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Choi and Choi: Efficacy of Spectacles before Amblyopia Treatment in Anisometropic Amblyopia
Original Article

J Korean Ophthalmol Soc 2011;52(5):550-556.

Published online: 3 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.5.550

Efficacy of Spectacles before Amblyopia Treatment in Anisometropic Amblyopia

Duk Kyu Choi, MD, Mi Young Choi, MD, PhD

Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Medical Research Institute, Cheongju, Korea

Address reprint requests to Mi Young Choi, MD, PhD Department of Ophthalmology, Chungbuk National University Hospital #410 Seongbong-ro, Heungdeok-gu, Cheongju 123-456, Korea Tel: 82-43-269-6335, Fax: 82-43-264-5263, E-mail: mychoi@chungbuk.ac.kr

Received 3 June 20102 November 2010       Accepted 21 February 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To identify the efficacy of spectacle wearing for 4 months before amblyopia treatment in children with anisometropic amblyopia.

Methods

The patients with anisometropic amblyopia without strabismus were selected for the present study. The patients were divided into 2 groups; patients who began amblyopia treatment while simultaneously wearing glasses (Group A, 16 patients) and patients who began amblyopia treatment after wearing spectacles for 4 months (Group B, 17 patients). Intermittent atropine penalization or part-time occlusion was provided for amblyopia treatment. Age and best-corrected visual acuity at the start and cessation of treatment, type of amblyopia, treatment method and duration of treatment were analyzed.

Results

There were no statistical differences among age, best-corrected visual acuity of the amblyopic and better eyes, type of amblyopia, or treatment method between the 2 groups. In Group B, visual acuity of the amblyopic and better eyes improved after 4 months of spectacle wearing. At the last visit, there were no statistical differences of visual acuity in the amblyopic eye between the 2 groups. In children with resolution of amblyopia, the treatment duration of Group A (15 patients) was 17.3 months, longer than the 4.7 months in Group B (13 patients) (p = 0.003).

Conclusions

Wearing spectacles for 4 months prior to amblyopia treatment may be an effective method of shortening the treatment duration.

Keywords: Amblyopia treatment, Anisometropic amblyopia, Spectacles

References

1. Pediatric Eye Disease Investigator Group. Treatment of anisom-tropic amblyopia in children with refractive correction. Ophthalmology. 2006; 113:895–903.
2. Kivlin JD, Flynn JT. Therapy of anisometropic amblyopia. J Pediatr Ophthalmol Strabismus. 1981; 18:47–56.
crossref
3. Clarke WN, Noel LP. Prognostic indicators for avoiding occlusion therapy in anisometropic amblyopia. Am Orthopt J. 1990; 40:57–63.
crossref
4. Moseley MJ, Fielder AR, Irwin M, et al. Effectiveness of occlusion therapy in ametropic amblyopia: a pilot study. Br J Ophthalmol. 1997; 81:956–61.
crossref
5. Krumholtz I, FitzGerald D. Efficacy of treatment modalities in refractive amblyopia. J Am Optom Assoc. 1999; 70:399–404.
6. Stewart CE, Moseley MJ, Fielder AR, et al. Refractive adaptation in amblyopia: quantification of effect and implications for practice. Br J Ophthalmol. 2004; 88:1552–6.
crossref
7. Moseley MJ, Neufeld M, McCarry B, et al. Remediation of refractive amblyopia by optical correction alone. Ophthalmic Physiol Opt. 2002; 22:296–9.
crossref
8. Kim JB, Moon CS, Chang YH, et al. The amblyopia and strabismus accompanied with anisometropia. J Korean Ophthalmol Soc. 2007; 48:411–7.
9. Rho SS, Yang HS, Chang YH, et al. The effect on outcome of amblyopia treatment in children with anisometropic amblyopia. J Korean Ophthalmol Soc. 2007; 48:535–40.
10. Chen PL, Chen JT, Tai MC, et al. Anisometropic amblyopia treated with spectacle correction alone: possible factors predicting success and time to start patching. Am J Ophthalmol. 2007; 143:54–60.
crossref
11. Li CH, Chen PL, Chen JT, Fu JJ. Different corrections of hypermetropic errors in the successful treatment of hypermetropic amblyopia in children 3 to 7 years of age. Am J Ophthalmol. 2009; 147:357–63.
crossref
12. Kim EK, Choi MY, Kim YH. Clinical analysis of successfully treated amblyopia with anisometropia, strabismis, and combined cause. J Korean Ophthalmol Soc. 2008; 49:303–8.
crossref
13. Lee CS, Shin MK, Paik HJ. Evaluation of factors affecting the outcome of occlusion treatment for amblyopia. J Korean Ophthalmol Soc. 2001; 42:1740–6.
14. Kim YT, Chang HR. Follow-up results of the monocular amblyopia. J Korean Ophthalmol Soc. 1998; 39:2803–9.
15. Chang HR, Hong SH, Huh DW. The clinical outcomes of occlusion for monocular amblyopia in children more than 8 years. J Korean Ophthalmol Soc. 2003; 44:1146–52.
16. Park SB, Kwon JY. Occlusion effects on anisometropic amblyopia. J Korean Ophthalmol Soc. 2001; 42:1753–9.

