal of this report is to describe the clinical manifestations and surgical protocols for treatment of isolated traumatic ASRP., Design: Retrospective observational case series., Method: Records of patients presenting with traumatic isolated ASRP from 2011 to 2020 were retrospectively reviewed. Variables analyzed included nature of the damage, ocular alignment, ocular motility, binocular vision, fundus photography, imaging and surgical treatment., Result: Of the 23,498 strabismus surgeries performed, 16 (0.07%) were identified as being attributable to traumatic isolated ASRP. Iatrogenic injury during orbital/brain tumorectomy was the most common cause for ASRP, followed by injury resulting from a sharp object, blunt instrument, car accident, dog bite, accidental fall and explosion. The main clinical features were hypotropia and deficient supraduction of the affected eye, accompanied by exotropia, extorsion, decreased vision and ptosis. The imaging examination showed the superior orbital wall fracture in 3 cases and superior rectus rupture in 7 cases. Inferior rectus recession and/or superior rectus resection comprised the major surgical procedures employed for these cases. Vertical deviations were reduced from 45.60 ± 17.52 PD preoperatively to 12.20 ± 12.97 PD postoperatively after an average of 22.70 months at follow-up, with a success rate of 50%., Conclusion: Traumatic isolated ASRP comprised only 0.07% of cases receiving strabismus surgery at our hospital. Orbital imaging is essential to identify whether muscle rupture, orbital fractures and/or other possible disorders are present. Superior rectus resection and inferior rectus recession represented the most frequently used surgical procedures., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To investigate, map, and synthesize evidence regarding the correlation between changes in binocular vision and fine motor skills among children., Methods: We conducted a scoping review of existing evidence, following the guidelines and checklist outlined in "Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Reviews" (PRISMAScR)., Results: Sixteen papers were systematically included in our scoping review. A predominant focus was placed on assessing the impact of strabismus on motor skills. Most of the studies used motor test batteries for comprehensive analysis, while the remaining employed methodologies, such as questionnaires or laboratory-based tests., Conclusion: Vision stands as a pivotal perceptual modality essential for the optimal development of children. Alterations in visual acuity can significantly affect fine motor skills. Pediatric ophthalmology and orthoptics frequently encounter binocular vision disorders, such as amblyopia and strabismus. Our finding showed that impaired binocular vision affects fine motor skills., Competing Interests: Declarations. Ethics approval: An ethics statement is not applicable because this study is based exclusively on published literature. Compliance with ethical standards: This article do not contain any study with animals or humans performed by any of the authors., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

There is currently a diverse array of treatment for amblyopia. In addition to the traditional penalization therapy, which has been used for over 200 years, there are not only more active treatments to recover the monocular visual loss of the amblyopic eye involving both behavioral (visual training) as well as non-invasive brain stimulation but also a variety of methods designed specifically to restore binocular function. Our understanding of visual function in general and of the etiology of the amblyopic loss in particular has progressed a great deal over the last 50 years and it is now time to take a more principled approach to how we treat, when we treat and why we treat., (Copyright © 2024 The Author. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Amblyopia, the leading cause of monocular childhood vision loss, affects millions and is projected to increase. Early detection and treatment are crucial for preventing vision impairment., Areas Covered: This commentary reviews the current state and opportunities for improvement in amblyopia screening strategy and technology focused primarily within the United States. A review of current guidelines from organizations and a literature review of innovations between 1999 and 2024 informed this commentary. Organizations recommend routine vision screening for children, starting in infancy and continuing through adolescence. However, the variations in screening devices, components, timelines, and requirements leave room for improving outcomes. An exploration of instrument-based screening which has emerged as an alternative to traditional optotype testing will be investigated, and the risks of these instruments with high sensitivity and varying specificity will be acknowledged. Finally, new approaches to directly identify amblyopia and search for innovative biomarkers that indicate amblyopia risk or amblyopia itself will be discussed., Expert Opinion: Improving the treatment of amblyopia necessitates the reimagination of current practices in connecting patients to care. Technologies that incorporate novel diagnostic approaches, like the consideration of specific biomarkers or the use of artificial intelligence, hold promise to identify cases of amblyopia rather than its risk factors.

