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Background Amblyopia and its risk factors have been demonstrated to be more common among children from low socioeconomic backgrounds. We sought to investigate this association in a region with orthoptic-delivered screening and whole population coverage, and to also examine the association of the Health Plan Indicator (HPI) with screening outcome. Methods Screening examination outcomes, postcodes and HPIs were extracted from the community child health database for every child who underwent preschool vision screening between March 2010 and February 2011 Tayside. We obtained the Scottish Index of Multiple Deprivation score for every child as a measure of area-based deprivation. We assessed the vulnerability/needs of the individual family through the HPI-'Core' (children and families receiving universal health visiting service), 'Additional' (receiving additional health/social support) and 'Intensive' (receiving high levels of support). The outcomes from follow-up examinations for those who failed screening were extracted from the orthoptic department database. Results 4365 children were screened during the year 2010-2011 of whom 523 (11.9%) failed. The odds of children from the least deprived socioeconomic group passing the visual screening test was 1.4 times higher than those from the most deprived socioeconomic group (OR 1.4, 95% CI 1.07 to 1.89, p=0.01). The odds of a child from a family assigned as 'Intensive' failing the preschool visual screening test was three times greater than the odds of a child from a family assigned as 'Core' (OR 3.59, 95% CI 1.6 to 7.8, p=0.001). Conclusions We found that children from the most deprived backgrounds and those from unstable homes were more likely to fail preschool vision screening. [ABSTRACT FROM AUTHOR]

Aim To compare cycloplegic autorefraction with non-cycloplegic subjective refraction across all age and refractive error groups. Methods In a cross-sectional study with random stratified cluster sampling, 160 clusters were chosen from various districts proportionate to the population of each district in Tehran. Following retinoscopy and autorefraction with the 0.25 D bracketing (Topcon KR- 8000, Topcon, Tokyo, Japan), all participants had a subjective refraction. Then all participants underwent cycloplegic autorefraction. Results The final analysis was performed on 3482 participants with a mean age of 31.7 years (range 5-92 years). Based on cycloplegic and subjective refraction, mean spherical equivalent (SE) was +0.31±1.80 and -0.32±1.61 D, respectively (p<0.001). The 95% limits of agreement (LoA) between these two types of refraction were from -0.40 to 1.70 D. The largest difference between these two types of refraction was seen in the age group of 5-10 years (1.11±0.60 D), and the smallest difference was in the age group of >70 years (0.34±0.45 D). The 95% LoA was -0.52 to 0.89 D in patients with myopia and -0.12 to 2.04 D in patients with hyperopia. We found that female gender (coefficients=0.048), older age (coefficients=-0.247), higher education (coefficients=-0.043) and cycloplegic SE (coefficients=-0.472) significantly correlated with lower intermethod differences. Conclusions The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclorefraction technique is highly recommended to exactly measure the refractive error in momentous conditions such as refractive surgery, epidemiological researches and amblyopia therapy, especially in hypermetropic eyes and paediatric cases. [ABSTRACT FROM AUTHOR]

Purpose To determine the prevalence of amblyopia and strabismus in preschool children in Eastern China. Methods The Nanjing Pediatric Vision Project was a cross-sectional, population-based cohort study conducted in preschool children aged 36-72 months from 2011 to 2012 in Yuhua District, Nanjing, China, using an age-stratified random sampling procedure. A questionnaire totalling 117 items was sent to be completed by the corresponding parents or legal guardians of each eligible child. Comprehensive eye examinations, including visual acuity, anterior segment examination, autorefraction, cover test and ocular motility, were conducted. Postcycloplegic refraction and fundus examinations were performed if necessary. Results Amblyopia was present in 68 children (1.20%, 95% CI 0.92% to 1.48%), with no statistical differences in gender ( p=0.903) and age ( p=0.835). Among these, 27 had bilateral amblyopia and 41 had unilateral amblyopia, including 26 anisometropic without strabismus, 26 binocular refractive, 7 strabismic, 6 combined strabismic/anisometropic and 3 deprivation amblyopia. Strabismus was found in 320 children (5.65%, 95% CI 5.05% to 6.25%), including 43 with concomitant esotropia, 259 with concomitant exotropia (1 esotropia at near but exotropia at distance), 8 with microtropia (3 esotropia and 5 exotropia), 10 with pure vertical strabismus (3 dissociated vertical deviation and 7 oblique muscle dysfunction) and 1 with Type I Duane syndrome. The prevalence of strabismus had no statistical differences in gender ( p=0.952), but had significant statistical differences between different age groups ( p=0.021). Conclusions The prevalence of amblyopia and strabismus in preschool children in Eastern China were 1.20% and 5.65%, respectively. The refractive and strabismus are the main factors associated with amblyopia. [ABSTRACT FROM AUTHOR]

Background/Aims Amblyopia is the most common condition affecting visual acuity in childhood. Left untreated it will not resolve itself, leading to increased risk of blindness. Occluding the good eye with a patch is a highly effective treatment if carried out before age 7 years but compliance is a major problem. This systematic review addresses the question: How effective are existing interventions at increasing compliance to patching treatment in children with amblyopia? Methods Electronic searches were carried out in June 2014 and updated in April 2015 to identify studies reporting primary data on interventions to increase patching compliance. Data screening, extraction and quality ratings were performed independently by two researchers. Results Nine papers were included. Interventions including an educational element (5 studies) significantly increased patching compliance and had higher quality ratings than interventions that changed aspects of the patching regime (3 studies) or involved supervised occlusion (1 study). Meta-analysis was conducted on four studies and indicated that overall interventions involving an educational element have a significant small effect r=0.249, p<0.001. Conclusions Interventions to increase patching compliance should include educational elements. High quality research is needed to further assess the effectiveness of specific elements of educational interventions and additional behaviour change techniques. [ABSTRACT FROM AUTHOR]