Table 1.
Demographic characteristics
Group A (n = 16) Group B (n = 17) p-value
Gender (n [%]) 0.579*
　Male 10 (62.5) 9 (52.9)
　Female 6 (37.5) 8 (42.1)
Age (mean ± SD, yr) 6.0 ± 1.4 6.2 ± 1.3 0.773†
Type of anisometropia (n [%]) 0.169*
　Hyperopia 12 (75.0) 8 (47.1)
　Myopia 2 (12.5) 2 (11.8)
　Astigmatism 2 (12.5) 7 (41.1)
Initial visual acuity (mean ± SD, logMAR)
　Amblyopic eye 0.72 ± 0.22 0.68 ± 0.19 0.634†
　Better eye 0.15 ± 0.17 0.22 ± 0.20 0.366†
No. of lines of Interocular acuity difference (mean ± SD) 5.68 ± 2.02 4.64 ± 2.28 0.124†
Interocular difference of spherical equivalent (mean ± SD, diopter) 3.31 ± 1.62 2.76 ± 2.14 0.418†
Absolute value of spherical equivalent of amblyopic eye (mean ± SD, diopter) 3.98 ± 1.76 3.64 ± 1.57 0.870†
Compliance (%) 99.4 96.8 0.004†
Therapeutic methods (n [%]) 0.622*
　Patching 10 (62.5) 12 (70.5)
　Atropine 6 (37.5) 5 (29.5)

Group A = amblyopia treatment with spectacle wearing; Group B = amblyopia treatment after 4-month spectacle wearing.

* Chi-square test;

† Mann-Whitney U-test.

Table 2.
Baseline profile of Group A
Case No. Age (yr) Visual acuity (logMAR) / Refractive error
 Follow-up interval (mon)
Amblyopic eye Better eye
1 2.9 1 / -7.5Ds 0.5 / +0.5Ds 1-2
2 4.4 1 / +6.5Ds=-1.0Dc×180A 0.2 / +2.0Ds=-0.25Dc×180A 2-3
3 7.1 0.7 / -1.0Ds=-2.0Dc×180A 0.2 / -0.5Ds 1-2
4 6.0 0.4 / +2.0Ds=-3.0Dc×180A 0 / +1.5Ds=-0.5Dc×180A 2-3
5 6.8 0.7 / +6.0Ds=-0.5Dc×180A 0 / +0.75Ds 1-2
6 6.3 0.3 / +3.0Ds 0 / +0.75Ds 1-2
7 4.9 1 / +6.5Ds=-0.5Dc×180A 0.3 / +2.5Ds=-0.25Dc×180A 1-2
8 7.3 0.9 / +2.5Ds=-0.5Dc×180A 0 / +0.25Ds 1-3
9 6.3 0.6 / +2.5Ds 0.3 / -0.5Dc×90A 2-3
10 6.8 0.8 / +6.25Ds=-0.5Dc×180A 0.5 / +1.0Ds 2-3
11 6.2 0.9 / +3.25Ds=-0.5Dc×180A 0.1 / +1.25Ds=-0.25Dc×90A 3
12 7.5 0.5 / +2.25Ds 0 / +0.25Ds 1-2
13 9.0 0.7 / +3.5Ds 0 / +0.25Dc×90A 1-2
14 6.1 0.5 / +5.0Ds=-1.0Dc×180A 0.1 / +1.25Ds=-0.5Dc×180A 2-3
15 4.0 1 / +2.75Ds=+0.75Dc×90A 0.2 / +0.25Ds 2-3
16 5.7 0.6 / -3.5Ds 0.1 / -1.0Ds=-0.25Dc×90A 1-2

Group A = amblyopia treatment with spectacle wearing; Group B = amblyopia treatment after 4-month spectacle wearing.

