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To define the prevalence of medical eye disease diagnoses among children enrolled in commercial insurance plans in the United States and to evaluate differences among groups based on the US census region, race/ethnicity, and familial net worth.: Retrospective study of de-identified claims data from the OptumLab® Data Warehouse (OLDW) between 2007 and 2018. All children (19 years) in the OLDW with coverage were studied and those with a claim for a significant eye disease (strabismus, amblyopia, nystagmus or structural eye disorders) with minimum 6-months follow-up were studied. Baseline characteristics were extracted for the calculation of eye disease prevalence, including age, sex, race/ethnicity, region of residence, and family net worth. The prevalence of each type of eye disease was calculated among all children and by baseline characteristics.: 10,759,066 children met the study criteria. The presence of any significant eye diagnosis was 6.7%. Disease was diagnosed more often in whites (6.9%) than blacks (5.6%) and Hispanics (5.9%). The most common eye disease diagnosed was strabismus (3.2%) followed by amblyopia (1.5%). In the North-East region, there was a 10.6% prevalence of any significant eye disease diagnosis, whereas in the Mid-West, it was 7.4% followed by the South and West (5.9% and 5.3%, respectively) (: Diagnosis of significant eye diseases is relatively common in American children. The most common medical eye disease diagnosis is strabismus. Prevalence of eye disease diagnosis from claims data varies between geographical regions and different income groups. This may reflect differences in healthcare utilization rather than true disease prevalence.

The parents of a 7-year-old boy reported to the ophthalmology clinic with complaints of a mass in both eyes of the child, noticed since birth, which had gradually increased in size. Antenatal, birth and family history were insignificant. On ocular evaluation, the best uncorrected visual acuity in

PURPOSE: To assess test-retest repeatability of the accommodative response (AR) in children with and without amblyopia and adults using the Grand Seiko autorefractor. DESIGN: Prospective reliability assessment. METHODS: Test-retest of accommodation was obtained while participants viewed 20/150 sized letters at 33 cm using the Grand Seiko autorefractor in children 5 to

Purpose: Theta Burst Stimulation can influence adult neuro-visual response in imbalanced visual pathways, possibly by influencing cortical excitability. Our objective was to compare suppressive imbalance (SI) and visual acuity (VA) after applying repetitive Transcranial Magnetic Stimulation (TMS) between groups of subjects with normal binocular vision, visual asymmetry and amblyopia. Methods: Thirty – five volunteers between 19 and 51 years of age, were split into three groups: 6 volunteers with asymmetric VA (group A); 19 amblyopes (group B); and 10 subjects with normal binocular vision (group C). VA and SI of all groups were evaluated before and after a single session of continuous theta-burst stimulation (cTBS) or placebo stimulation over the right occipital cortex. Results: In both groups A and B we found a significant VA improvement in the non-dominant eye after cTBS (p=0.04 and p=0.01, respectively). In SI evaluation, group A and group B also revealed a significant improvement after the cTBS session (p=0.03 and p=0.01, respectively).Finally, in the group of volunteers with normal binocular vision and for placebo groups A and B, there were no significant differences in VA and SI after cTBS. Conclusions: Amblyopic and visually asymmetric individuals improved VA and SI of the non-dominant eye after cTBS when compared to baseline and to placebo stimulation. These enhancements were not found in the group of volunteers with normal binocular vision. We can therefore reasonably assume that cTBS may interfere with the visual system of subjects that present some kind of asymmetry, possibly by improving neuronal imbalances.

PURPOSE To compare visual outcomes in children with moderate bilateral astigmatism treated with glasses with those who were merely observed. DESIGN Retrospective case series. METHODS The medical records of all children 1 to

Purpose: To compare referral results from two photoscreening devices that are in wide use relative to a manual screening test protocol in preschool children. Methods: Children aged 3 to 5 years who attended preschools in two counties within the State of Michigan (N = 1,085) took part in the State's vision screening program, which included the Lea Symbols and Stereo Butterfly tests, during a 3-month period. All who failed this screening or were unable to be tested, and 20% of those who passed, were then invited to undergo testing with the Plusoptix Vision Screener Model S-12C (Plusoptix, Inc) and Welch Allyn SPOT Vision Screener Model VS-100 (Hill-Rom, Inc) photoscreening devices. Screening was conducted by State-trained technicians. With the State's test results considered the gold standard for screening, sensitivity and specificity of the two photo-screening devices were calculated. McNemar's test and logistic regression were used to evaluate the findings. Results: A total of 1,085 children took part in the State's screening program. Their mean ± standard deviation age was 48.8 ± 7.2 months, with a 51:49 female-to-male ratio, and a similar percentage were Black (34.1%) or White (33.3%). The sensitivity of the SPOT and Plusoptix screening was 61.0% and 65.2%, respectively. The specificity of the SPOT and Plusoptix screening was 92.9% and 82.4%, respectively. For 84 children who were unable to be tested by the State's screening, the SPOT and Plusoptix devices completed the screening on the majority (86.9% and 73.8%, respectively). Conclusions: The photoscreening devices yielded numerous false-negative results and fewer false-positive results. Their ability to screen many children who could not be screened by manual testing indicates a useful application. [ J Pediatr Ophthalmol Strabismus . 2022;59(1):46–52.]

Summary Objective To investigate the differences between the amblyopic eye and the fellow eye in adults with anisometropic amblyopia. Materials and methods Measurements of the central macular thickness [CMT], subfoveal choroidal thickness [SFCT], and retinal nerve fiber layer [RNFL] in patients with anisometropic amblyopia were obtained using optical coherence tomography [OCT]. Axial length [AL], anterior chamber depth [ACD], and central corneal thickness [CCT] were measured with optical biometry. All 12 parameters were compared between the amblyopic eye [Group 1] and the fellow eye [Group 2]. Results A total of 110 eyes of 55 patients [9 myopic, 46 hypermetropic] were analyzed retrospectively. The ages of the patients ranged from 17 to 55 years, with a mean of 30.8 ± 10.7 years. 56.4% [n = 31] of the patients were female, and 43.6% [n = 24] were male. The mean spherical equivalent [SE] was 1.96 ± 3.79 in Group 1 and 1.28 ± 2.45 in Group 2. SFCT was 312.00 ± 53.03 in Group 1 and 283.47 ± 51.91 in Group 2. AL was 22.53 ± 1.40 in Group 1 and 22.79 ± 1.18 in Group 2. SE, SFCT, and AL were statistically significantly different between the two groups. There was no difference between the two groups in terms of CMT, RNFL , ACD and CCT values. Conclusion In adults with anisometric amblyopia, the SFCT of the amblyopic eye is greater than that of the fellow eye. The choroid plays an important role in the nutrition of the retinal layers, the development of ocular function and refractive error, and its development may be affected by the refractive error. Since the majority of our patients were hyperopic, the AL was found to be shorter in the amblyopic eye. CMT, RNFL, ACD and CCT values were the similar in both groups. There was no clinically significant relationship between biometric parameters and OCT parameters.