Background: Active vision therapy for amblyopia shows good results, but there is no standard vision therapy protocol. This study compared the results of three treatments, two combining patching with active therapy and one with patching alone, in a sample of children with amblyopia., Methods: Two protocols have been developed: (a) perceptual learning with a computer game designed to favour the medium-to-high spatial frequency-tuned achromatic mechanisms of parvocellular origin and (b) vision therapy with a specific protocol and 2-h patching. The third treatment group used patching only. Fifty-two amblyopic children (aged 4-12 years), were randomly assigned to three monocular treatment groups: 2-h patching (n = 18), monocular perceptual learning (n = 17) and 2-h patching plus vision therapy (n = 17). Visual outcomes were analysed after 3 months and compared with a control group (n = 36) of subjects with normal vision., Results: Visual acuity (VA) and stereoacuity (STA) improved significantly after treatment for the three groups with the best results for patching plus vision therapy, followed by monocular perceptual learning, with patching only least effective. Change in the interocular difference in VA was significant for monocular perceptual learning, followed by patching. Differences in STA between groups were not significant. For VA and interocular differences, the final outcomes were influenced by the baseline VA and interocular difference, respectively, with greater improvements in subjects with poorer initial values., Conclusions: Visual acuity and STA improved with the two most active treatments, that is, vision therapy followed by perceptual learning. Patching alone showed the worst outcome. These results suggest that vision therapy should include monocular accommodative exercises, ocular motility and central fixation exercises where the fovea is more active., (© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Objective: To assess the barriers to parental compliance with preschool vision screening tests and the recommended follow-up eye care. Methods: This prospective study included children aged 3-6 years attending 46 preschools. Parents were asked for consent for their children to participate in a vision screening test. Parents whose child did not participate due to lack of parental consent and parents whose child failed the screening test were contacted by telephone and given a standardized questionnaire to identify potential barriers to compliance. Results: A total of 1511 children (mean age 4.76 years ± 0.76, 51.3% boys) were eligible for vision screening. Consent was given by the parents of 1295 children (85.7%). Lack of consent in children who had never been examined by an ophthalmologist was primarily due to unawareness of the screening test or other logistical reasons (117 cases, 92.1%). Of the children screened, 140 (11.1%) failed the test and 80.0% of their parents adhered to the recommended follow-up eye care. Parents who followed the screening vision test recommendations were more likely to be native language speakers (82.8% vs. 58.8% mothers and 88.9% vs. 60.0% fathers; p = 0.049 and 0.015, respectively). There was a higher chance of at least one parent being native-born if recommendations were followed (90.6% vs. 58.8%, p = 0.004). All other factors tested were insignificant. Conclusions : Parental consent and cooperation with vision screening test and its recommendations were high. Migrant families are more likely to face challenges in following vision screening test recommendations, underscoring the need for tailored approaches for specific populations.

Objective: To investigate if the type of unilateral amblyopia can impact the improvement of visual acuity in amblyopic eyes during a longitudinal interventional study involving standard occlusion therapy in children., Methods: A longitudinal and interventional study of 91 children, aged 3-9 years (6.12 ± 1.879) with amblyopia was undertaken. Amblyopia was unilateral and caused by either strabismus, anisometropia, or both. Amblyopia was divided into three levels of severity mild, moderate, and severe. Children underwent amblyopia treatment with standard occlusion therapy and were followed monthly, for eight visits., Results: A significant improvement in visual acuity was observed in all assessment visits across the three types of amblyopia, with a mean improvement of (0.30 ± 0.184) LogMAR. Specifically, anisometropic amblyopia with (0.28 ± 0.18) LogMAR, strabismic amblyopia (0.31 ± 0.18) LogMAR, and mixed amblyopia (0.31 ± 0.18) LogMAR. No significant differences were found between the improvement in visual acuity during the eight control visits and the types of amblyopia (r = 0.174, p = 0.182). However, a significant correlation was observed within all groups in the mean improvement in visual acuity and the severity level (r = 0.712, p = 0.034)., Conclusion: Amblyopia types do not appear to significantly affect the improvement in visual acuity; however, the initial severity of amblyopia may be a key factor influencing the degree of visual recovery achieved with occlusion therapy., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Purpose : To study and evaluate the change in retinal nerve fiber layer (RNFL) and macular thickness and its clinical correlation with visual outcome following amblyopia therapy. Methods : In this prospective interventional study, children with moderate to severe amblyopia were given optical correction and part-time occlusion therapy. Visual assessment and optical coherence tomography (OCT) were performed at days 0 and 3, 6 months of follow-up. Results : A total of 30 children aged from 5 to 12 years with a mean age of 5.26 ± 1.65 years with moderate to severe amblyopia were included. About 19 patients (63.33%) were males and 11 patients (36.66%) were females. Anisometropia was the most common cause of amblyopia in our study population affecting 46.67% of patients. The mean global RNFL thickness in amblyopic eyes before and after patch therapy were 111.13 um and 104.96 um respectively (6.17 um thinner than better eyes). The macular thickness before and after patch therapy was 227.06 um and 226.80 um respectively (0.26 um thinner than better eyes). Conclusions : Part-time occlusion therapy results in visual gain in children with moderate to severe amblyopia. However, it causes thinning in both the RNFL and macular thickness at days 0 and 3, 6 months of follow-up.