Ds = diopter spherical; Dc = diopter cylinder.

Table 3.
Baseline profile of Group B
Case No. Age (yr) Visual acuity (logMAR) / Refractive error
 Follow-up interval (mon)
Amblyopic eye Better eye
1 8.5 0.8 / -7.5Ds 0 / +1.0Ds 1-2
2 5.6 0.6 / +3.0Ds=-2.5Dc×180A 0.1 / +3.25Ds 1-3
3 7.1 0.8 / +2.75Ds=-1.0Dc×180A 0.1 / +1.0Ds=-0.25Dc×180A 1-3
4 7.4 1 / +5.25Ds=-0.5Dc×180A 0.2 / +0.75Ds 1-2
5 5.7 0.7 / -3.5Dc×180A 0.4 / -0.5Dc×180A 1-2
6 7.1 1 / +6.5Ds 0.1 / Em 1-2
7 3.8 0.7 / +3.25Ds=-1.5Dc×180A 0.4 / +3.0Ds 1-2
8 7.7 0.6 / +0.5Ds=-4.0Dc×180A 0 / +0.5Ds=-2.0Dc×180A 1-2
9 6.9 0.7 / +1.0Ds=-4.0Dc×180A 0.5 / +1.5Ds=-1.5Dc×180A 1-2
10 6.6 0.3 / +1.25Ds=-3.5Dc×180A 0 / +1.75Ds=-2.0Dc×180A 1-2
11 4.4 0.7 / +1.5Ds=-2.0Dc×180A 0.1 / +0.5Ds=-0.5Dc×180A 1-2
12 5.5 0.5 / +3.5Ds=-0.5Dc×180A 0.2 / +2.0Ds 1-3
13 8.2 0.5 / +5.0Ds 0 / +1.0Ds 1-2
14 6.0 1 / -6.0Ds=-2.0Dc×180A 0.7 / -2.5Dc×180A 1-2
15 5.7 0.5 / +5.5Ds 0.2 / +2.5Ds 1-2
16 4.1 0.6 / +4.0Ds=+0.5Dc×90A 0.4 / +2.0Ds=+0.5Dc×90A 1-2
17 6.5 0.7 / +3.5Ds=+2.0Dc×90A 0.4 / +2.0Ds=+1.5Dc×90A 1-2

Group A = amblyopia treatment with spectacle wearing; Group B = amblyopia treatment after 4-month spectacle wearing.

Ds = diopter spherical; Dc = diopter cylinder.

Table 4.
Visual outcome according to treatment group
Visual acuity (mean ± SD, logMAR)
 p-value*
Baseline 4 mon Last 4 mon† Last‡
Group A (n = 16)
　Amblyopic eye 0.72 ± 0.22 0.35 ± 0.27 0.05 ± 0.10 0.001 0.002
　Better eye 0.15 ± 0.17 0.08 ± 0.15 0.03 ± 0.07 0.034 0.236
Group B (n = 17)
　Amblyopic eye 0.68 ± 0.19 0.57 ± 0.18 0.12 ± 0.19 0.017 0.001
　Better eye 0.22 ± 0.20 0.07 ± 0.10 0.06 ± 0.08 0.002 0.564

Group A = amblyopia treatment with spectacle wearing; Group B = amblyopia treatment after 4-month spectacle wearing.

* Wilcoxon signed rank test;

† Wilcoxon signed rank test between baseline acuity and 4 months acuity;

‡ Wilcoxon signed rank test between baseline acuity and the last visual acuity.

Table 5.
Baseline visual acuity according to treatment
Visual acuity (mean ± SD, logMAR)
 p-value*
Group A (n = 16) Group B (n = 17)
Amblyopic eye 0.72 ± 0.22 0.57 ± 0.18 0.074
Better eye 0.15 ± 0.17 0.07 ± 0.10 0.160

Group A = amblyopia treatment with spectacle wearing; Group B = amblyopia treatment after 4-month spectacle wearing.

* Mann-Whitney U-test.

Table 6.
The distribution of spherical equivalent according to treatment
Spherical equivalent (diopter) Group A (n = 16) Group B (n = 17)
≥ 6 3 1
3 to <6 6 6
0 to <3 4 4
-3 to <0 1 4
-6 to <-3 1 0
<-6 1 2

Group A = amblyopia treatment with spectacle wearing; Group B = amblyopia treatment after 4-month spectacle wearing.

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