Purpose To determine the thickness of the fovea in eyes of children with anisohypermetropic amblyopia, their fellow eyes and eyes of age-matched controls. Additionally, to assess the effects of optical treatment on the foveal thickness in eyes with anisohypermetropic amblyopia. Materials and methods Twenty-one patients (6.0 ±2.3 years, mean±SD) with anisohypermetropic amblyopia and 25 age-matched controls (5.6±1.9 years) were studied. Spectral-domain optical coherence tomography (SD-OCT) was used to obtain OCT images. The foveal thickness and the thickness of the outer nuclear layer (ONL), photoreceptor inner segment (IS) layer and outer segment (OS) layer were measured by the embedded OCT software. Results The length of the OS was significantly greater in the fellow eyes (48.0±6.6 mm) than in the amblyopic eyes (42.4±4.6 mm, p=0.03). One year after the optical treatment of the anisohypermetropia, the best-corrected visual acuity (BCVA) improved and the length of the OS was significantly increased (p=0.0001). After optical treatment, there was no more significant difference in the OS length between the amblyopic eyes and the fellow eyes ( p=0.95). The change of BCVA was significantly correlated with the change of the length of the OS 1 year after the treatment (r=0.52; p=0.0004). Conclusions Anisohypermetropic amblyopic eyes have qualitative and quantitative differences in the retinal microstructures of the fovea from normal eyes. An increase in the OS length was detected in the amblyopic eyes after the optical treatment. A significant correlation was found between the increased OS length and better BCVA. [ABSTRACT FROM AUTHOR]

Aim To evaluate the prevalence of lateral incomitance (LI) and its association with surgical outcome in intermittent exotropia. Methods We retrospectively surveyed patients who had been followed up for 18 months or more after surgery for intermittent exotropia conducted from 1 September 2008 to 31 December 2010. Preoperative significant LI (preLI+) was defined as a decrease of >5 prism dioptres (PD) in exodeviation of distant gaze at lateral gaze. Postoperative significant LI (postLI+) was defined as a difference of >5 PD between distant and lateral gaze. Gender, age at surgery, binocular spherical equivalent, preoperative angle of deviation, type of intermittent exotropia, type of surgery, and stereopsis were investigated together with associations with LI and surgical results. Surgical results were analysed using data from a postoperative period of at least 18 months. Results Of 155 patients, 63 (40.6%) had preLI+. Surgical failure including consecutive esotropia was not associated with preLI+ ( p=0.140). In subgroup analysis, bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession (ULR) procedures did not induce significant LI, but non-operated eyes with ULR showed reduced LI after surgery. Conclusions Surgical outcomes in ULR and BLR for intermittent exotropia correction showed no association with preLI+. The prevalences of significant LI were unchanged after surgery in both groups. [ABSTRACT FROM AUTHOR]

Background To investigate the optimal surgical dose for treating infantile exotropia. Methods In this retrospective study, clinical records of 44 children who had undergone bilateral lateral rectus recessions before 4 years of age for an exotropia present before 12 months of age were studied. Children had 1 year of follow-up after surgery. Patients were separated into those who had traditional surgery and those who received a reduced recession of their lateral recti. Results The traditional surgery group comprised 36% of the patients and the reduced recession group, 1-2 mm reduction in the recession, comprised 64% of the study group. There was borderline significance (p=0.074) when the postoperative angle of deviation was compared in the early postoperative period. The traditional group had a mean deviation of 5.25 prism dioptres (PD) of esodeviation compared with the reduced recession group having a 2.91 esodeviation. There was no statistical difference at the 1-year evaluation of the alignment. The traditional group had a mean exodeviation of 2.63 PD compared with the reduced recession group having a 2.91 PD exodeviation. Conclusions Postoperative surgical outcome was not affected by a reduction in the amount of recession by 1-2 mm from traditional tables used for treatment of exotropia. Reducing the recession of the lateral recti reduces the risk of overcorrection in this sensory labile population. [ABSTRACT FROM AUTHOR]

Aim To describe a surgical procedure for excising the eyelash line to treat cilial entropion in patients with Down's syndrome. Methods 24 Down's patients with cilial entropion and medial epiblepharon underwent eyelash line resection bilaterally. The area and density of fluorescein staining of the superficial punctate keratopathy (SPK; 0=none to 3=wide or severe) and the frequency of spectacle wear (0=no wear to 2=all day wear) were evaluated prospectively. Results The postoperative area and density of the SPK improved significantly in both eyes (p<0.001, p<0.001). The score of spectacle wear was 1.3±0.8 preoperatively which improved significantly to 1.7±0.5 after surgery (p=0.018). Five patients had a partial recurrence of misdirected eyelashes adjacent to the site of the excision. Two patients had extended excisions of the misdirected eyelashes 3 years after the initial surgery, and they did not have any further recurrences. Three other patients were followed without additional treatment because lacrimation and eye discharge were mild even with some eyelashes misdirected toward cornea. Conclusions Eyelash line resection is a simple and effective technique for cilial entropion and medial epiblepharon in patients with Down's syndrome. The surgery improves the SPK and frequency of spectacle wear. [ABSTRACT FROM AUTHOR]

Background Anisometropia was recently shown to occur in 10% of infants diagnosed with dacryostenosis at a mean age of 1 year. The purpose of this study was to determine whether earlier (<1 year) spontaneous resolution or probing decreases the risk of anisometropia in infants with dacryostenosis. Methods The medical records of all patients diagnosed as infants with dacryostenosis at Mayo Clinic, Rochester, Minnesota, USA, from 1 January 1988 to 31 December 1992 were retrospectively reviewed. Of 662 consecutive infants diagnosed with dacryostenosis, 244 (36.9%) were subsequently examined in the ophthalmology department and included in the study. Each of the study patients was followed through to 30 June 2011. The main outcome measure was the rate of anisometropia (⩾1 dioptre between the two eyes) among those who spontaneously resolved and those who underwent surgery. Results Among the 244 cases, 189 (77.5%) spontaneously resolved at a mean age of 4.5 months (range 0.3-35 months), and 55 (22.5%) underwent surgery at a mean age of 16 months (range 0-53 months). Anisometropia was diagnosed in 17 (9.0%) of the 189 who spontaneously resolved and in 2 (3.6%) of the 55 operated children ( p=0.19). Although there was no significant trend, earlier resolution was associated with higher rates of anisometropia. Conclusions Early spontaneous resolution of dacryostenosis was more likely to have a higher, not lower, rate of anisometropia than late spontaneous or surgical resolution. Further studies are warranted to clarify the relationship between infantile dacryostenosis and the development of hyperopic anisometropia. [ABSTRACT FROM AUTHOR]

Background Previous reports suggest that adherence to patching is a major issue in amblyopia treatment. We tested with an unmasked randomised controlled clinical trial whether an intense educational/motivational intervention improves adherence when a high-dose regime is prescribed. Methods 62 children with newly diagnosed amblyopia were randomly allocated into two treatment arms with and without educational/motivational intervention material. Both were prescribed patching 10 h/day, 6 days/week for a fixed period of 12 weeks. The intervention arm received an educational/motivational intervention before patching which included information booklets, video, a cartoon story book, sticker charts and a dedicated session with a researcher. The control arm received the usual clinical information. The primary outcome measure was adherence measured using electronic occlusion dose monitors where a success/failure binary outcome was used to account for participants who dropped out of the study defined as patching >4 h/day. Visual outcome, expressed as percentage visual deficit, was measured as secondary outcome. Results The intervention increased adherence success rate from 45.2% in the control group to 80.6% in the intervention group (p=0.0027). However, visual outcome was not significantly better in the intervention group (p=0.190). Conclusions Our study shows that an intense educational/motivational intervention can improve adherence to patching to high prescribed doses although no significant improvement in visual outcome was observed. Trials registration number: ISRCTN05346737 (International Standard Randomised Controlled Trial Number Register). [ABSTRACT FROM AUTHOR]