CLINICAL RELEVANCE Nunavik Inuit patients, in Northern Canada, have a significant burden of refractive error. The frequency at which they access eye care is insufficient. This exposes children of this population to a substantial risk of refractive amblyopia. BACKGROUND No data are available on eye health and services among Nunavik Inuit in Quebec, Canada. This study aims to describe the prevalence of ametropias, risk of refractive amblyopia, and eye health services uptake amongst a sample of Nunavik Inuit. METHODS Retrospective cohort using data from electronic records of the sole government-contracted eye team travelling to all 14 Nunavik villages, from 2006 to 2018. RESULTS Some 26,541 examinations were analysed, with data from 6,341 patients (median age 27 years (IQR 30); 32% aged under 19 years; 60.3% female) representing 48% of the census population. Population weighted prevalence of ametropias was myopia 46.5% (95% CI 45.3 - 47.6), hyperopia 17.1% (95% CI 16.2 - 18.1), astigmatism 39.6% (95% CI 38.4 - 40.8) and presbyopia 30.0% (95% CI 28.9 - 31.0). Some 5.9% of patients aged 0-9 years present a risk of refractive amblyopia. Mean frequency of examinations for all ages was once per 4 years (95% CI 4.0 - 4.0) and for children aged 5 - 19 years, frequency was once per 4.8 years (95% CI 4.8 - 5.0). In 2018, 74% of patients who were prescribed spectacles purchased them, with a median time of procurement of 21 days (IQR 247, skewness 2.7). CONCLUSION There is a high prevalence of ametropias amongst the clinical population of Nunavik Inuit. Most patients needing spectacles obtain them within a few weeks. Frequency of eye health services is insufficient to meet recommended guidelines, especially in children, for whom the risk of refractive amblyopia is pervasive.

To synthesize and appraise economic evaluations of vision screening to detect vision impairment in children.Literature searches were conducted on seven electronic databases, grey literature, and websites of agencies conducting health technology assessments. Studies were included if they (1) were full, comparative economic evaluations that used cost-utility, cost-benefit, cost-effectiveness, cost-consequence, or cost-analysis methods; (2) described screening services designed to detect amblyopia, strabismus, or uncorrected refractive errors in children under 6 years of age; and (3) published after 1994. High-quality studies were synthesized descriptively. Currencies were reported in 2019 Canadian dollars. Quality was assessed with the Pediatric Quality Appraisal Questionnaire (PQAQ).Vision screening services were conducted by paid staff, volunteers, or health care professionals in schools or clinics. Thirteen studies were published from five countries: China (n = 1), United States (n = 4), United Kingdom (n = 1), Canada (n = 1), and Germany (n = 6). Analytical techniques included cost-utility/cost-effectiveness combination (n = 2), cost-effectiveness analysis (n = 7), cost-utility analysis (n = 1), cost-benefit analysis (n = 1), cost-consequence analysis (n = 1), and cost analysis (n = 1). Incremental cost-effectiveness ratios ranged from C$1,056 to C$151,274 per additional case detected/prevented and from C$9,429 to C$30,254,703 per additional QALY gained, depending on the type of screening service and comparator. Six studies were determined to be of high quality.Vision screening to detect amblyopia for young children may be cost-effective compared with no screening if amblyopia reduced quality of life. Studies varied significantly in the type of screening services and comparators used. Methodological limitations were common. Future studies would be aided immensely by prospective studies on the impact of amblyopia on the health-related quality of life of young children and guidelines on the effective conduct of vision screening.RéSUMé: OBJECTIF: Synthétiser et évaluer des évaluations économiques de dépistages visuels visant à détecter la déficience visuelle chez les enfants. MéTHODE: Nous avons interrogé sept bases de données électroniques, la littérature grise et les sites Web d’organismes effectuant des évaluations des technologies de la santé. Nous avons inclus les études correspondant aux critères suivants : (1) évaluations économiques comparatives exhaustives utilisant l’analyse coûts-utilité, coûts-bénéfices, coûts-efficacité ou coûts-conséquences ou l’analyse des coûts; (2) décrivant des services de dépistage visant à détecter l’amblyopie, le strabisme ou les anomalies de la réfraction non corrigées chez les enfants de moins de six ans; et (3) publiées après 1994. Nous avons fait la synthèse descriptive des études de haute qualité. Les devises ont été converties en dollars canadiens de 2019. Nous avons évalué la qualité des études à l’aide de l’outil PQAQ (Pediatric Quality Appraisal Questionnaire). RéSULTATS: Les services de dépistage visuel étaient offerts par du personnel rémunéré, des bénévoles ou des professionnels de santé dans des écoles ou des cliniques. Treize études ont été publiées dans cinq pays : Chine (n = 1), États-Unis (n = 4), Royaume-Uni (n = 1), Canada (n = 1) et Allemagne (n = 6). Les techniques d’analyse employées étaient la combinaison analyse coûts-utilité/analyse coûts-efficacité (n = 2), l’analyse coûts-efficacité (n = 7), l’analyse coûts-utilité (n = 1), l’analyse coûts-avantages (n = 1), l’analyse coûts-conséquences (n = 1) et l’analyse des coûts (n = 1). Les rapports coût-efficacité différentiels s’échelonnaient entre 1 056 $ CA et 151 274 $ CA par cas supplémentaire détecté/prévenu et entre 9 429 $ CA et 30 254 703 $ CA par année de vie pondérée par la qualité (AVPQ) supplémentaire gagnée, selon le type de service de dépistage et le comparateur. Six études ont été jugées être de haute qualité. CONCLUSION: Comparativement à l’absence de dépistage, les dépistages visuels pour détecter l’amblyopie chez les jeunes enfants peuvent être efficaces par rapport à leur coût lorsque l’amblyopie réduit la qualité de vie. Le type de services de dépistage et les comparateurs utilisés variaient considérablement d’une étude à l’autre. Les contraintes méthodologiques étaient courantes. Les études futures seraient grandement favorisées par des études prospectives des incidences de l’amblyopie sur la qualité de vie liée à la santé chez les jeunes enfants et par des lignes directrices sur l’exécution efficace des dépistages visuels.

Purpose The present study compared the expression of early growth responsive gene-1 (Egr-1) in visual cortex between amblyopia kittens and normal kittens, and to explore the role of Egr-1 in the pathogenesis of amblyopia. Methods A total of 20 healthy kittens were randomly divided into deprivation group and control group with 10 kittens in each group. Raised in natural light, and covered the right eye of the deprived kittens with a black opaque covering cloth. Pattern visual evoked potentials (PVEP) were measured before and at the 1st, 3rd and 5th week after covering in all kittens. After the last PVEP test, all kittens were killed. The expression of Egr-1 in the visual cortex of the two groups was compared by immunohistochemistry and in situ hybridization. Results PVEP detection showed that at the age of 6 and 8 weeks, the P100 wave latency in the right eye of deprivation group was higher than that in the left eye of deprivation group (P P P P P P P Conclusions Monocular form deprivation amblyopia can lead to the decrease of Egr-1 protein and mRNA expression in visual cortex, and then promote the occurrence and development of amblyopia.

Purpose: To evaluate children in the Za'atari refugee camp in Jordan to better understand the prevalence of ocular pathology and to compare two photoscreening devices to evaluate their utility. Methods: Families at the Syrian American Medical Society Clinic were offered vision screening for children aged 1 to 18 years. Participants were offered visual acuity measurement and photoscreening with two devices approved for use in the United States. If visual acuity in either eye was worse than 20/40 or either photoscreening device indicated possible pathology, a complete eye examination was performed with cycloplegic refraction and dilated examination. Results: Ninety-one participants completed the screening protocol. The average age of participants who completed the study was 7.8 years (range: 1 to 16 years). Twenty-eight participants (30.8%) failed at least one screening component. In this population, the following pathology was identified: astigmatism (12.1%), esotropia (9.9%), amblyopia (9.9%), hyperopia (7.7%), exotropia (3.3%), and myopia (1.1%). The Plusoptix vision screener (Plusoptix) had a sensitivity of 100% for the identification of amblyopia and 85% specificity. The GoCheck Kids application (Gobiquity) had a sensitivity of 66.67% for the identification of amblyopia and 94% specificity. The positive predictive value for the Plusoptix vision screener and the GoCheck Kids application for the detection of amblyopia risk factors was 77% for both. Conclusions: The high rate of ophthalmic pathology identified in this study reinforces the urgent need for proper vision screening and intervention in this population. [ J Pediatr Ophthalmol Strabismus . 2021;58(6):396–400.]