Background: acquired exotropia mostly manifests as an intermittent form, and very few cases show constant exotrpia. However, the differences in the clinical features of the constant and intermittent exotropia patients has not been clear yet., Methods: We retrospectively evaluated 6159 patients with exotropia from 2012 to 2022 in Farabi Eye Hospital, Tehran, Iran. The preoperative data collected were best corrected distance visual acuity (BCVA), spherical equivalent refractive error, amount and laterality of exotropia, presence of amblyopia and anisometropia., Results: The mean age at the time of surgery was 21.9 ± 13.8 (range, 2-77) years and 3104 (50.4%) cases were male. Constant and intermittent exotropia were observed in 4244 (68.9%) and 1915 (31.1%) cases, respectively. BCVA was significantly worse in the constant than in the intermittent group (P < .05). In cases with dominancy, the non-dominant eye in intermittent exotropia patients showed significantly more minus spherical equivalent (-1.28 ± 3.03 diopter) compared to the constant group (-0.63 ± 4.41 diopter) (P < .001). Moreover, the mean angle of horizontal and vertical deviation at distance and near in patients with constant exotropia was significantly higher than in the intermittent cases, either when there was a dominance in one eye or in cases with no dominance (P < .001). Amblyopia was found in 38.3% of cases with constant and 13.1% with intermittent exotropia (P < .001). Anisometropia was observed in 821 (19.34%) with constant and 88 (4.6%) with intermittent exotropia (P < .001)., Conclusion: Constant exotropic patients had worse BCVA, larger angle of deviation, and higher prevalence of amblyopia and anisometropia compared to the intermittent cases., Competing Interests: Declarations. Ethics approval and consent to participate: The ethical committee of Tehran university of medical sciences approved the protocol of this study (IR.TUMS.FNM.REC.1401.038) and the study adhered to the tenets of the Declaration of Helsinki and HIPAA. Informed written consent was waived due to the retrospective nature of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Abnormal visual experience during development resulting from an imbalance in the activity of the two eyes can lead to permanent severe visual deficits, a pathology called amblyopia (lazy eye). While this condition is extremely difficult to treat in adults, current interventions can elicit significant amounts of visual recovery when performed in juveniles before the end of the critical period, even if the achievable results can be unsatisfactory due to the progressive decline in visual cortical plasticity. Similarly to human subjects, rodents becoming amblyopic due to early visual deprivation can display spontaneous functional recovery if the deprivation ends within the critical period time window. With the aim to investigate the impact of non-invasive strategies able to increase this spontaneous potential for plasticity, we wondered whether physical exercise could speed up spontaneous recovery of visual functions in juvenile amblyopic rats. Our results show that physical exercise accelerates visual recovery in adolescent rats, encouraging application of behavioral plasticizing treatments to promote recovery in young individuals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Di Marco, Sansevero, Berardi and Sale.)