Purpose To determine the choroidal thickness (CT) in the macular area of eyes of children with hyperopic anisometropic amblyopia and to compare the thickness with that of fellow eyes and age-matched controls. Materials and methods Twenty-five patients (6.6±2.2 years, mean±SD) with hyperopic anisometropic amblyopia and twenty age-matched controls (6.7±1.9 years) were studied. The CT was measured with the enhanced depth imaging programme of a spectral domain optical coherence tomographic instrument in all patients and controls. The CT of the subfoveal area and at 1 mm and 3 mm diameter around the fovea was determined. In addition, the correlation between the CT and axial length was calculated. Results The mean subfoveal CT was 351.3±54.7 mm in the amblyopic eyes, 283.5±55.2 mm in the fellow eyes and 282.7±73.3 mm in the control eyes. The subfoveal choroid in amblyopic eyes was significantly thicker than that of the fellow eyes and control eyes (p=0.001). There was a significant negative correlation between the subfoveal CT and the axial length in the amblyopic eyes (amblyopic eyes: r=-0.51, p=0.01) and the control eyes (r=-0.46, p=0.01). Conclusions The subfoveal choroid of eyes with hyperopic anisometropic amblyopia is significantly thicker than that of the fellow eye and the age-matched controls. The profile of the CT in the amblyopic eyes was different from that of the fellow eyes and control eyes. [ABSTRACT FROM AUTHOR]

Background To report the effect of restoration of binocular functions in adult strabismus on the healthrelated quality of life (HRQOL). Methods 61 adults undergoing strabismus surgery completed Adult Strabismus-20 (AS-20) and Amblyopia and Strabismus (A&SQ) HRQOL questionnaires preoperatively and postoperatively. Patients were grouped according to their responses to binocular tests as binocular vision positive (BVP) and binocular vision negative (BVN) groups. Changes in AS-20 and A&SQ scores of the overall group and the subgroups were evaluated. Results Motor success was 90%, and 43% of the cohort showed measurable level stereopsis and central fusion on the Worth four-dot test or on the synoptophore. HRQOL scores (composite, psychosocial and functional) of the cohort measured by AS-20 and A&SQ showed significant improvement after surgery (AS- 20: 42,40,45 vs 85,86,84, AS&Q: 46,52,38 vs 76,75,78, p<0.05 for all comparisons). But the BVP (n-26) group was not found superior to the BVN (n-35) group both functionally and psychosocially ( p>0.05). Only after the exclusion of the amblyopic patients, functional superiority of the BVP group (n-20) over the BVN group (n-20) was disclosed (AS-20: 45 vs 31, A&SQ: 28 vs 16, p<0.05), while the composite and psychosocial subscale score improvements were not different (AS-20: 44,40 vs 34,38, A&SQ: 30,38 vs 20,37, p>0.05 for all comparisons). Conclusions The restoration of binocular vision is possible in adults with a long-term history of strabismus and both AS-20 and A&SQ questionnaires are sensitive to detect additive effect of binocular vision on functional aspects of the quality of life. To increase this sensitivity, questionnaires can be modified to include items inquiring tasks that require fine stereopsis. [ABSTRACT FROM AUTHOR]

Aims To investigate the neuromechanisms of perceptual learning treatment in patients with anisometropic amblyopia using functional MRI (fMRI) and diffusion tensor imaging (DTI) techniques. Methods 20 patients with monocular anisometropic amblyopia participated in the study. Both fMRI and DTI data were acquired for each patient twice: before and after 30 days' perceptual learning treatment for the amblyopic eye. During fMRI scanning, patients viewed the stimuli with either the sound or amblyopic eye. Changes of cortical activation after treatment were evaluated. In the DTI exams, the fractional anisotropy (FA) values, apparent diffusion coefficient (ADC) values, the voxel numbers of optic radiations (ORs), and the number of tracks were compared between the ipsilateral and the contralateral ORs and also between the previous and posterior scans. Results Remarkable increased activation via the amblyopic eyes was found in Brodmann Area (BA) 17-19, bilateral temporal lobes, and right cingulate gyrus after the perceptual learning treatment. No significant changes were found in the FA values, ADC values, voxel numbers, and the number of tracks after the treatment. Conclusions These results indicate that perceptual learning treatment for amblyopia had a positive effect on the visual cortex and temporal lobe visual areas in patients with anisometropic amblyopia. [ABSTRACT FROM AUTHOR]

Aim To determine the age and ethnicityspecific prevalence of anisometropia in Australian preschool-aged children and to assess in this populationbased study the risk of anisometropia with increasing ametropia levels and risk of amblyopia with increasing anisometropia. Methods A total 2090 children (aged 6-72 months) completed detailed eye examinations in the Sydney Paediatric Eye Disease Study, including cycloplegic refraction, and were included. Refraction was measured using a Canon RK-F1 autorefractor, streak retinoscopy and/or the Retinomax K-Plus 2 autorefractor. Anisometropia was defined by the spherical equivalent (SE) difference, and plus cylinder difference for any cylindrical axis between eyes. Results The overall prevalence of SE and cylindrical anisometropia ≥1.0 D were 2.7% and 3.0%, for the overall sample and in children of European-Caucasian ethnicity, 3.2%, 1.9%; East-Asian 1.7%, 5.2%; South-Asian 2.5%, 3.6%; Middle-Eastern ethnicities 2.2%, 3.3%, respectively. Anisometropia prevalence was lower or similar to that in the Baltimore Pediatric Eye Disease Study, Multi-Ethnic Pediatric Eye Disease Study and the Strabismus, Amblyopia and Refractive error in Singapore study. Risk (OR) of anisometropic amblyopia with ≥1.0 D of SE and cylindrical anisometropia was 12.4 (CI 4.0 to 38.4) and 6.5 (CI 2.3 to 18.7), respectively. We found an increasing risk of anisometropia with higher myopia ≥-1.0 D, OR 61.6 (CI 21.3 to 308), hyperopia > +2.0 D, OR 13.6 (CI 2.9 to 63.6) and astigmatism ≥1.5 D, OR 30.0 (CI 14.5 to 58.1). Conclusions In this preschool-age population-based sample, anisometropia was uncommon with inter-ethnic differences in cylindrical anisometropia prevalence. We also quantified the rising risk of amblyopia with increasing SE and cylindrical anisometropia, and present the specific levels of refractive error and associated increasing risk of anisometropia. [ABSTRACT FROM AUTHOR]