To investigate the improvement of fixation stability of severe amblyopia with traditional patching treatment by the MP-1 microperimeter.Eighteen patients with severe unilateral amblyopia were enrolled and received prescribed 6 h per day of patching of the fellow eye with optical correction if needed. Fixation test was performed on eighteen severe unilateral amblyopia patients by the MP-1 microperimeter in baseline, 3-month and 6-month after treatment. The bivariate contour ellipse area (BCEA, degThe RMANOVA showed that significant differences were found in best-corrected visual acuity (BCVA) between amblyopia eyes/fellow eyes (AE/FE) group (F = 113.52, p 0.001) and among follow-up time (F = 74.684, p 0.001). Moreover, a significant interaction could be found between AE/FE group and follow-up time (baseline/3-month/6-month, F = 60.189, p 0.001). Post hoc analysis by Bonferroni showed significant improvement of BCVA in AE at 3-month (p 0.001) and 6-month (p 0.001), compared to baseline, and also significant between 3-month and 6-month (p = 0.002). The RMANOVA showed that significant differences were found in BCEA between AE/FE group (F = 8.432, p = 0.006) and among follow-up time (F = 10.431, p = 0.003). Moreover, a significant interaction could be found between AE/FE group and follow-up time (F = 9.099, p = 0.005). The mean BCEA of AE changed from 13.14 ± 17.97 degThe fixation stability in the amblyopic eyes is significantly worse than that of the fellow eyes in patients with unilateral severe amblyopia. The fixation stability became better after 6-month occlusion treatment, but the change of fixation stability was not correlated with visual acuity improvement. These quantitative results highlight the importance of fixation in the mechanism of amblyopia.

To determine the prevalence of amblyopia and the factors associated with delayed diagnosis among school-aged children in Hong Kong.Completed comprehensive ophthalmoscopic examinations were conducted among 4.273 children aged 6-8 years in the population-based Hong Kong Children Eye Study. New and previous diagnoses of amblyopia were identified. Socioeconomic status was surveyed through questionnaires.According to criteria from the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS), amblyopia was present in 43 out of 4,273 children (1.01%; 95% CI, 0.71-1.31). Among them, 33 (0.77%) were newly detected cases that were more likely from families living in Public Rental Housing or subdivided flats (OR, 4.22;These children with delayed diagnoses of amblyopia were more likely to come from lower socioeconomic backgrounds. Public education aimed at increasing awareness and utilization of child vision screening among such families is needed.

CHARGE syndrome is a rare genetic disorder associated with many ocular anomalies including amblyopia, strabismus and high refractive errors. It has been found that the visual acuity of patients with CHARGE syndrome is typically lower than 20/60. After reviewing the literature, there has been a lack of detailed information about the assessments of visual function. Thus, this case report illustrates the strategy plan to treat amblyopia and refractive correction for a young girl with CHARGE syndrome.

Purpose In an ongoing randomised clinical trial comparing dichoptic VR video games with patching for amblyopia, we evaluated any potential barriers to successful use of this novel amblyopia treatment method. Methods From December 2017, all newly diagnosed amblyopic children were recruited. Excluded were children under age 4 and patients with strabismus exceeding 30PD. The video game was played for 1 h per week at the outpatient clinic under direct supervision. Records were kept of difficulties encountered during treatment and categorised into domains. Factors influencing the successful completion of this treatment were identified and related to patient characteristics. Results Ninety-one children were recruited for the trial, 20 parents refused participation before randomisation, because of the logistical challenges the outpatient dichoptic treatment would cause them. Of the 17 children who commenced dichoptic treatment (median age 6.2 years; IQR 4.9–8.4 years), 10 did not complete treatment. Children under age 5.5 years were unable to comprehend the game settings or the game itself. Older children (N = 7; 41%) were less willing to comply with the video game. Loss of interest in the game (N = 8; 47%) was found to be a limiting factor at all ages. Conclusion Half of the children failed to complete VR dichoptic treatment, mainly due to young age. In countries with nationwide screening where amblyopia is detected before age 6, the applicability of such dichoptic treatment is limited.

Purpose To identify demographic and disease-related characteristics predictive of Lost-to-Follow-Up (LTFU) status in amblyopia treatment and create a risk model for predicting LTFU status. Design Retrospective cohort study Methods Setting: Single-center, ophthalmology department at Boston Children's Hospital (BCH). Patients: 2037 patients treated for amblyopia at BCH between 2010 and 2014. Observation procedure: LTFU was defined as patients who did not return after initial visit, excluding those who came for second opinion. Multiple variables were tested for association with LTFU status. Outcome measure: Odds ratio of LTFU risk associated with each variable. Multivariate logistic regression was used to create a risk score for predicting LTFU status. Results A large proportion of patients (23%) were LTFU after first visit. Older age, nonwhite race, lack of insurance, previous glasses or atropine treatment, and longer requested follow-up intervals were independent predictors of LTFU status. A multivariable risk score was created to predict probability of LTFU (area under the curve 0.68). Conclusions Our comprehensive amblyopia database allows us to predict which patients are more likely to be LTFU after baseline visit and develop strategies to mitigate these effects. These findings may help with practice efficiency and improve patient outcomes in the future by transitioning these analyses to an electronic medical record that could be programmed to provide continually updated decision support for individual patients based on large data sets.

Background To investigate the clinical characteristics of children with congenital ptosis, with particular attention given to the incidence of anisometropia, and the difference in axial length (AL) between the right and left eyes. Methods The medical charts of 55 patients with congenital ptosis at Niigata University Medical and Dental Hospital were retrospectively analyzed. Clinical characteristics, including age, cycloplegic refraction, AL, and the presence of amblyopia and its causes were analyzed. Results Age at the initial visit was 16 ± 20 (mean ± standard deviation, the same applies below) months. Of the 49 patients whose cycloplegic refraction was measured, hyperopic anisometropia, defined as ≥ one-diopter difference in spherical equivalent (SE), was observed in 1/11, 9/27 and 5/11 patients with bilateral, right, and left ptosis, respectively. Among 14/38 patients with hyperopic anisometropia involving unilateral ptosis, 13 demonstrated a larger SE in the ptotic eye than in the non-ptotic eye. The inter-eye difference in AL (AL of the ptotic eye minus that of the non-ptotic eye) in six patients with unilateral ptosis and hyperopic anisometropia ipsilateral to the ptotic eye (-0.29 ± 0.40 mm) was significantly smaller than that in three patients with unilateral ptosis and no hyperopic anisometropia (0.38 ± 0.29 mm). Conclusions At our institute, children with congenital ptosis had a high incidence of hyperopic anisometropia ipsilateral to the ptotic eye. Furthermore, this condition was associated with a shorter axial length. These results indicate that refractive correction for hyperopic anisometropia is important for proper visual development in children with congenital ptosis.

