Amblyopia II Flashcards
Optical correction for anisometropia amblyopia objective
Evaluate the effectiveness of refractive correction alone for the treatment of untreated anisometropic amblyopia in children younger than 7
Outcome of optical correction for anisometropic amblyopia
Max improvement in VA in the anlyopic eye and proportion of children whose amblyopia resolved with refractive correction alone
Results of optical correction for anisometropic amblyopia
Amblyopia improved with correction by >2 lines in 77%
Resolved in 27%
Improvement mostly about 15 weeks
Notes about optical correction for anisometropic amblyopia
Outcome was not related to age, but was related to better baseline visual acuit and lesser anisometropia
-most resolution occurred in cases with moderate amblyopia
Conclusion of optical correction for anisometropic amblyopia
Refractive correction alone improves VA in many cases and results in resolution of amblyopia in at least 1/4 of childrenyounger than 7 with untreated anisometropia amblyopia
Objective of pathcing vs atropine in kids 7-12
RCT to compare pathcing and atropine as treatmetn of moderate amblyopia in children aged 7-12
Outcome of pathcing vs atropine in kids 7-12
Average VA improvement from baseline
Results of patching vs atropine in children 7-12
Pathcing group: 8.6 letters Atropine group: 7.6 letters VA >20/25 in the amblyopic eye Patching group: 24% Atropine group: 17%
Notes about patching vs atropine in kids 7-12
Mean difference between the 2 groups adjusted for baseline acuity was 1.2 letters
Conclusion of patching vs atropine in kids 7-12
Treatment with atropine or pathcing produced similar improvement in the treatment of moderate amblyopia in children 7-12
Near activity pathcing objective
To determine if performing near activities, which patching for amblyopia, enhances improvement in VA
Outcome of near activity with patching
Improvement in amblyopic eye VA at 8 weeks
Results of near activity patching
- distance activity group: 2.6 lines
- near activity group: 2.5 lines
Notes about near activity patching
At 17 weeks, children with severe amblyopia improved with 2 hours pathcing
Conclusion of near activity with patching
Near activities does not improve VA outcome when treating anismetropic, strabismic or combined amblyopia with two hours of daily pathcing
Children with severe amblyopia (20/100-20/400) May respond to two hours of daily pathcing
Weekend atropine with plan lenses vs atropine alone objective
To compare weekend atropine augmented by a Plano lens for the sound eye vs weekends atropine alone for moderate amblyopia in children 3 to <7 years old
Outcome of weekend atropine with Plano lens vs atropine alone
VA in amblyopic eye at 18 weeks
Results of weekend atropine with Plano lens vs atropine alone
Amblyopic eye improvement in atropine plus Plano lens group: 2.8 lines
Amblyopic eye improvent in atropine alone group: 2.4 lines
Note about weekend atropine with Plano lens vs atropine alone
More patients in the atropine with optical penzalization group had reduced sound eye acuity at 18 weeks; however, there were no cases of persistent reverse amblyopia
Conclusion of weekend atropine with Plano lenses vs atropine alone
As an inital treatment for moderate amblyopia, the augmentation of one drop of weekend atropine with a Plano lens does not substantially imrpove amblyopic eye acuity when compared with atropine alone
Objective of patching vs bangerter occlusion filter
Too determine whether VA improvement with Bergerter filters is similar to improvement with pathcing as inital therapy for children with moderate amblyopia
Outcome of patching vs bangerter occlusion filter
VA in amblyopic eyes at 24 weeks
Results of patching vs bangerter occlusion filter
Amblyopic eye improvement with bangerter filter: 1.9 lines
Amblyopic eye improvement with patching: 2.3 lines
> 3 line improvement
Bangerter filter group: 38%
Pathcing group: 35%
Notes on patching vs bangerter occlusion filter
Lower treatment burden in the bangerter group as measured with the amblyopia treatment index
Could change the density of the filter
Compliance may be better
No difference between treatment groups in stereoacuity
Conclusion of patching vs bangerter occlusion filter