Aims To investigate the potential morphological alterations of grey and white matter in monocular amblyopic children using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). Methods A total of 20 monocular amblyopic children and 20 age-matched controls were recruited. Whole-brain MRI scans were performed after a series of ophthalmologic exams. The imaging data were processed and two-sample t-tests were employed to identify group differences in grey matter volume (GMV), white matter volume (WMV) and fractional anisotropy (FA). Results After image screening, there were 12 amblyopic participants and 15 normal controls qualified for the VBM analyses. For DTI analysis, 14 amblyopes and 14 controls were included. Compared to the normal controls, reduced GMVs were observed in the left inferior occipital gyrus, the bilateral parahippocampal gyrus and the left supramarginal/postcentral gyrus in the monocular amblyopic group, with the lingual gyrus presenting augmented GMV. Meanwhile, WMVs reduced in the left calcarine, the bilateral inferior frontal and the right precuneus areas, and growth in the WMVs was seen in the right cuneus, right middle occipital and left orbital frontal areas. Diminished FA values in optic radiation and increased FA in the left middle occipital area and right precuneus were detected in amblyopic patients. Conclusions In monocular amblyopia, cortices related to spatial vision underwent volume loss, which provided neuroanatomical evidence of stereoscopic defects. Additionally, white matter development was also hindered due to visual defects in amblyopes. Growth in the GMVs, WMVs and FA in the occipital lobe and precuneus may reflect a compensation effect by the unaffected eye in monocular amblyopia. [ABSTRACT FROM AUTHOR]

Purpose To study macular morphology in amblyopic eyes using high-definition spectral domain optical coherence tomography (SD-OCT) and to compare the findings with fellow eyes. Methods This was a prospective institutional study of patients =6 years of age with unilateral amblyopia. Enhanced high-definition single line macular scans of amblyopic eyes were obtained using SD-OCT and compared with fellow eyes. Scans were evaluated qualitatively for structural differences. Central foveal thickness was measured and areas of the different retinal layers were computed within 500 mm from the foveal centre nasally and temporally. Results Forty-five patients with unilateral amblyopia were included: 25 with strabismic and 20 with anisometropic amblyopia with a mean age of 24.8 years. Qualitatively, the bulge in the inner segment/outer segment junction of the central fovea was noted to be attenuated or absent in 60% of amblyopic eyes compared with 29% of normal eyes, p=0.02. Also, amblyopic eyes demonstrated a shallow foveal pit compared with normal fellow eyes. Mean foveal thickness was significantly increased in amblyopic (228.56 mm) versus fellow eyes (221.72 mm), p=0.03. Upon exploring different retinal layers, the temporal inner nuclear layer area was increased (p=0.04) while the outer nuclear layer area was decreased ( p=0.04) in amblyopic eyes compared with fellow eyes. Conclusions Using enhanced high-definition SD-OCT, amblyopic eyes demonstrated qualitative and quantitative differences in macular features, possibly representing signs of immaturity compared with normal fellow eyes. [ABSTRACT FROM AUTHOR]

Aim To establish the range of normal stereoacuity thresholds and evaluate the diagnostic reliability of stereoacuity tests in preschool-aged children. Methods 1606 children, aged 24-72 months, had detailed eye examinations and stereoacuity testing. Lang-Stereotest II (LangII) was attempted on all children, Stereo Smile Stereoacuity II Test (SSST) was conducted on children aged <30 months and on older children who could not complete the Randot Preschool Stereoacuity Test (RPST). The RPST was conducted on children aged =30 months and on some younger children who passed both the LangII and SSST. Results Modes for the age groups 24-47 months and 48-72 months were: 200 arcsec for both age groups with the LangII test; 120 arcsec and 60 arcsec, respectively, with the SSST; 100 arcsec and 60 arcsec, respectively, with the RPST. Age-adjusted areas under the curve for detecting amblyopia, strabismus and anisometropia were: for the LangII test, 0.72, 0.68 and 0.60, respectively; for the SSST, 0.73, 0.80 and 0.57, respectively; for the RPST, 0.92, 0.82 and 0.73, respectively. Conclusions Normative data for the LangII, RPST and SSST stereoacuity tests were determined for children aged 24-72 months. Sensitivity and specificity at individual disparity levels for detecting anisometropia, amblyopia and strabismus were also determined for RPST and SSST. Using area under age-adjusted receiver operating curves, the RPST was found to be the most reliable in detecting ocular conditions compared with the LangII and SSST tests. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: Several studies have recently provided insights into how amblyopia may be most effectively managed. Despite the new evidence, a US study reported that a recent randomised controlled trial had made little influence on clinical practice. The aims of this research are to assess current practice of amblyopia management in the UK and to determine the comparability with the evidence-based recommendations. METHODS: A questionnaire was constructed to assess current amblyopia management practice, particularly in relation to areas investigated by recent research and emailed to every head orthoptist within the UK. RESULTS: There was a great deal of variability in the amount of occlusion that was prescribed for moderate and severe amblyopia. Sixty per cent of clinicians indicated that the maximum they would prescribe was in excess of the 6 h recommended by research. Atropine was rarely recommended as a first-line treatment, with occlusion generally being considered to be more effective. Despite recommendations regarding education as a means of reducing non-compliance, only 39% of clinicians always gave written information, although various other methods of enhancing compliance were used. A period of refractive adaptation was allowed by most clinicians but often far less than recommended. CONCLUSION: The uptake of recent research evidence into clinical practice is sporadic and incomplete with one-third of respondents indicating that following the studies, they had made no changes whatsoever to their practice. This is similar to other areas of medicine; the reasons are likely to be varied, and is an area that would benefit from greater attention. [ABSTRACT FROM AUTHOR]