Clinical relevance Ptosis surgery induces some changes in pre-existing refractive errors and astigmatism. Monitoring refractive outcomes, planning of vision rehabilitation, and amblyopia treatment may be required following ptosis surgery. Background The few studies published on the outcomes of refractive error after ptosis surgery have been controversial. The aim of this study was to evaluate long-term outcomes of refractive error in patients with congenital blepharoptosis who had undergone ptosis surgery. Methods Patients with congenital blepharoptosis who had undergone ptosis surgery were enrolled in the study. Data on pre- and post-operative refractive errors, marginal reflex distance 1 (MRD1), and levator function were obtained. The data from fellow eyes were used as the control. Results The mean patient age of patients undergoing ptosis surgery was 19.8 ± 8 years. The mean follow-up time (time between the operation and post-up measurements) was 4.7 ± 2.1 years with a range of 2-10 years. There were no significant differences in mean refractive changes, being 0.53 ± 0.40D vs. 0.36 ± 0.45D in sphere (p = 0.19) and 0.48 ± 0.56 vs. 0.30 ± 0.23 in cylinder (p = 0.17) in operated and control eyes, respectively. Astigmatism change was, however, significantly higher in the operated eyes with an MRD1 change of ≥2.5 mm (0.84 ± 0.66 vs. 0.27 ± 0.39, p = 0.024). The changes in astigmatism in the operated eyes had a significantly positive correlation with the changes of MRD1 (r = 0.497, p = 0.019). Vectorial analysis showed no significant difference between the changes in astigmatism of the operated and control eyes (0.58 *48o vs. 0.45*53o, respectively). Conclusion Spherical power of the eyes of patients with congenital ptosis who undergo ptosis surgery does not change. A significant change in astigmatism can be anticipated in eyes with more than 2.5 mm change in MRD1. There is an association between change in astigmatism and MRD1 following ptosis surgery.

Background Amblyopia, when not diagnosed at appropriate age, leads to uncorrectable visual impairment with considerable social and financial implications. The aim of this study was to assess socio-demographic disparities in amblyopia prevalence among Israeli adolescents, in order to identify susceptible groups in the population. Methods A nationwide, population-based, cross-sectional study of Israeli adolescents examined between 1993 and 2017. All study participants underwent visual acuity examination with socio-demographic data and previous medical history documented. Associations were analyzed using univariable and multivariable logistic regression models. Results Among 1 334 650 Israeli-born candidates aged 17.15±0.26 years, amblyopia was diagnosed in 1.07%. The overall prevalence of amblyopia has declined from 1.59% in 1993 to 0.87% in 2017. Being in the lowest socioeconomic status and below average cognitive function scores increased the odds of amblyopia in both males [odds ratio (OR) 1.64, 95% confidence interval (CI) 1.45–1.87; OR 1.27, 95% CI 1.19–1.35, respectively] and females (OR 1.61, 95% CI 1.30–1.98; OR 1.27, 95% CI 1.18–1.36, respectively). Among males, Orthodox and ultra-Orthodox educational systems were associated with increased odds of amblyopia (OR 1.16, 95% CI 1.09–1.25; OR 1.90, 95% CI 1.73–2.09). A significantly higher prevalence of amblyopia was recorded among 219 983 immigrants (1.51%, P Conclusions Although the overall prevalence of amblyopia has decreased during the observed years, we found substantial evidence of socio-demographic disparities in amblyopia prevalence among adolescents, suggesting disparities in the prevention of the disease and its treatment. Demonstration of inequities at a national level could aid future guidance of health policy and augment current vision screening programs.

To explore the distribution of stereoacuity and to examine its determinants in school-age children in Tibetan plateau, Southwest China. This is the cross-sectional part of a school-based cohort study of 7-year-old children in Lhasa, Tibet Autonomous Region, Southwest China. Children in first year of primary school were invited to undergo a comprehensive examination, including height, weight, visual acuity, cycloplegic autorefraction (1% cyclopentolate), anterior segment, cover and uncover test, and stereoacuity (Titmus Stereo Test). A total of 1833 eligible subjects were included, with a mean age of 6.82 ± 0.46 years. Mean stereoacuity was 1.78 ± 0.21 in log units (median: 60 arcsec). Children with stereoacuity equal to 40 arcsec and stereoacuity worse than 100 arcsec accounted for 29.24% and 8.18% of the cohort, respectively. Tibetan ethnicity (OR = 1.98; 95%CI, 1.30–3.03), astigmatism (OR = 1.65; 95%CI, 1.26–2.17), strabismus (OR = 2.92; 95%CI, 1.38–6.18), and amblyopia (OR = 3.77; 95%CI, 1.14–12.49) were risk factors for normal stereoacuity (= 40 arcsec). Shorter height, younger age, strabismus, and worse BCVA (P

Optical coherence tomography angiography (OCTA) is a non-invasive tool to assess the retino-choroidal vasculature in vivo. It tracks the red blood cell movement and maps the vasculature in quick succession. In routine, diabetic retinopathy, age related macular degeneration, central serous chorioretinopathy, and others are commonly being studied to unveil its clinic role. On the other hand, amblyopia is a condition where the visual acuity is subnormal due to non-organic causes in the eye. But the OCTA studies till now have shown variable changes along retino-choroidal vasculature. Hence, to comprehend the existing literature knowledge, a systematic literature search was carried out and the original works describing novel findings in amblyopic eyes on OCTA were included. Upon detailed assessment, firstly, the disturbed vasculature along superficial retinal plexus, deeper retinal plexus, and choroidal plexus were evident in most untreated amblyopic eyes. However, such changes were not uniform, which is due to noted heterogenic patient profile, small sample size, biometric biases, non-uniform algorithms, and other factors. And to note, even in presence of such diverse changes, almost all the authors stated a plausible explanation for their notable changes. Secondly, the utility of OCTA in identifying vascular changes with standard treatments and segregation of visual beneficiaries from non-beneficiaries were possible. Hence, to conclude, OCTA is a valuable tool which can provide valuable useful insights into the amblyopic eyes during pre and post treatment periods. However, to gather more concrete evidence for clinical benefits, systematic, homogenous, and better structured clinical studies are mandated.

Background Acquired sixth nerve (CN6) palsies in children may be benign or associated with an underlying neurologic condition. In children who presented with isolated (no associated neurologic or ophthalmic symptoms or signs) CN6 palsies, the rate of newly diagnosed neurologic disorders (such as tumors) is unclear. Moreover, the factors associated with spontaneous resolution and amblyopia in children with acquired CN6 palsies are unknown. Methods We retrospectively reviewed the charts of all children younger than 18 years diagnosed with CN6 palsy at our institution from 2010 to 2020. We recorded ophthalmologic and neurologic history and examination findings, neuroimaging results, etiology of CN6 palsy, and outcomes including spontaneous resolution and amblyopia. We assessed etiologies of isolated and nonisolated CN6 palsies as well as frequency and factors associated with spontaneous resolution and amblyopia (in children ≤7 years). Results One hundred seventy-two children met inclusion criteria. Twenty CN6 palsies (12%) were isolated at presentation. Most isolated cases were presumed postviral or postvaccination (50%) or idiopathic (30%), but 2 cases (10%) were associated with newly diagnosed tumors. Spontaneous resolution occurred in 59% of CN6 palsies at a median of 12.3 weeks and was associated with older age (P = 0.03) and nontumor etiology (P = 0.006). Amblyopia developed in 18% of children at risk, exclusively in those with anisometropia, pre-existing strabismus, or younger than 12 months. Conclusions Our findings and chart reviews suggest that approximately 10% of isolated acquired pediatric CN6 palsies are associated with a newly diagnosed brain tumor. This risk must be discussed with parents when considering immediate vs delayed neuroimaging. In addition, infants and children ≤7 years with secondary amblyogenic risk factors (anisometropia or pre-existing strabismus) require close follow-up to monitor and treat amblyopia.