Purpose: To evaluate the compatibility and readability of ChatGPT-4 in providing responses to common inquiries about strabismus and amblyopia., Materials and Methods: A series of commonly asked questions were compiled, covering topics such as the definition, prevalence, diagnostic approaches, surgical and non-surgical treatment alternatives, postoperative guidelines, surgery-related risks, and visual prognosis associated with strabismus and amblyopia. Each question was asked three times on the online ChatGPT-4 platform both in English and French, with data collection conducted on February 18, 2024. The responses generated by ChatGPT-4 were evaluated by two independent pediatric ophthalmologists, who classified them as "acceptable," "unacceptable," or "incomplete." Additionally, an online readability assessment tool called "readable" was utilized for readability analysis., Results: The majority of responses, totaling 97% of the questions regarding strabismus and amblyopia, consistently met the criteria for acceptability. Only 3% of responses were classified as incomplete, with no instances of unacceptable responses observed. The average Flesch-Kincaid Grade Level and Flesch Reading Ease Score were calculated as 14.53±1.8 and 23.63±8.2, respectively. Furthermore, the means for all readability indices, including the Coleman-Liau index, the Gunning Fog index, and the SMOG index, were found to be 15.75±1.4, 16.96±2.4, and 16.05±1.6, respectively., Conclusions: ChatGPT-4 consistently produced acceptable responses to the majority of the questions asked (97%). Nevertheless, the readability of these responses proved challenging for the average layperson, requiring a college-level education for comprehension. Further improvements, particularly in terms of readability, are necessary to enhance the advisory capacity of this AI software in providing eye and health-related guidance for patients, physicians, and the general public., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Aim: To establish an animal model of form deprivation amblyopia based on a simulated cataract intraocular lens (IOLs)., Methods: Poly(dimethyl siloxane)-SiO 2 thin films (PSF) with different degrees of opacity as IOL materials were prepared. The light transmission of the PSF-IOL was measured, and its in vitro biosafety was determined by cell counting kit (CCK)-8 assay using the HLEC-B3 cell line and ARPE-19 cell line. Subsequently, the in vivo safety was determined by implanting the PSF-IOL with 10% wt SiO 2 into the right eyes of New Zealand white rabbits (PSF-IOL group), and compared with two control groups: contralateral comparison group and normal control (NC) group (Contralateral comparison group: the fellow eye; NC group: a group of binocular normal rabbits without intervention). The flash visual-evoked potentials (F-VEPs) were measured to verify amblyopia., Results: PSFs containing 0, 2%, and 10% wt SiO 2 were successfully constructed. The 0 SiO 2 PSF was transparent, while the 10% wt SiO 2 PSF was completely opaque. It was found that PSF did not induce unwanted cytotoxicity in HLECs and ARPE19 cells in vitro . In vitro , PSF-IOL with 10% wt SiO 2 was also non-toxic, and no significant inflammation or structural changes occurred after four weeks of PSF-IOL implantation. Finally, our IOL-simulated congenital cataract rabbit detected by F-VEPs suggested tentative amblyopia., Conclusion: A PSF-IOL that mimics cataracts is created. A novel form deprivation model is created by the IOL-simulated congenital cataract rabbit. It can be developed fast and stable and holds great potential for future study., Competing Interests: Conflicts of Interest: Gu SY, None; Xu LM, None; Sun WJ, None; Liang LL, None; Lin L, None; Zou H, None; Xu JY, None; Zheng Y, None; Li YY, None; Zhao YY, None; Chang PJ, None; Zhao YE, None., (International Journal of Ophthalmology Press.)

Objective: To evaluate the therapeutic effects of Visual Training System 4 (VTS4) as an adjunctive therapy for patients with refractive amblyopia., Method: A total of 82 patients with refractive amblyopia (142 eyes) treated at the Zhongshan Ophthalmic Center of Sun Yat-sen University, were enrolled and divided into two groups based on the treatment protocol. The control group included 40 patients (68 eyes) who received conventional comprehensive treatment, while the observation group was comprised of 42 patients (74 eyes) treated with VTS4 in addition to conventional therapy. The therapeutic effects, best-corrected visual acuity (BCVA), spherical equivalent (SE), ocular accommodative function, and ocular convergence were compared between the two groups., Results: The total effective rate of visual improvement in the observation group was 86.49%, significantly higher than 66.18% in the control group. BCVA at 3 and 6 months was superior in the observation group compared to the control group (P < 0.05). At 6 months, the normal rate of binocular fusion images in the observation group was 94.59%, higher than 76.47% in the control group. The observation group showed greater improvement in accommodative flexibility and amplitude, and lower accommodative lag compared to the control group. Improvements in negative relative accommodation, positive relative accommodation, and near point of convergence were also more pronounced in the observation group (all P < 0.05). No significant differences were observed in SE, axial length, or corneal curvature within or between the groups before and after treatment (all P > 0.05)., Conclusion: VTS4, as an adjunctive therapy for refractive amblyopia, significantly improves visual acuity, enhances accommodative and convergence functions, and demonstrates strong clinical applicability., Competing Interests: None., (AJTR Copyright © 2024.)