AIMS: To study the effect and long-term sustainability of part-time occlusion therapy for anisometropic amblyopia after 8 years of age. METHODS: A total of 41 anisometropic amblyopes aged ≥8 years were analysed. In six patients, best-corrected visual acuity (BCVA) of amblyopic eye improved more than two lines within 2 weeks of full-time spectacle wear. The remaining patients were assigned to perform part-time patching during out-of-school hours. Long-term results were assessed in patients who were observed over 1 year after the end of the treatment. RESULTS: Among 35 patients, four dropped out, refusing further treatment, and one changed to atropine penalisation. The part-time patching schedule was completed in 30 patients. 90% of patients (27/30) complied well. Mean BCVA in the amblyopic eye improved significantly (p<0.001), and 96.7% of patients (29/30) achieved the final BCVA of 0.1 logMAR or better. In long-term results, 87% preserved the BCVA of 0.1 logMAR or better. None of four dropouts achieved the BCVA of 0.1 logMAR or better in long-term results even on the continuous spectacle wear. CONCLUSIONS: The part-time occlusion treatment in school-aged amblyopes, which had been carried out after school hours, was successful and the effect was sustained in most cases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Penetrating keratoplasty in infants has a very poor outcome compared to adults. It is of intrinsic interest to gain insight into the still unknown immunological mechanisms of graft failure because any form of uncorrected corneal opacity leads to amblyopia. METHODS: Allogeneic keratoplasty was performed between Lewis and Fisher rats. The recipients' ages were 10 and 3 weeks, respectively. All experiments were controlled syngeneically. Survival rates were calculated and cellular infiltrates analysed histologically. RESULTS: Median graft survival times were 15 days in old recipients and 9 days in young recipients (p<0.01). There were fewer infiltrating cells in the younger rats than in the older ones on the day of rejection. Despite the fact that T cells dominated there were significantly more NK cells in young recipients at all time points after transplantation when compared to old recipients. CONCLUSIONS: An animal model has been established that shows similar rejection kinetics as in children, that is corneal graft failure occurs sooner in young rats. Already little infiltration was sufficient to reject a corneal allograft. The dominance of infiltrating NK cells and the vigorous rejection process suggest an involvement of the innate immune system in this process. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: Little is known about the effectiveness of occlusion therapy in hospital settings. A retrospective analysis was conducted to assess modalities, outcome and hospital costs of children treated for amblyopia with patching in a UK clinic. METHODS: Notes of 322 children with amblyopia discharged after occlusion treatment were selected consecutively and reviewed. Data collated included age at presentation, amblyopia type, visual acuity (VA; before/after occlusion and at discharge), number of prescribed hours of occlusion, duration of patching treatment, number of glasses prescribed and number of visits attended or failed to attend. Hospital treatment costs were estimated. RESULTS: Mixed amblyopes were prescribed the longest amount of patching (mean 2815 h over 23 months) followed by strabismic (1984 h) and anisometropic (1238 h) amblyopes. 319 amblyopes received glasses and five atropine treatment. The percentage of patients reaching VA of 6/12 was best in the anisometropic and strabismic groups (>75%) and worse in mixed amblyopia (64%). Average hospital costs were estimated at £1365. CONCLUSION: Although the mean duration of treatment was long, involving many hospital visits, the visual outcome was variable, unsatisfactory (<6/9) and more expensive than necessary. As compliance has been identified as a major problem methods to improve amblyopia treatment are needed, possibly by using educational/motivational intervention. [ABSTRACT FROM AUTHOR]

Objective: To estimate the distribution and predictors of some common visual problems (strabismus, amblyopia, hypermetropia) within a population-based cohort of children at the age of 7 years. Methods: Children participating in a birth cohort study were examined by orthoptists who carried out cover/uncover, alternate cover, visual acuity and non-cycloplegic refraction tests. Prospectively collected data on potential risk factors were available from the study. Results: Data were available for 7825 seven-year-old children. 2.3% (95% Cl 2.0% to 2.7%) had manifest strabismus, 3.6% (95% Cl 3.3% to 4.1%) had past/present amblyopia, and 4.8% (95% Cl 4.4% to 5.3%) were hypermetropic. Children from the lowest occupational social class background were 1.82 (95% Cl 1.03% to 3.23%) times more likely to be hypermetropic than children from the highest social class. Amblyopia (p = 0.089) and convergent strabismus (p = 0.066) also tended to increase as social class decreased. Conclusions: Although strabismus has decreased in the UK, it and amblyopia remain common problems. Children from less advantaged backgrounds were more at risk of hypermetropia and to a lesser extent of amblyopia and convergent strabismus. Children's eye-care services may need to take account of this socio- economic gradient in prevalence to avoid inequity in access to care. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To compare visual outcome in response to two prescribed rates of occlusion (six hours a day and 12 hours a day). Design Unmasked randomised trial. Setting Research clinics in two London hospitals. Participants 97 children with a confirmed diagnosis of amblyopia associated with strabismus, anisometropia, or both. Interventions 18 week period of wearing glasses (refractive adaptation) followed by occlusion prescribed ("patching") for six or 12 hours a day. Main outcome measures Visual acuity measured by logMAR letter recognition; objectively monitored rate of occlusion (hours a day). Results The mean age of children at study entry was 5.6 (SD 1.5) years. Ninety were eligible for occlusion but 10 dropped out in this phase, leaving 80 children who were randomised to a prescribed dose rate of six (n=40) or 12 (n=40) hours a day. The mean change in visual acuity of the amblyopic eye was not significantly different (P=0.64) between the two groups (0.26 (95% confidence interval 0.21 to 0.31) log units in six hour group; 0.24 (0.19 to 0.29) log units in 12 hour group). The mean dose rates (hours a day) actually received, however, were also not significantly different (4.2 (3.7 to 4.7) in six hour group v 6.2 (5.1 to 7.3) in 12 hour group; P=0.06). The visual outcome was similar for those children who received three to six hours a day or more than six to 12 hours a day, but significantly better than that in children who received less than three hours a day. Children aged under 4 required significantly less occlusion than older children. Visual outcome was not influenced by type of amblyopia. Conclusions Substantial (six hours a day) and maximal (12 hours a day) prescribed occlusion results in similar visual outcome. On average, the occlusion dose received in the maximal group was only 50% more than in the substantial group and in both groups was much less than that prescribed. Younger children required the least occlusion. Trials registration Clinical Tria [ABSTRACT FROM AUTHOR]