Objectives: To determine the prevalence of refractive errors and visual impairment in Down syndrome (DS) patients compared to normal controls. Materials and Methods: Cycloplegic refraction was tested in 213 DS patients and 184 normal age- and gender-matched controls using autorefraction followed by retinoscopy. Data from the worse eye of each case were used in the analyses. Results: In the DS and control groups, respectively, mean age was 17.2±4.8 and 17.2±4.4 years (p=0.993) and 53.0% and 49.5% were male (p=0.473). In the DS and control groups, respectively, mean spherical equivalent (SE) was -5.13±4.47 and -4.15±3.04 diopters (D) in myopics (p=0.050) and 2.47±1.64 and 2.36±2.04 D in hyperopics (p=0.482), mean cylinder error was -2.17±1.39 and -2.05±1.57 D (p=0.451), mean J0 was -0.03±0.89 and 0.12±0.76 D (p=0.086), and mean J45 was 0.11±1.02 and -0.13±1.03 D (p=0.024). The prevalence of oblique astigmatism was higher in the DS group (20.4% vs. 6.1%) while against-the-rule astigmatism was more prevalent in the control group (84.0% vs. 71.6%) (p

Background: Bornholm eye disease (BED) is a rare X-linked cone dysfunction disorder with high myopia, amblyopia, and color vision defects.Materials and methods: Visual and ocular outcomes in a family where two of five siblings had molecularly confirmed BED are reported. Ophthalmological assessments included best-corrected visual acuity (BCVA), color vision test, and optical coherence tomography (OCT). Medical records, electroretinography (ERG), and genetic analyses were re-evaluated.Results: Two male siblings had confirmed BED with myopia and protanopia. The younger brother had high myopia, subnormal BCVA, and ocular fundi that showed tilted discs, crescent shaped peripapillary atrophy, and visible choroidal vessels. OCT confirmed retinal and choroidal atrophy. The older brother was lightly myopic with normal/subnormal BCVA and subtle findings in the fundi. Both brothers had abnormal ERG recordings with a decreased cone response. They also had a structurally intact OPN1LW/OPN1MW gene cluster. The OPN1LW gene was shown to carry a deleterious variant combination in exon 3 known to result in mis-splicing of opsin mRNA and acknowledged as LIAVA amino acid delineation (Leu153-Ile171-Ala174-Val178-Ala180), while the OPN1MW gene exon 3 showed a non-pathogenic variant combination (MVVVA). Another normal-sighted brother carried another wildtype variant combination (LVAIS) in exon 3 of the OPN1LW gene.Conclusions: The two affected brothers demonstrated a large variability in their phenotypes even though the genotypes were identical. They presented a disease-associated haplotype in exon 3 of OPN1LW that has been described as the molecular cause of BED.

PURPOSE To quantitatively compare reflectivity and other morphological changes of the photoreceptors of normal eyes with amblyopic eyes using the longitudinal reflectance profile (LRP) on swept-source optical coherence tomography (SS-OCT) images in children and adolescents with unilateral high myopia. The relationships between OCT parameters and visual acuity were investigated. METHOD Twenty-six amblyopes with unilateral high myopia and 34 age-, axial length- and spherical equivalent-matched normal controls were recruited. All participants underwent SS-OCT and detailed ophthalmic investigations. The reflectivity of the outer retinal and photoreceptor outer segment layer thickness were quantified by LRP using ImageJ software. All parameters were measured at three selected regions: at the fovea, 1 mm nasal to the fovea and 1 mm temporal to the fovea. Differences between the groups were evaluated. RESULTS The mean choroidal thickness was thinner in amblyopic eyes compared with controls (165.19 ± 59.02 μm vs 214.97 ± 66.41 μm at the fovea; 128.77 ± 57.06 μm vs 161.54 ± 57.37 μm at 1 mm nasal to the fovea; 188.13 ± 59.51 μm vs 219.87 ± 61.78 μm at 1 mm temporal to the fovea, P

Amblyopia is a cause of significant ocular morbidity in pediatric population and may lead to visual impairment in future life. It is caused due to formed visual deprivation or abnormal binocular interactions. Several risk factors in pediatric age group may lead to this disease. Author groups have tried managing different types of amblyopia, like anisometropic amblyopia, strabismic amblyopia and combined mechanism amblyopia, with optical correction, occlusion therapy, penalization, binocular therapy and surgery. We review historical and current management strategies of different types of amblyopia affecting children and outcomes in terms of visual acuity, binocularity and ocular deviation, highlighting evidence from recent studies. Literature searches were performed through Pubmed. Risk factors for amblyopia need to be identified in pediatric population as early in life as possible and managed accordingly, as visual outcomes in amblyopia are best if treated at the earliest. Although, monocular therapies like occlusion or penalization have been shown to be quite beneficial over the years, newer concepts related to binocular vision therapy are still evolving.摘要: 弱视是儿童重要的眼病之一, 并可能对今后的视力造成损害。它是由于形觉剥夺或不正常的双眼交互运动而引起的。儿童期的多种危险因素可导致本病的发生。本团队尝试了光学矫正、遮盖疗法、药物压抑疗法、双眼治疗和手术等方法, 以治疗不同类型的弱视, 如屈光参差性弱视、斜视性弱视以及斜视联合屈光参差性弱视。我们从视力、双眼协调能力和眼位偏差的结果, 回顾了影响儿童不同类型弱视的以往和当前的治疗策略, 并重点强调了近期的研究证据。我们对Pubmed进行了文献检索。儿童弱视的危险因素需要尽早察觉, 并进行相应的治疗和管理, 因为越早治疗, 弱视的视力恢复越好。尽管像遮盖疗法或药物压抑疗法这样的单眼治疗多年来被证明是非常有益的, 但与双眼治疗相关的新概念仍在不断更新。.

Purpose: to compare the Subfoveal choroidal thickness (SFCT) and Retinal Nerve Fiber Layer Thickness (RNFL) of amblyopic and normal fellow eyes. Design: Prospective, cross-sectional, observational case series. Methods: Forty patients age 12 to 41 years (mean 23.73 ± 6.42) with unilateral amblyopia were studied. Among them, 11(28.2%) patients had amblyopia secondary to strabismus and 29(71.8 %) had anisometropic amblyopia. Optical coherence tomography (OCT) of the peripapillary RNFL thickness of amblyopic and fellow eyes was performed. RNFL thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. Also, subfoveal choroidal thickness (SFCT) was measured using spectral domain optical coherence tomography (SD-OCT). Results: Mean global RNFL thickness of the amblyopic and fellow eyes was 104.48 microns and 102.83 microns, respectively. The difference between the two groups was not statistically significant (p>0.05%). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the amblyopic and normal fellow eyes showed no statistically significant difference (p>0.05%). However, the SFCT of amblyopic eye was 11 or more microns thicker than the fellow eye and this was statistically significant different (p 0,05%). As espessuras dos quadrantes superior, inferior, nasal e temporal da camada de fibras nervosas da retina entre o olho amblíope e o normal não apresentaram diferença estatisticamente significativa (p > 0,05%). No entanto, a CSF do olho amblíope foi 11 mícrons mais espessa (ou mais) do que a do outro olho - essa diferença foi estatisticamente significativa (p < 0,05%). Conclusões: Este estudo demonstrou que a CSF dos olhos amblíopes foi significativamente mais espessa do que a dos olhos normais. O processo amblíope pode envolver a coroide, mas ele não envolve a CFNR peripapilar.