Objectives: Congenital nasolacrimal duct obstruction (CNLDO) is a condition that can lead to the development of anisometropia and amblyopia. This study aimed to identify refractive errors in children with unilateral and bilateral CNLDO., Methods: A total of 220 eyes from 110 patients with CNLDO were retrospectively analyzed in this study. All patients underwent at least one surgery, and their most recent refractive errors were compared based on the laterality of the disease. The risk factors for amblyopia were established in accordance with the 2013 and 2021 American Association for Pediatric Ophthalmology and Strabismus guidelines. The investigated risk factors included disease laterality, surgical technique, number of surgeries, age at the time of surgery, and manifest strabismus., Results: The nasolacrimal duct obstruction was unilateral in 66.4% (n=73) of the patients. The average ages at the last examination and at the time of surgery were 57.3±37.6 months (range: 12-153 months) and 29.6±22.3 months (range: 12-128 months), respectively. Hypermetropia was the most common refractive error, followed by astigmatism. The anisometropia and amblyopia rates were 11.8% (n=13) and 5.4% (n=6), respectively. No significant refractive difference was observed between the eyes in unilateral and bilateral CNLDO (p>0.05). After regression analyses, manifest strabismus was the only factor associated with amblyogenic risk factors in children with CNLDO (odds ratio = 0.132, 95% confidence interval = 0.529-17.400, p<0.001)., Conclusion: As a result, children diagnosed with CNLDO should be treated at as optimal time as possible, and visual maturation should be monitored for the development of high hypermetropia, anisometropia, and amblyopia. These children should receive a complete ophthalmic examination, including cycloplegic refraction, and orthoptic evaluations., Competing Interests: Conflict of Interest: The authors declare that they have no competing interests.

Congenital cataract is a blinding condition that presents at birth. Form-deprivation amblyopia can be developed and has become the leading cause of childhood blindness in China. For the problems and challenges in the treatment of congenital cataract, this article discusses the surgical treatment and postoperative rehabilitation strategies and emphasizes the importance of developing effective intervention strategies to improve the visual outcomes in children with congenital cataract, providing valuable guidance for clinical treatment.

Background: Amblyopia is the most common cause of vision loss in children. Amblyopia has been associated with impaired depth perception but little attention has been paid to the extent to which amblyopia increases the risk of obesity. Methods: Public-use data from the 1999-2008 National Health and Nutrition Examination Survey were used. Analyses were limited to children aged 12-18, who had a visual examination, and a best corrected visual acuity (BCVA) of at least 20/40 in the better-seeing eye. Amblyopia was defined as two or more-line interocular difference in BCVA. Obesity was defined as Body Mass Index (BMI) or body fat percentage (BFP) ≥95th percentile for age and gender. Sedentary lifestyle was defined as cardiovascular fitness level (CFL) rating of "low." We used Mantel-Haenszel odds ratios (ORs) to examine the relative prevalence of obesity in children with/without amblyopia. Results: Adolescents with amblyopia ( n = 360) were more likely than those without ( n = 7935) to have a high BMI [OR = 1.56; 95% confidence interval (CI): 1.24-1.98; p < 0.001]. The associations with either high BFP (OR = 1.20; 95% CI: 0.86-1.56, p = 0.167) or low CFL (OR = 1.15; 95% CI: 0.83-1.57; p = 0.267) were not statistically significant but in the direction of a priori hypotheses. Conclusions: This analysis of population-based data suggests that adolescents with amblyopia may be at higher risk of having obesity. Given the high prevalence of amblyopia and the range of morbidities associated with childhood obesity, targeted interventions to reduce the risk of obesity among children with amblyopia could be warranted.

We present three cases where traditional occlusion therapy with an eye patch proved ineffective for treating amblyopia associated with fusion maldevelopment nystagmus. In these cases, we transitioned to dichoptic therapy using the Occlu-pad, achieving successful outcomes. Eye patch occlusion of the sound eye consistently exacerbated nystagmus, whereas dichoptic treatment did not. Visual acuity improved to 0 (logMAR) in all cases following dichoptic therapy. This approach demonstrates the effectiveness of dichoptic treatment for managing amblyopia in patients with fusion maldevelopment and nystagmus., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Iwata et al.)