Aim: To document the long term outcome of congenital cataract surgery with primary posterior chamber (PC) lens implantation in the first year of life. Method: A retrospective review of congenital cataract surgery in the first year of life with PC lens implantation in 18 infants, eight with unilateral and 10 with bilateral cataract. The average age at surgery was 15 weeks (range 3–44 weeks). The mean follow up was 95 months (range 60–139 months). Results: The best outcomes were in the bilateral group where 50% of eyes achieved 6/18 or better, with a best acuity of 6/9. Acuities were poor in the unilateral group where only 38% achieved 6/60 or better, with a best acuity of 6/24. There was a mean refractive shift between first refraction after surgery and refraction at 36 months after surgery of -3.44 dioptres with a very wide range (+2.00 to -15.50). There was a significantly greater myopic shift in the unilateral cases. Many eyes in both groups continued to show an increasing myopic shift between 36 months after surgery and their final recorded refraction. The main complications were amblyopia, especially in unilateral cataracts, and posterior capsular opacification. Amblyopia was most probably related to a combination of early onset of dense cataract in this young age group, late presentation for initial surgery, delay in capsulotomies, and imperfect compliance with a rigorous occlusion regime. Conclusion: Intraocular lens implantation in infants less than 1 year of age is generally a safe procedure. The spread of final refractive error was very wide. Final refraction in the unilateral group was significantly more myopic than the bilateral group. Final acuities were often disappointing especially in the unilateral group. [ABSTRACT FROM AUTHOR]

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

Aim: To evaluate if functionally relevant deficits in reading performance exist in children with essential microstrabismic amblyopia by comparing the monocular and binocular reading performance with the reading performance of normal sighted children with full visual acuity in both eyes. Methods: The reading performance of 40 children (mean age 11.6 (SD 1.4) years) was evaluated monocularly and binocularly in randomised order, using standardised reading charts for the simultaneous determination of reading acuity and speed. 20 of the tested children were under treatment for unilateral microstrabismic amblyopia (visual acuity in the amblyopic eyes: logMAR 0.19 (0.15); Fellow eyes-0.1 (0.07)); the others were normal sighted controls (visual acuity in the right eyes-0.04 (0.15); left eyes-0.08 (0.07)). Results: In respect of the binocular maximum reading speed (MRS), significant differences were Found between the children with microstrabismic amblyopia and the normal controls (p = 0.03): whereas the controls achieved a binocular MRS of 200.4 (11) wpm (words per minute), the children with unilateral amblyopia achieved only a binocular MRS of 172.9 (43.9) wpm. No significant differences between the two groups were found in respect of the binocular logMAR visual acuity and reading acuity (p>0.05). For the monocular reading performance, significant impairment was found in the amblyopic eyes, whereas no significant differences were found between the sound fellow eyes of the amblyopic children and the control group. Conclusion: in binocular MRS, significant differences could be found between children with microstrabismic amblyopia and normal controls. This result indicates the presence of a functionally relevant reading impairment, even though the binocular visual acuity and reading acuity were both comparable with the control group. [ABSTRACT FROM AUTHOR]

Aim: To describe the visual response to spectacle correction ("refractive adaptation") for children with unilateral amblyopia as a function of age, type of amblyopia, and category of refractive error. Method: Measurement of corrected amblyopic and fellow eye IogMAR visual acuity in newly diagnosed children. Measurements repeated at 6 weekly intervals for a total 18 weeks. Results: Data were collected from 65 children of mean (SD) age 5.1 (1.4) years with previously untreated amblyopia and significant refractive error. Amblyopia was associated with anisometropia in 18(5.5(1.4) years), strabismus in 16 (4.2 (0.98) years), and mixed in 31(5.2 (1.5) years) of the study participants. Mean (SD) corrected visual acuity of amblyopic eyes improved significantly (p<0.001) from 0.67(0.38) to 0.43 (0.37) logMAR: a mean improvement of 0.24 (0.18), range 0.0-0.6 log units. Change in logMAR visual acuity did not significantly differ as a function of amblyopia type (p =0.29) (anisornefropia 0.22 (0.13); mixed 0.18 (0.14); strabismic 0.30 (0.24)) or for age (p =0.38) ("under 4 years" 0.23 (0.18); "4-6 years" 0.24 (0.20); "over 6 years" 0.16 (0.23)). Conclusion: Refractive adaptation is a distinct component of amblyopia treatment. To appropriately evaluate mainstream therapies such as occlusion and penalisation, the beneficial effects of refractive adaptation need to be fully differentiated. A consequence for clinical practice is that children may start occlusion with improved visual acuity, possibly enhancing compliance, and in some cases unnecessary patching will be avoided. [ABSTRACT FROM AUTHOR]

Strabismus (misalignment of the eyes; also known as “squint”) comprises a common heterogeneous group of disorders characterised by a constant or intermittent ocular deviation often associated with amblyopia (uniocular failure of normal visual development) and reduced or absent binocular vision. The associated poor cosmetic appearance may also interfere with social and psychological development. Extensive twin and family studies suggest a significant genetic component to the aetiology of strabismus. The complexity of the molecular basis at strabismus is now beginning to be elucidated with the identification of genetic loci and disease causing genes. Currently greater insights have been gained into the incomitant subtype (differing magnitude of ocular misalignment according to direction of gaze), whereas less is known about the pathogenesis of the more common childhood concomitant strabismus. It is hoped that a greater understanding of the molecular genetics of these disorders will lead to improved knowledge of disease mechanisms and ultimately to more effective treatment. The aim of this paper is to review current knowledge of the molecular genetics of both incomitant and concomitant strabismus. [ABSTRACT FROM AUTHOR]

Aims: To estimate the long term cost effectiveness of treatment for amblyopia in 3 year old children. Methods: A cost utility analysis was performed using decision analysis including a Markov state transition model. Incremental costs and effects during the children's remaining lifetime were estimated. The model took into account the costs and success rate of treatment as well as effects of unilateral and bilateral visual impairment caused by amblyopia and other eye diseases coming along later in life on quality of life (utility). Model parameter values were obtained from the literature, and from a survey of experts. For the utility of unilateral visual impairment a base value of 0.96 was assumed. Costs were estimated from a third party payer perspective for the year 2002 in Germany. Costs and effects were discounted at 3%. Uncertainty was assessed by univariate and probabilistic sensitivity analysis (Monte-Carlo simulation). Results: The incremental cost effectiveness ratio (ICER) of treatment was €2369 per quality adjusted life year (QALY). In univariate sensitivity analysis the ICER was most sensitive to uncertainty concerning the utility of unilateral visual impairment-for example, if this utility was 0.99, the ICER would be €9148/ QALY. Monte-Carlo simulation yielded a 95% uncertainty interval for the ICER of €710/QALY to €38 696/QALY; the probability of an ICER smaller than €20 000/QALY was 95%. Conclusion: Treatment for amblyopia is likely to be very cost effective. Much of the uncertainty in results comes from the uncertainty regarding the effect of amblyopia on quality of life. In order to reduce this uncertainty the impact of amblyopia on utility should be investigated. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity. Design: Randomised controlled trial of full treatment with glasses and patching, if required, compared with glasses only or no treatment. Masked assessment of best corrected acuity after one year of follow up. Setting: Eight UK eye departments. Participants: 177 children aged 3-5 years with mild to moderate unilateral impairment of acuity (6/9 to 6/36) detected by screening. Results: Children in the full and glasses treatment groups had incrementally better visual acuity at follow up than children who received no treatment, but the mean treatment effect between full and no treatment was equivalent to only one line on a Snellen chart (0.11 log units; 95% confidence interval 0.050 to 0.171; P < 0.0001). The effects of treatment depended on initial acuity: full treatment showed a substantial effect in the moderate acuity group (6/36 to 6/18 at recruitment) and no significant effect in the mild acuity group (6/9 to 6/12 at recruitment) (P=0.006 for linear regression interaction term). For 64 children with moderate acuity loss the treatment effect was 0.20 log units, equivalent to one to two lines on a Snellen chart. When all children had received treatment, six months after the end of the trial, there was no significant difference in acuity between the groups. Conclusions: Treatment is worth while in children with the poorest acuity, but in children with mild (6/9 to 6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness. [ABSTRACT FROM AUTHOR]