Bangerter filter treatment is a reasonable option to consider for initial treatment for moderate amblyopia. You need to monitor compliance
Objective of intense final punch of patching and atropine
To determine whether an intensive final push with combined pathcing and atropine can improve VA in children with residual amblyopia
Outcome with intense final push of pathcing and atropine
Improvement in VA of hte amblyopic eye
Rustles of intense final push of pathcing and atropine
No significant difference in the improvement of VA between the groups
Notes of intense final push of patching and atropine
The study was DCed because of slow recruitment and a poor confditional power analysis
Included because of the salvaged data
Conclusion of intense final push of pathing and atropine
For kids who have already stopped improving (VA at 20/32-20/63) with 6 hours daily pathcing or with dailiy atropine, a further intensive final push of combined treatment with patching and atropine did not give a abetter VA outcome after 10 weeks compared with a control group in whom treatment was gradually DCed
Objective of effect off optical correction alone on amblyopia
To determine VA improvement in kids withstrabismic and combined strab-anismetropic amlboypia treated with optical correction alone and to explore factors associated with improvement
Results of effect of optical correction alone on amblyopia
Children with resolution of amblyopia: 32%
Treatment effect for strab amblyopia: 3.2 lines
Treatment effect for combined mechanism amblyopia: 2.3 lines
Notes of effect of optical correction alone on amblyopia
- VA improved regardless of whether eye alignment improved-shows the importance of optical correction
- children were previously not treated
- authors gave 2 possible hypotheses for improvements in VA of amblyopic eye. VA improvement might be associated with: improvement in ocular alignment OR improved retinal image clarity, despite persistent strab
Conclusion of effect of optical correction alone on amblyopia
Optical correction alone for strab and combined amblyopia gives VA improvement in amblyopic eye for most 3-7 years old kids, resolving in at least 1/4 without the need for additional treatment
Consider Rxing refractive correction as the sole inital treatment for children with strab or combined mechanism amblyopic before starting other therapies
Increasing daily pathcing for residual amblyopia objective
To evaluate the effectiveness of increasing daily pathcing from 2 to 6 hours in kids with stable residual amblyopia
Results of increasing daily pathcing for residual amblyopia
Mean amblyopic eye VA improvement in 6 hour: 1.2 lines
Mean amblyopic eye VA imrpveoment in 2 hours: 0.5 lines
>2 line improvement
6 hours pathcing group: 40%
Continued 2 hours patching group: 18%
Notes about increasing daily pathcing for residual amblyopia
Children in this study were 3-8 with stable residual amblyopia for about 12 weeks
Conclusion of increasing dialing patching for residual amblyopia
When amblyopic eye VA stops improvement with 2 hours of daily patching increasing the daily percentage dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily
Objective as levodopa as TX for residual amblyopia
To assess the efficacy and short term safety of levodopa as additional treatment to pathcing for amblyopia
Results of levodaop for residual amblyopia
VA imrpveoemtn in levodopa: 5.2 letters
VA improvement in placebo: 3.8 letters
- 20/30 or > 3 line imrpove net
- patching: 79%
- levodopa: 74%
Notes about levodaop as treatment for residual amblyopia
There is nos evidence of a deficiency of dopamine in amblyopes, but levodopa has been used in studies of amblyopia treatment
No serious adverse effects from levodopa were reported during treatment
No dyskinesia
Conclusion of levodopa for amblyopia
Does not improve
VA improvement in BV activities vs pathcing objective
To compare VA improvement in children with amblyopia treated with a BV iPad game vs part time pathcing in kids aged 5 yo younger than 13
Results of BV activities vs pathcing
BV: 1.05 lines
Patching: 1.35 lines
Notes about BV vs pathcing for amblyopia
Amb,topic eye VA improved with BV game play with patching
Conclusion of BV activities vs patching
Analysis suggested that VA improvement with this particular BV iPad game was not as goof as with 2 hours of Rxed daily pathcing