Background: To investigate visual cognitive functions, including visual attention, executive function, and visual working memory, in children with anisometropic amblyopia versus those with normal vision., Methods: Thirty-five children with anisometropic amblyopia and 34 with normal vision participated. Visual acuity, stereoacuity, and contrast sensitivity were measured, followed by the Cambridge Neuropsychological Test Automated Battery's six subtests for cognitive evaluation. Visual attention was assessed using reaction time (RTI) and rapid visual information processing (RVP). Executive function was evaluated through the multitasking test (MTT). Visual working memory was assessed with spatial working memory (SWM), delayed matching to sample (DMS), and paired association learning (PAL), all under binocular conditions., Results: The amblyopia group exhibited longer reaction and movement times in the RTI than the control group (p < 0.01). A trend towards lower RVP A' scores, reflecting reduced ability to detect target sequences, appeared in the amblyopia group (p = 0.056). Amblyopic children demonstrated a lower multitasking cost in the MTT compared with the control group (p = 0.04). As difficulty increased in the SWM (from four to six boxes), amblyopic children revisited more (p = 0.01). In the DMS task, while no differences were observed across all delay times (p = 0.55), amblyopic children performed significantly worse than the control group under the 12-second delay (p = 0.04). In the eight-pattern PAL condition, the amblyopia group made more errors (p = 0.01)., Conclusions: Children with anisometropic amblyopia performed poorly on neuropsychological tests, particularly visual attention and working memory, but outperformed the control group in multitasking. These findings highlight the broader cognitive impacts of anisometropic amblyopia beyond vision., (© 2024 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To compare macula and optic-disc optical coherence tomography angiography (OCTA) metrics of adult amblyopic eyes with healthy controls and investigate whether these differ according to amblyopia etiology., Methods: This cross-sectional study included 35 unilateral amblyopic adults ( n = 35 eyes) and 35 age-matched healthy controls ( n = 35 eyes). Amblyopia subgroups consisted of anisometropic ( n = 12 eyes), strabismic ( n = 12 eyes), and combined-mechanism amblyopia ( n = 11 eyes). Foveal avascular zone area (FAZA), vessel density (VD), and retinal thickness were obtained using OCTA. Retinal thicknesses were measured at the fovea, parafovea, perifovea, and retinal nerve fiber layer. Foveal, parafoveal, perifoveal, whole-macula, intradisc, peripapillary, and whole-disc VD were recorded. Groups were compared regarding OCTA metrics after adjusting for axial length, spherical equivalent, age, gender, and signal quality index using a one-way analysis of covariance test., Results: Amblyopic eyes had significantly lower foveal, parafoveal, perifoveal, whole-macula VD in superficial capillary plexus (SCP), and deep capillary plexus (DCP) than control eyes after adjusting for confounders ( P < 0.05 for all). All amblyopia subgroups had significantly lower parafoveal, perifoveal, and whole-macula VD in SCP and DCP than control eyes after adjusting for confounders ( P < 0.05 for all). There was no significant difference in retinal thickness, FAZA, intradisc VD, peripapillary VD, and whole-disc VD between amblyopic and control eyes, as well as amblyopia subgroups and control eyes., Conclusion: These results suggest that effect of amblyopia on macular microvasculature should be considered when interpreting OCTA metrics of adults with concomitant diseases. It also supports that adult amblyopic eyes of different etiology have similar microvascular features., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Middle East African Journal of Ophthalmology.)