Aim: To analyse the test characteristics of orthoptic screening for amblyopia or amblyogenic risk factors (target conditions) in kindergarten. Methods: 1180 three year old children were screened by orthoptists in 121 German kindergartens. Orthoptic screening consisted of cover tests, examination of eye motility and head posture, and monocular visual acuity testing with the Lea single optotype test. Children were re-examined in kindergarten by different orthoptists after 3-6 months using a more demanding pass threshold for visual acuity. All children with at least one positive orthoptic test result or an inconclusive re-examination were referred to an ophthalmologist for diagnosis. The gold standard was set positive if a target condition was diagnosed on ophthalmological examination. It was set negative if no target condition was found upon ophthalmological examination, or if a child who screened negative or inconclusive passed the orthoptic re-examination without any positive test result. Results: The gold standard was ascertained in 1114 children. 26 (2.3%) children had a "positive" gold standard. In 10.8% of the children the initial screening was "inconclusive," mostly due to lock of collaboration. Screening test sensitivity (based on conclusive results only) was 90.9% and specificity was 93.8%. Conclusions: Orthoptic vision screening of 3 year olds in kindergarten is sensitive and specific. However, owing to a substantial proportion of inconclusive screening results, rescreening of non-cooperative 3 year old children should be considered. [ABSTRACT FROM AUTHOR]

Background: Amblyopia treatment is not standardised and differences between centres and countries have not been systematically investigated. This survey compares the different patterns of orthoptic treatment of amblyopia in the United Kingdom (UK) and three German speaking countries (GSC). Methods: Questionnaires were sent to orthoptists in the UK and the GSC asking for their preferred choices of treatment of amblyopia between the ages of 6 months to 10 years. Results: The following significant differences in management of amblyopia were found: (1) the number of hours of occlusion per week was higher in the GSC, p<0.0001, (2) orthoptists in the GSC treat amblyopia up to an older age. Orthoptists in the GSC and in the UK predicted similar treatment outcomes. Conclusion: Orthoptists in the GSC usually treat patients more intensively and for longer, while the prediction of visual outcome does not differ significantly between countries. These results highlight the lack of standardisation in the treatment of the various types of amblyopia. [ABSTRACT FROM AUTHOR]

Aim: To identify which factors influence the final visual acuity in children with anisometropic amblyopia. Methods: A retrospective analysis of 112 children with anisometropic amblyopia, identified from examining all case notes of children who had failed preschool or school screening. Results: The age at presentation had no effect on the final visual outcome (p=0.804). Both the degree of refractive error and the degree of anisometropia at presentation correlated with final visual acuity (p<0.001 and p=0.001). Those with strabismus had a poorer final outcome. Conclusions: The age at presentation of a child with anisometropic amblyopia appears to have no significant effect on the final visual acuity. The amount of refractive error and degree of anisometropia at presentation do correlate strongly with final visual acuity. This would suggest, firstly, that children with poorer visual acuity at presentation and higher degrees of anisometropia should be treated more aggressively and that, secondly, children with anisometropic amblyopia should be treated regardless of age. [ABSTRACT FROM AUTHOR]

Aim: To evaluate long term visual outcome of treatment for amblyopia. Methods: In a previous study, 44 children with unilateral amblyopia caused by strabismus or anisometropia were enrolled in a prospective study investigating the results of treatment. All children were regularly examined up to at least 8 years of age and outcome was evaluated. All subjects were invited to a re-examination and in total 26 subjects attended. Two of these were excluded because of insufficient records. The final sample consists of 24 subjects. Mean follow up time was 10.4 (SD 1.9) years. Results: For the amblyopic eyes, 17% deteriorated in visual acuity, 50% were stable, and 33% gained in visual acuity. For the non-amblyopic eyes, 8% lost one line in visual acuity, 38% were stable, and 54% gained in visual acuity. No eye in any subject shifted more than 0.2 IogMAR units. The increase in visual acuity for the non-amblyopic eyes was significant, while the increase for the amblyopic eyes was not. All straight eyed anisometropic amblyopes showed a distinct decrease in magnitude of anisometropia. Conclusions: Visual acuity was essentially stable in the amblyopic eyes 10 years after cessation of treatment in the studied population. [ABSTRACT FROM AUTHOR]

Background/aims: The effectiveness of occlusion therapy for the treatment of amblyopia is a research priority. The authors describe the design of the Monitored Occlusion Treatment for Amblyopia Study (MOTAS) and its methodology. MOTAS will determine the dose-response relation for occlusion therapy as a function of age and category of amblyopia. Methods: Subjects progress through up to three study phases: (1) Assessment and baseline phase: On confirmation of eligibility, and after parental consent, baseline visual functions are determined, and spectacles prescribed as necessary; (2) Refractive adaptation phase: Subjects wear spectacles full time and return to clinic at 6 weekly intervals until 18 weeks, by which time all improvement due to refractive correction is complete; (3) Occlusion phase: All subjects are prescribed 6 hours of occlusion per day. Daily occlusion is objectively monitored using an occlusion dose monitor (ODM). Outcome variables: visual acuity (IogMAR charts), log contrast sensitivity (Pelli-Robson chart), and stereoacuity (Frisby) are assessed at 2 weekly intervals until gains in visual acuity cease to be statistically verifiable. Conclusion: Four methodological issues have been addressed; firstly, baseline stability of visual function; secondly, differentiation of refractive adaptation from occlusion; thirdly, objective measurement of occlusion dose and concordance; fourthly, use of validated outcome measures. [ABSTRACT FROM AUTHOR]

The article discusses several important issues to put in mind when it comes to amblyopia, a form of cortical visual impairment. Topics covered include a table that outlines visual functions adversely affected in amblyopia and their definitions, how amblyopia is diagnosed, and a diagram that shows correction of different refractive errors.