Objectives Amblyopia is a decrease of visual acuity that cannot be attributed to any structural abnormality of the eye or visual system, causing a partial or complete loss of vision due to inadequate stimulation in early life. Citicoline has been reported to improve visual acuity in amblyopic eyes as adjuvant treatment. This study was aimed to determine the effectiveness of citicoline in pediatric patients with refractive amblyopia in ophthalmology daily practices. Methods This was a retrospective–descriptive study with a time limited sampling method. This study was conducted at Surabaya Eye Clinic, East Java, Indonesia, by reviewing medical records for the period of January 2018 to December 2019. Results A total of 34 eyes were included in the study with the majority aged five years (41.2%) and six years (35.3%). The severity of amblyopia varied among patients, 21 eyes (61.76%) had mild amblyopia, seven eyes (20.59%) had moderate amblyopia, and two eyes (5.88%) had severe amblyopia. The duration of given therapy also varied, 18 eyes (52.94%) were given 3 months therapy, two eyes were given 4 months therapy, 12 eyes were given 6 months therapy, and two eyes were given 8 months therapy. Citicoline was found effective in mild and moderate amblyopia and for the duration of 3 and 6 months (p Conclusions Citicoline therapy resulted in a clinically and statistically improvement in refractive amblyopia patients.

Objectives Fixation preference testing is widely used to detect amblyopia, particularly in preverbal children. Pattern electroretinogram (pERG) is an electrophysiological test which is a sensitive indicator of macular function. The aim of this study was to investigate the relationship between fixation preference and macular function on pERG in children with strabismus. Materials and methods The study included 11 children with strabismus. All underwent ophthalmological examination including fixation preference by binocular fixation pattern test, best corrected visual acuity (BCVA) assessment, and pERG. Results The mean age of the patients was 10.09±1.18 years. All patients had unilateral fixation. The mean BCVA was 0.85±0.17 in preferred and 0.48±0.19 in non-preferred eyes (p=0.003). The mean p50 amplitude was 6.07±2.06 μV in preferred and 5.29±2.20 μV in non-preferred eyes (p=0.203), and the mean N95 amplitude was 8.27±2.86 μV and 8.03±3.24 μV respectively (p=0.594). BCVA was correlated with p50 and N95 amplitudes in the non-preferred eyes (p=0.023 and p=0.014). Interocular BCVA difference was correlated with interocular P50 amplitude difference (r=0.688, p=0.019). Conclusion Although amblyopia is typically considered a cortical phenomenon, future larger studies are needed to investigate the relationship between fixation preference and macular electrophysiological function.

Purpose: To compare the visual outcome of occlusion therapy with virtual reality game playing as a new therapy for children with amblyopia. Methods: This randomized clinical trial was performed on 50 children between 4 and 10 years old who had unilateral amblyopia. They were randomly divided into virtual reality and patching groups (n = 25 in each). The virtual reality group was trained binocularly using the virtual reality games through a head set for 1 hour per day 5 days a week for 4 weeks. Patients in the patching group occluded their non-amblyopic eyes 2, 4, and 6 hours for mild (best corrected visual acuity [BCVA] 0.2 to 0.3 logarithm of the minimum angle of resolution [logMAR]), moderate (0.3 to 0.6 logMAR), and severe (worse than 0.6 logMAR) amblyopia, respectively. Results: The mean BCVA based on logMAR units improved significantly in both groups ( P < .0001), but the difference between the two groups was not significant ( P = .59). BCVA based on the responded letters improved in both groups (virtual reality: P = .0001, patching: P = .001), and change in BCVA in the virtual reality group was higher than in the patching group ( P = .002). Conclusions: Virtual reality game playing was equal or superior to patching in an analysis of linear and letter BCVA, respectively. Therefore, applying this new amblyopia therapy is recommended. [ J Pediatr Ophthalmol Strabismus . 2021;58(3):154–160.]

Mebratu Mulusew Tegegne,1 Abel Sinshaw Assem,1 Yosef Antehun Merie2 1Department of Optometry, School of Medicine, College of Medicine & Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia; 2FelegeHiwot Comprehensive Specialized Hospital, Bahir Dar, EthiopiaCorrespondence: Mebratu Mulusew TegegneDepartment of Optometry, School of Medicine, College of Medicine & Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, EthiopiaTel +251-92-425-165Email mebrieophta@gmail.comIntroduction: Worldwide, amblyopia prevalence among children is in the range of 0.13% to 12.9%. However, there are no known community-based data regarding amblyopia prevalence and its associated factors among school age children in Ethiopia. The aim of this study was to determine the prevalence of amblyopia and to identify factors associated with amblyopia among school age children in Bahir Dar city, northwest Ethiopia.Methods and Materials: A cross-sectional study among a school age community of Bahir Dar city was conducted from April 1 to May 29, 2018. Data were collected using a pretested structured questionnaire and checklist through interview and physical examination. Bivariable logistic regression was done, and variables with p value < 0.2 were entered to multivariable logistic regression using SPSS 20. Variables with p value of < 0.05 in the multivariable binary logistic regression were considered as significant predictors.Results: In total 601 (94.8%) subjects participated. Amblyopia was prevalent in 6.5% of school age children in Bahir Dar city. The odds of being amblyopic among participants who had anisometropia > 2D were about 9.3 times (AOR=9.35, CI: 2.86– 30.60) more as compared to those who had no anisometropia. The odds of being amblyopic among participants having a refractive error >+5D hypermetropia were about 22 times (AOR=21.77, CI: 7.15– 66.34) more as compared to participants who had no hypermetropia.Conclusion: The prevalence of amblyopia among school age children at Bahir Dar city is higher than the World Health Organization cut point. Having anisometropia greater than 1 diopter, anisometropia > 2 diopter, having anisometropia less than 1 diopter, having a history of strabismus, having a hyperopia of > +5 diopter, > +2 diopter, having a positive history of visual deprivation and having a positive history of strabismus in the family were the significant factors positively associated with amblyopia.Keywords: amblyopia, prevalence, school, children, Bahir Dar, Ethiopia

Purpose To investigate the clinical features of strabismus in patients with congenital optic disc anomaly and compare and analyze the characteristics of patients who showed changes in the strabismus pattern with those who did not. Methods Medical records of the patients who were diagnosed with both strabismus and congenital optic disc anomaly and followed-up for ≥1 year were reviewed retrospectively. Clinical characteristics and ophthalmic features at the initial visit and final follow-up were assessed. Patients with a change in the direction of strabismus or a difference of g10 prism diopters in the deviation angle during the follow-up period were allocated to the changed group. The remaining patients were assigned to the unchanged group. The clinical characteristics of the two groups were compared. Results Twenty-eight patients (15 boys) were included (mean age, 39.0 months; range, 5-150 months). Three (10.7%) patients were born preterm and four (14.3%) had other underlying systemic disease. Sixteen (57.1%) patients had exotropia, and 12 (42.9%) had esotropia. Concurrent vertical strabismus was present in three (10.7%) patients. Strabismus features changed in 14 (50.0%, changed group) patients and remained unchanged in 14 (50.0%, unchanged group) patients. Age, sex, and laterality did not differ between groups. Preterm birth history (n = 3) and combined systemic disease (n = 4) were only observed in the changed group (p = 0.111 and p = 0.049, respectively). Conclusions Considering the possibility of changes in strabismic features, close monitoring of patients with strabismus combined with congenital disc anomaly is essential, particularly in those with preterm birth history or underlying systemic conditions.

