Contact Lens and Amblyopia Treatment in Children With Unilateral High Myopic Anisometropia

Byung Joo Lee; Jeong Hun Kim; Young Suk Yu

doi:10.3341/jkos.2010.51.1.88

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Lee, Kim, and Yu: Contact Lens and Amblyopia Treatment in Children With Unilateral High Myopic Anisometropia

Original Article

J Korean Ophthalmol Soc 2010;51(1):88-94.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.1.88

Contact Lens and Amblyopia Treatment in Children With Unilateral High Myopic Anisometropia

Byung Joo Lee, MD¹, Jeong Hun Kim, MD, PhD^1,², Young Suk Yu, MD, PhD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

Address reprint requests to Young Suk Yu, MD., PhD Department of Ophthalmology, Seoul National University College of Medicine #28 Yeongun-Dong, Chongro-Ku, Seoul 110-799, Korea Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: ysyu@snu.ac.kr

Received 27 April 2009 Accepted 22 September 2009

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 report the clinical outcome of children with unilateral high myopic anisometropic amblyopia who were treated with contact lenses (CL).

Methods

Patients who had myopic anisometropia greater than −7 diopters and was treated with contact lenses combined with occlusion therapy during the period between 1998 and 2007 were retrospectively reviewed. Twenty-seven patients who were followed up for more than 1 year after treatment were included in the study. Initial and final best corrected visual acuities (BCVA) were compared and factors which influence the visual outcome were analyzed.

Results

A total of 10 out of 27 patients (37%) acquired visual improvement of more than 2 lines. At the final examination, 6 patients (22.2%) had BCVA better than logMAR 0.3 and 10 patients (37.0%) had BCVA better than logMAR 0.7. Medullated nerve fiber and strabismus were the most commonly associated ocular pathologies among the patients. Patients without strabismus or medullated nerve fiber acquired greater visual improvement than patients with these comorbidities. Patients with lower initial refractive error (spherical equivalent) in the amblyopic eye acquired a better final vision. Poor compliance to CL wearing or occlusion therapy adversely affected the final vision.

Conclusions

In the present study of children with unilateral severe myopic anisometropic amblyopia treated with CL combined with occlusion therapy, a third of the patients acquired visual improvement of more than 2 lines. The absence of medullated nerve fiber or strabismus was determined to be a good prognostic factor.

Keywords: Amblyopia treatment, Anisometropic amblyopia, Contact lens, Pediatric ophthalmology

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Figure 1.

Distribution of initial best corrected visual acuity (BCVA) and final BCVA in unilateral severe myopic anisometropia children treated with contact lens and occlusion therapy. Linear line indicates no change in vision.

Figure 2.

A. Comparison of initial and final best corrected visual acuity(BCVA) between having strabismus (S), medullated nerve fiber (M) group and nonhaving (NSNM) group in unilateral severe myopic anisometropia children treated with contact lens and occlusion therapy. B. Distribution of vision change (Final BCVA-Initial BCVA; LogMAR) in each group.

Figure 3.

Distribution of final best corrected visual acuity (BCVA) according to initial refractive error and astigmatism in unilateral severe myopic anisometropia children treated with contact lens and occlusion therapy. Linear regression analysis shows that final BCVA of amblyopic eye have a significant negative correlation with initial SE (A), but no significant correlation with initial astigmatism (B). SE: spherical equivalent, BCVA: best corrected visual acuity.^* F-test(ANOVA).

Table 1.

Comparison of factors that could influence the visual outcome between each amblyopia groups

Factors that could influence the visual outcome	S^*	M^†	NSNM^‡	p-value
Factors that could influence the visual outcome	S^*	M^†	NSNM^‡	S vs NSNM	Mvs NSNM
Age at the treatment (years)	3.3	4.1	5.3	p=0.224^П	p=0.310^П
Initial BCVA (logMAR)	1.55	1.75	1.52	p=0.955^П	p=0.247^П
Initial SE (D)	−10.83	−12.58	−9.61	p=0.529^П	p=0.058^П
Initial astigmatism (D)	1.88	0.54	1.44	p=0.224^П	p=0.169^П
Initial anisometropia (D)	11.23	12.68	9.21	p=0.272^П	p=0.018^П
Compliance to CL^§ (%)	65.0	45.0	76.7	p=0.456^П	p=0.018^П
Compliance to occlusion (%)	56.0	41.8	72.5	p=0.524^П	p=0.027^П
Final BCVA (logMAR)	1.25	1.28	0.40	p=0.012^П	p=0.002^П

^* S=strabismus group

^† M=medullated nerve fiber group

^‡ NSNM=non-having strabismus and medullated nerve fiber group

^§ CL= Contact lens

^П =Mann-Whitney U-test.

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