Examines advances and issues in ophthalmology. Side effects of some drugs for primary open angle glaucoma; Doubt on the effectiveness of the standard treatment of amblyopia; How most visually impaired elderly people are treated.

This study presents a case of an 8-year-old boy with iris heterochromia and anisometropic amblyopia who was diagnosed with Waardenburg syndrome (WS) type 2. An ophthalmic examination revealed iris heterochromia and anisometropic amblyopia in our patient. In the systemic examination, a white forelock and vitiligo on the arms and body were observed and neurosensory hearing loss was revealed, for which the patient used hearing aids. Identification and typing of patients with WS is crucial to address neurosensory hearing loss, glaucoma and fundus changes. While it might be challenging to communicate with a patient with speech and hearing problems, visual acuity should be examined carefully and probable amblyopia should be identified. Anterior segment changes and signs of glaucoma should also be evaluated in detail. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 68-year old woman who was brought to a hospital for choroidal pigmental tumour in the left eye. During eye examination, it was revealed that the tumour was asymptomatic, parapillary and is covered with drusen and with the absence of any orange pigment. The visual acuity of the patient was 0.7 in the right eye relative to hypermetropic amblyopia since her childhood.

Background: Unilateral visual impairment (UVI) as a result of amblyopia or refractive error is common in childhood, but its functional significance remains largely unexplored. Aim: To investigate the influence of visual acuity and stereoacuity on the performance of preschool children on tasks requiring visuomotor skills and visuospatial ability. Methods: Children with normal (6/6) visual acuity (VA) in both eyes and children with UVI ranging from 6/9 to 6/60, with no strabismus and normal vision in the fellow eye, were assessed on a neurodevelopmental test battery of visually guided tasks. Results: 50 children (mean age (SD): 52.4 (5.7) months; median (range) VA: 6/9 (6/6 to 6/60); median (range) stereoacuity: 70 seconds arc (40-absent)) completed the test battery. UVI and stereoacuity correlated moderately (Pearson's r=0.537, p<0.001) but seven of 28 children with impaired VA had normal stereoacuity (<70 seconds arc) while five of 22 with normal VA had abnormal stereoacuity. Stereoacuity correlated with performance on a task requiring fine hand-eye coordination and a task measuring visuomotor integration. UVI did not correlate with performance on any test battery items. Conclusions: UVI itself does not appear to relate to visuomotor actions, except when associated with reduced stereoacuity. Stereoacuity appears to have an influential role in fine visuomotor actions and spatial representation in preschool children. [ABSTRACT FROM AUTHOR]

Aims: To describe the effect of amblyopia on education, occupation, and 5 year incident vision loss. Methods: 3654 participants aged 49 years or older participated in the Blue Mountains Eye Study (BMES I, 1992-4) and 2335 (75.1 % of survivors) were reexamined (BMES II, 1997-9). All participants underwent detailed eye examination. Amblyopia, defined as best corrected visual acuity of less than or equal to 6/9 and not attributable directly to any underlying structural abnormality of the eye or the visual pathway, was identified in 118 participants (32%) in BMES I, of whom 73 were re-examined in BMESII. Occupation and educational classifications used definitions of the Australian Bureau of Statistics. Results: The mean age of people with amblyopia seen at baseline was 67.0 years. Amblyopia did not affect lifetime occupational class (p = 0.5), but fewer people completed higher university degrees (p =0.05). In people with amblyopia, there was an increased risk of 5 year incident visual impairment in the better seeing eye worse than 6/12, relative risk (RR) 2.7,95% confidence interval (CI) 1.6 to 4.6. One of 11 (9.1 %) people with amblyopia showed significant improvement in visual acuity in the poorer seeing eye after a two line (10 logMAR letter) vision loss in the better seeing eye. Conclusion: This study Further documents the longitudinal history of amblyopia using population based data. [ABSTRACT FROM AUTHOR]

Aim: To offer a critique of current methods of defining amblyopia treatment outcome and to examine alternative approaches. METHOD: Literature appraisal and descriptive case presentations. RESULTS: Currently, the outcome of amblyopia treatment is expressed as the number of acuity chart lines gained or, alternatively, achievement of an arbitrarily adopted level of visual acuity. As binocular vision is optimised with equal visual input from each eye the authors propose that the optimum outcome of amblyopia therapy is to achieve a visual acuity in the amblyopic eye equal to that of its fellow. In addition, improvement should be graded as the proportion of change in visual acuity with respect to the absolute potential for improvement (that is, that pertaining in the fellow eye at end of treatment). CONCLUSIONS: There are two methods of appropriately describing the outcome of amblyopia treatment: firstly, by the difference in final visual acuity of amblyopic and fellow eye (residual amblyopia); secondly, the proportion of the deficit corrected. [ABSTRACT FROM AUTHOR]

Abstract Objective: To assess the effectiveness of early treatment for amblyopia in children. Design: Follow up of outcomes of treatment for amblyopia in a randomised controlled trial comparing intensive orthoptic screening at 8, 12, 18, 25, 31, and 37 months (intensive group) with orthoptic screening at 37 months only (control group). Setting: Avon, southwest England. Participants: 3490 children who were part of a birth cohort study. Main outcome measures: Prevalence of amblyopia and visual acuity of the worse seeing eye at 7.5 years of age. Results: Amblyopia at 7.5 years was less prevalent in the intensive group than in the control group (0.6% v 1.8%; P=0.02). Mean visual acuities in the worse seeing eye were better for children who had been treated for amblyopia in the intensive group than for similar children in the control group (0.15 v 0.26 LogMAR units; P <0.001). A higher proportion of the children who were treated for amblyopia had been seen in a hospital eye clinic before 3 years of age in the intensive group than in the control group (48% v 13%; P=0.0002). Conclusions: The intensive screening protocol was associated with better acuity in the amblyopic eye and a lower prevalence of amblyopia at 7.5 years of age, in comparison with screening at 37 months only. These data support the hypothesis that early treatment for amblyopia leads to a better outcome than later treatment and may act as a stimulus for research into feasible screening programmes. [ABSTRACT FROM AUTHOR]

Enumerates the disorders related to vision. Description of squints among children; Methodology in treatment of squints; Diagnosis of amblyopia.