Microtropia describes a primary ocular deviation of less than 10 prism diopters associated with harmonious anomalous retinal correspondence and reduced stereopsis. It is routinely accepted that children with microtropia are less likely to achieve equal vision following occlusion therapy than those with bifoveal fixation. The most commonly used methods of diagnosing a microtropia are the 4 diopter prism test (4∆PT) and assessment of ocular fixation. This study examines the agreement between the two tests. One hundred and twelve typically developing children without a manifest strabismus who were able to undertake a linear visual acuity test and had two or more lines of anisoacuity following refractive adaption to their full cycloplegic correction underwent assessment of the 4∆PT and ocular fixation along with their routine orthoptic examination. One hundred and twelve children (46 boys and 66 girls) attending the Orthoptic department who fitted the above criteria were included in the analysis. The mean age at examination was 6 years. 80.3% had anisometropia of at least 1.25 diopters. The 4∆PT indicated a microtropia in 74 cases, whereas assessment of fixation indicated a microtropia in 68 cases. In 88 cases (78.6%), the results of the two tests agreed. Analysis found only moderate agreement between the two tests (k = 0.540 (CI 0.379-0.700)). Logistic regression analysis comparing those children where the two tests agreed with those where they disagreed found no difference in the level of anisoacuity (p = 0.7823), degree of anisometropia (p = 0.9385), the vision in the worst eye (p = 0.5260), the refractive error in the "worst" eye (p = 0.865), or the age at the time of testing (p = 0.4485) between the two groups. When assessing for a microtropia, it was found that not all children who elicit a central suppression response on the 4∆PT are found to be fixing eccentrically and vice versa. This could potentially have implications for the treatment of their amblyopia. It is important not to rely on just one test at one time to make the diagnosis of microtropia. Rather, if one or other test indicates a microtropia the first time they are attempted, this should be reassessed regularly as treatment progresses and certainly before treatment is stopped and suboptimal visual acuity is accepted.

Strabismus is a genetically heterogeneous disorder with complex molecular and neurophysiological causes. Evidence in the literature suggests a strong role for motor innervation in the etiology of strabismus, which connects central neural processes to the peripheral extraocular muscles. Current treatments of strabismus through surgery show that an inherent sensorimotor plasticity in the ocular motor system decreases the effectiveness of treatment, often driving eye alignment back toward its misaligned pre-surgical state by altering extraocular muscle tonus. There is recent interest in capitalizing on existing biological processes in extraocular muscles to overcome these compensatory mechanisms. Neurotrophins are trophic factors that regulate survival and development in neurons and muscle, including extraocular muscles. Local administration of neurotrophins to extraocular muscles partially reversed strabismus in an animal model of strabismus. The hypothesis is that sustained release of neurotrophins gives more time for the ocular motor system to adapt to a slow change in alignment in the desired direction. The effect of neurotrophins on extraocular muscles is complex, as different neurotrophic factors have diverse effects on extraocular muscle contraction profiles, patterns of innervation, and density of extraocular muscle precursor cells. Neurotrophic factors show promise as a therapeutic option for strabismus, which may help to improve treatment outcomes and offset devastating amblyopia and psychosocial effects of disease in strabismus patients.

Jordan Murray,1 Kiran Garg,2 Fatema Ghasia3 1Cleveland Clinic Cole Eye Institute, Ophthalmological Research, Cleveland, OH, USA; 2Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Cleveland Clinic Cole Eye Institute, Department of Ophthalmology, Cleveland, OH, 44195-0001, USACorrespondence: Fatema GhasiaCleveland Clinic Cole Eye Institute, Department of Ophthalmology, 2022, East 105th Street, Cleveland, OH, 44195-0001, USAEmail fatemaghasia@gmail.comPurpose: The aim of the study is to examine the association between amblyopia type and the presence of nystagmus on binocular and monocular functions of the fellow (FE) and amblyopic eye (AE).Methods: We recruited 19 controls and 44 amblyopes (anisometropes=13, strabismic=10, mixed=21). We measured visual, grating, and vernier acuities and high/low spatial frequency (SF) contrast sensitivities in each eye using a staircase method. Stereoacuity was measured with the Titmus fly test. We recorded fixation eye movements (FEM) using high-resolution video-oculography. Subjects were classified as having either no nystagmus (n=18), fusion maldevelopment nystagmus syndrome (FMNS) (n=12), or nystagmus without any structural anomalies that does not meet the criteria for FMNS or infantile nystagmus (n=14).Results: Analysis of visual function by clinical amblyopia type showed that patients with strabismus/mixed amblyopia (F (2,54)=9.5, p< 0.001) were more likely to have poor stereopsis while controlling for AE grating acuity deficit. The FE of patients with anisometropia had greater contrast sensitivity deficits at low (F (2,43)=4.4, p=0.018) and high SF (F (2,42)=10.1, p< 0.001). Analysis of visual function by FEM characteristics (low SF: (F (3,43)=4.3, p=0.010) and high SF: (F (3,42)=7.1, p=0.001) showed that the FE of patients with FMNS had worse low and high SF contrast sensitivities, whereas those without FMNS had greater contrast sensitivity deficits only at high SF compared to controls. Patients with FMNS (F (3,54) = 12.9, p< 0.001) were more likely to have poor stereopsis while controlling for AE grating acuity deficit compared to patients without FMNS. All amblyopic patients had worse high SF contrast sensitivity of the AE irrespective of type or FEM characteristics (Type = F (2,43)=8.8, p=0.001; FEM characteristics= F (3,43)=5.1, p=0.004).Conclusion: The presence of FMNS in patients with strabismic/mixed amblyopia is associated with poor/absent stereopsis. FE deficits vary across amblyopia type. Like FEM abnormalities, visual function deficits are seen in the FE of patients with and without nystagmus.Keywords: amblyopia, fellow eye, contrast sensitivity, fusion maldevelopment nystagmus, stereopsis

Objective: To see the frequency and compare the type of refractive error and strabismus in amblyopic versus non amblyopic children. Study Design: Comparative cross sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi, from Jan to Jul 2019. Methodology: The sample population comprised of 250 patients of new or previously diagnosed children with refractive error and strabismus presenting at children eye outdoor patient department of armed forces institute of ophthalmology. Strabismus was diagnosed by the consultant eye specialist on the basis of heterotropia at near or distance fixation. Amblyopia and refracttive error was assessed by a trained optometrist. Patients were classified into amblyopia and non- amblyopia groups. The type of squint and refractive error was noted down along with demographic details. Chi square test was used to assess thesignificance of association between various categorical variables. Results: A total of 250 participants were included with a mean age of 5.00 ± 1.07 years. Out of total, 132 (52.8%) were males while 118 (47.2%) were females. One hundred and fifty (59.5%) patients were suffering from amblyopia while 100 (39.5%) patients were normal with comparable vision in both the eyes. Out of 150 amblyopic patients 134 (89.3%) were suffering from unilateral amblyopia while 16 (10.6%) patients had amblyopia in both the eyes. Out of refractive errors astigmatism was present in 83 (55.3 %) of amblyopia patients while hypermetropia was present in 54 (36%) of the patients. Out of total patients of strabismus, 95 (63.3%) of non-alternating esotropic patients..........