Introduction : Physical activity in adolescence plays an important role in reducing the lifetime risk of chronic disease. Recent studies have shown that individuals with amblyopia may have difficulties with coordinating balance and may be at greater risk of developing fine motor impairments. The purpose of this study was to determine if there is an association between the presence of amblyopia and physical activity (PA) in adolescents. Methods : Adolescent patients aged 12-18 years with a history of childhood amblyopia were age- and gender-matched to control patients with no other ocular pathology aside from refractive error. Each participant's best corrected visual acuity and refractive error were recorded in addition to their height and weight to calculate body mass index (BMI). A 32-question electronic survey was used to calculate self-reported physical activity level (PAL) score and type of PA over the previous seven days. The Ainsworth Compendium of Physical Activities was taken as a reference to calculate Metabolic Equivalent of Task (MET) minutes for the most frequently performed activity. Results : A total of 26 adolescents with amblyopia (10 strabismic, 16 anisometropic) and 26 healthy controls were recruited. The MET-minute values were 2404.3 ± 2313.9 in the control group and 905.6 ± 1196.0 in the amblyopia group ( p  = .008). The PAL scores were similar between amblyopia and control groups (1.15 ± 0.70 versus 1.24 ± 0.60, p  = .63); however, BMI was significantly higher in amblyopia participants (25.2 ± 6.3 versus 21.1 ± 5.4, p  = .003). When compared with controls, amblyopes perceived physical activity to be of significantly lower importance in their lives compared to controls ( p  = .009). Discussion : Amblyopic adolescents may represent a population with increased vulnerability to significantly lower energy expenditure and higher BMI. Future studies with a larger number of participants and further investigation into the impact of refractive error on physical activity are warranted.

Purpose: To determine the clinical pattern and burden of strabismus in a teaching institute of Northeast (NE) India., Methods: In this hospital-based, cross-sectional study, detailed clinical evaluation of patients with manifest strabismus was carried out for a period of one and half years., Results: Out of the 7222 new outpatient department attendances, a total of 110 new patients with manifest strabismus were found, with a hospital-based burden of 1.52% [95% confidence interval: 1.3-1.8]. Comitant strabismus was seen in 84.55%, and incomitant in 15.45%. Exotropia comprised 70%, esotropia 26.36%, hypertropia 10%, and hypotropia 2.72%. The angle of deviation was large in most of the participants (69.09%) with a mean of 34.90 ± 17.08 PD for horizontal and 13.29 ± 8.97 PD for vertical deviations. A cause of strabismus could be identified in 30.91%. Paralytic strabismus was seen in 15.45%, sensory in 11.82%, infantile in 1.82%, and accommodative in 1.82%. Amblyopia was found in 5.45%. In our study, 25.45% patients underwent strabismus surgery, while 74.55% patients either needed conservative management or were being worked up for surgery till the end of this study., Conclusion: This study determined the pattern and burden of strabismus in a teaching institute of NE India. Since the institute caters to patients from different states of NE India, this study gives an indirect picture of the burden of strabismus of the whole of NE India. It is hoped that these data will aid in determining the overall burden of strabismus in the country. They will also help the family medicine and primary care physicians to have an idea about the burden and pattern of strabismus in the community, thus enabling them to create awareness about strabismus, remove the undue apprehensions of patients, and do timely referrals for treatment and prevent irreversible visual loss., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: Horizontal strabismus is a binocular alignment disorder that can lead to significant complications in childhood, such as visual impairment and amblyopia. This study aimed to evaluate the success rates of horizontal strabismus surgery in pediatric patients and to identify the factors affecting surgical outcomes. Specifically, it examined the relationship between surgical success and factors such as age, deviation angle, and amblyopia in pediatric horizontal strabismus cases., Methods: The medical records of 95 patients diagnosed with horizontal strabismus and treated surgically between 2016 and 2022 were reviewed. Surgical success was defined by a postoperative deviation angle of less than 10 prism diopters (PD). Visual acuity and deviation angles were measured before and after surgery, and the data were analyzed statistically., Results: Among the cases, 49 (51.5%) were diagnosed with esotropia and 46 (48.5%) with exotropia. One year after surgery, the overall success rate was recorded at 73.6%. The success rates were 77.6% in the esotropia group and 69.6% in the exotropia group, with no statistically significant difference between the groups (p=0.515). In age-based analyses, the surgical success rate was 73.8% in patients aged 0-9 years and 73.5% in those aged 10-18 years. Patients with a deviation angle greater than 45 PD had a success rate of 61.5%, while those with an angle below 45 PD achieved a success rate of 82.1% (p<0.05). Surgical success was observed in 50% of patients with amblyopia and 80.9% of those without amblyopia. Improvement in visual acuity was observed in 5.5% of non-amblyopic patients and in 22.7% of amblyopic patients; however, this improvement was not statistically correlated with surgical success., Conclusions: This study revealed that factors such as the deviation angle and the presence of amblyopia affected the success rate of horizontal strabismus surgery. Surgical success rates did not differ significantly between esotropia and exotropia cases. Consistent with existing literature, patients with larger deviation angles and amblyopia were found to have lower surgical success rates., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of the Non-Interventional Ethical Committee of the Adiyaman University Medical Faculty issued approval Number: 2022/8-21. The study was conducted in accordance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Non-Interventional Ethical Committee of the Adiyaman University Medical Faculty (number: 2022/8-21, date of approval: November 15, 2022). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yetkin et al.)

Introduction: This study aimed to analyse the clinical characteristics of open globe injury (OGI) in children under six., Methods: A retrospective analysis was conducted on the medical data of children with OGI admitted to the Eye Center of the Second Hospital of Jilin University, China, between 1 January 2012 and 31 December 2020., Results: The study included 106 children, with 61 males (57.5%) and 45 females (42.5%), and the mean age was 4.14 ± 1.58 years. Injuries predominantly affected the right eye (53.8%). Sharp objects were the leading cause of injuries (56.6%). Most wounds (91.5%) occurred in zone I, and penetrating trauma was the most common injury type (64.2%). The concomitant OGI findings included traumatic cataracts (47.2%), iris prolapse (53.8%), endophthalmitis (22.4%), vitreous prolapse (17.0%), retinal detachment (5.7%), eyelid laceration (7.5%), and orbital fractures (1.9%). Univariate analysis showed that wooden materials ( p  = 0.045), needles ( p  = 0.045), postinjury admission time ( p  < 0.001), injury zone ( p  = 0.025), and iris prolapse ( p  = 0.022) were significantly associated with endophthalmitis. Multivariate logistic regression analysis revealed that delayed admission for ≥24 h was an independent risk factor for endophthalmitis ( p  = 0.007). Preoperative and postoperative visual acuities were significantly correlated ( p  < 0.001)., Conclusions: OGIs are more common in males under six years old, with sharp objects being the primary cause. Prompt surgical intervention can lower the risk of endophthalmitis. Increased awareness of the severity of OGI and understanding the risk factors for endophthalmitis will aid in developing effective strategies to minimise ocular complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Li, Qi, Zhang and Wang.)

Purpose: Trigonocephaly is associated with suboptimal visual outcomes in young children. However, the presence of orthoptic abnormalities after completed visual development remains unknown. The purpose of this study is to assess the prevalence of orthoptic abnormalities in trigonocephaly patients, after completed visual development., Methods: A retrospective study among non-syndromic trigonocephaly patients aged 8 years and older was conducted at the Dutch Craniofacial center. Ophthalmologic records were reviewed for refractive errors and a history of strabismus and amblyopia. Refractive errors were classified as follows: myopia: spherical equivalent (SE) ≤ -0.50 diopters (D), emmetropia: SE -0.50 D to + 0.50 D, hyperopia: ≥ + 0.50 D, astigmatism: cylinder error ≥ 1.00 D. The history of strabismus and amblyopia was assessed retrospectively. Prevalence and cumulative incidence of these abnormalities in healthy age-matched populations were retrieved from literature., Results: We included 78 trigonocephaly patients with a median (interquartile range) age of 10.0 (9.0-12.0) years. Thirty-four (43.6%) of these patients presented with a refractive error after the age of 8 years. Specific findings in these 78 patients versus controls were hyperopia in 35.9% vs 8.4%; myopia in 6.4% vs 11.4%; astigmatism in 20.5% vs 11.9%; strabismus in 14.1% vs 2.65%; amblyopia in 6.4% vs 3.4%., Conclusions: Trigonocephaly patients have a two-to-threefold higher risk of hyperopia, astigmatism, amblyopia, and strabismus, as compared to healthy populations. We recommend screening and, in case of abnormalities, regular follow-up before completed visual development. In addition, we recommend long-term surveillance of visual functioning by a pediatric ophthalmologist and/or orthoptist., Competing Interests: Declarations. Ethical approval: This study was exempted from review by the relevant institutional review boards (MEC-2016–312) in view of the retrospective nature of the study and the procedures being performed were part of the routine care. Conflict of interest: There are no conflicts of interest in relation to the materials or subject matter dealt with in this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)