According to current estimations, globally, there are around 150 million people with an uncorrected refractive disorder, which means 27% of the world’s population. Approximately 1.4 million of these are children and have a milder or more severe form of visual dysfunction secondary to refractive errors. Since 1990, refractive errors are considered to be a public health problem among children and cause visual dysfunction, with a prevalence of up to 43%. Vision maturation occurs in early childhood, when all the senses and motor skills work together to acquire language, first ideas about the environment and all the elements that define the person himself. Sight is a contributory percep-tual system for the cognitive, social, sensory-motor development and for the assemblage of information about the environment. In the first years of life, the child increasingly discovers complex activities, requiring the ability to change the eyes fixation in space from one point to another and a normal binocular motility

The purpose of this study was to compare the efficiency of conventional screening and of the Spot™ Vision Screener (SVS)-based screening in detecting potential cases of amblyopia during the Visual examination in Three-Year-Old Health Screening Program (VTYOS), that need to be referred for comprehensive examination.Population-based cross-sectional study METHODS: This study introduced the SVS-based test to the VTYOS (which includes primary, secondary, and comprehensive examinations) of Sagae, Yamagata Prefecture, Japan. Children aged 3 years 6 months scheduled to undergo the secondary examination were subjected to both the SVS-based (evaluation of refractive error and eye alignment) and conventional screening test (questionnaire and visual acuity evaluation). Success rates, proportion of children who needed a comprehensive examination, rates of actual comprehensive examinations, and positive predictive value were determined and compared between conventional screening and SVS-based screening.There were 294 participants; the rate of success of SVS-based screening (99.7%) was higher than conventional screening (89.5%, p 0.01). The proportion of participants found to need a comprehensive examination according to SVS-based findings (7.5%) was lower than that according to conventional screening-based findings (23.5%, p 0.01). The positive predictive value of the SVS-based screening test (75.0%) was higher than that of the conventional screening test (31.6%, p 0.01). SVS-based screening detected 2 cases of amblyopia in 225 cases that passed conventional screening.The VTYOS should ideally add SVS-based screening to conventional screening.

Objective: To compare corneal aberrations and densitometry values in children with amblyopia due to anisometropic hyperopia with those of healthy children. Methods: This study included 173 children with amblyopia due to hyperopic anisometropia in one eye and 173 children with both healthy eyes. The amblyopic eye (Group 1) and the fellow normal eye (Group 2) of the amblyopic patients and the right eye of the healthy control group (Group 3) were evaluated. Of the corneal aberration and corneal densitometry (CD) measured using Scheimpflug corneal topography values were noted. Results: While there was a significant difference in total root mean square (RMS), higher-order aberration (HOA) RMS, coma horizontal, trefoil horizontal and spherical aberration values between the groups (p

A newborn male with cat eye syndrome presented with progressively worsening bilateral upper eyelid imbrication, floppy eyelids, and ptosis. Despite conservative management, he remained unable to open his eyelids. Surgical correction was planned to prevent bilateral sensory deprivation amblyopia and was delayed until 5 months of age due to systemic health concerns. Bilateral full-thickness wedge excision and frontalis suspension with silicone rods in a double rhomboid fashion was performed. Postoperatively, the patient demonstrated spontaneous eyelid opening, resolution of spastic eversion of the upper eyelids, and adequate eyelid closure. The authors present the first case of concurrent floppy eyelid syndrome and upper eyelid imbrication reported in a cat eye syndrome patient.

Background: Several visual functions are impaired in patients with oculocutaneous albinism (OCA) associated to albinistic bilateral amblyopia (ABA). Objective: In this study, we aimed at exploring whether perceptual learning (PL) can improve visual functions in albinism. Method: Six patients and six normal sighted controls, were trained in a contrast detection task with lateral masking. Participants were asked to choose which of the two intervals contained a foveally presented low-contrast Gabor patch. Targets were presented between higher contrast collinear flankers with equal spatial frequency. When increasing target-to-flanker distance, lateral interactions effect normally switches from inhibition to facilitation, up to no effect. Results: Our findings showed that before PL, only controls showed facilitation. After PL, results suggest that facilitatory lateral interactions are found both in controls as well as in albino patients. These results suggest that PL could induce higher processing efficiency at early cortical level. Moreover, PL positive effect seems to transfer to higher-level visual functions, but results were not very consistent among tasks (visual acuity, contrast sensitivity function, hyperacuity and foveal crowding). Conclusions: Although a small sample size was tested, our findings suggest a rehabilitative potential of PL in improving visual functions in albinism.

Objective: To study per-papillary retinal nerve fibre layer (pRNFL) and central macular thickness (CMT) changesin adults with hyperopic anisometropic amblyopia using optical coherence tomography. Study Design: Cross sectional study. Place and Duration of Study: Combined Military Hospital, Lahore, Pakistan, from Oct 2019 to Feb 2020. Methodology: In this study 30 adults, 18-40 years of age were included who presented in our clinic with monocular poor vision. They underwent detailed ophthalmic clinical examination: including corrected and uncorrected distance visual acuity, slit lamp bio-microscopy and fundus examination with 90 diopter lens. After fulfilling criteria of anisometropic amblyopia, central maular thickness (CMT) and per-papillary retinal nerve fibre layer (pRNFL) thickness was measured by using RS-3000 SLO, NIDEK Co, Japan spectral domain optical coherence tomography device and compared the central maular thickness (CMT) and per-papillary retinal nerve fibre layer (pRNFL) thickness in amblyopic and fellow eye of same individual. Results: The mean change in per-papillary retinal nerve fibre layer (pRNFL) thickness in amblyopic eyes, 121.48± 4.90 μm and non amblyopic eyes was 112.92 ± 4.72 μm with statistical significance (p

Purpose: To determine change in visual acuity (VA) in the population of a previous amblyopia treatment study (Loudon 2006) and assess risk factors for VA decrease. Methods: Subjects treated between 2001 and 2003 were contacted between December 2015 and July 2017. Orthoptic examination was conducted under controlled circumstances and included subjective refraction, best corrected VA, reading acuity, binocular vision, retinal fixation, cover-uncover and alternating cover test. As a measure for degree of amblyopia, InterOcular VA Difference (IOD) at the end of occlusion therapy was compared with IOD at the follow-up examination using Wilcoxon’s signed-rank test. Regression analysis was conducted to determine the influence of clinical and socio-economic factors on changes in IOD. Results: Out of 303 subjects from the original study, 208 were contacted successfully, 59 refused and 15 were excluded because of non-amblyopic cause of visual impairment. Mean IOD at end of therapy (mean age 6.4 years) was 0.11 ± 0.16 logMAR, and IOD at follow-up examination (mean age 18.3 years) was 0.09 ± 0.21 logMAR; this difference was not significant (p = 0.054). Degree of anisometropia (p = 0.008; univariable analysis), increasing anisometropia (p = 0.009; multivariable), eccentric fixation (p

Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error. RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.