The Effect of Amblyopia Treatment with Patching on Ocular Alignment

Seung Woo Kim; Seung Ah Chung

doi:10.3341/jkos.2016.57.2.302

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Kim and Chung: The Effect of Amblyopia Treatment with Patching on Ocular Alignment

Original Article

J Korean Ophthalmol Soc 2016;57(2):302-309.

Published online: 7 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.2.302

The Effect of Amblyopia Treatment with Patching on Ocular Alignment

Seung Woo Kim, MD, Seung Ah Chung, MD, PhD

Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea

Address reprint requests to Seung Ah Chung, MD, PhD Department of Ophthalmology, Ajou University Hospital, #164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: 82-31-219-5257, Fax: 82-31-519-5209 E-mail: mingming8@naver.com

Received 20 August 2015 Revised 22 October 2015 Accepted 21 December 2015

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 evaluate the effect of patching on ocular alignment in children with unilateral amblyopia.

Methods

We evaluated the change in ocular alignment during and after patching in patients who had started amblyopia treatment with patching, and analyzed the aspects of change according to the cause and severity of amblyopia, type and magnitude of deviation, type of refractive error, and age at initiation. A change of eight prism diopters (PD) or more in horizontal deviation, or two PD or more in vertical deviation was considered significant.

Results

A total of 209 patients were enrolled; 135 had amblyopia associated with anisometropia, 50 with strabismus, 19 with combined cause, and 5 with deprivation. After patching, there was no change in distant deviation in 177 patients (84.7%), while a decrease was noted in 23 patients (11.0%) and an increase in nine patients (4.3%). The angle of deviation decreased in 7.4% of anisometropic amblyopia, 20.0% of strabismic amblyopia, 10.5% of combined amblyopia, and 20.0% of deprivation amblyopia. The angle of deviation increased in 4.4% of anisometropic amblyopia, 5.3% of combined amblyopia, and 40.0% of deprivation amblyopia. The angle of deviation decreased in 24.2% of exodeviation, and 21.6% of esodeviation, but there was no change in vertical deviation among the studied patients. The angle of deviation decreased in 31.9% of patients with deviation greater than 8 PD. The change did not differ according to severity of amblyopia, type of refractive error, or age. Among the successes, decrease in deviation was more common until they achieved equal visual acuity between both eyes, while the increase during tapering of patching.

Conclusions

Change in ocular alignment may occur after patching in some patients with amblyopia, and seems to be more frequent in cases associated with horizontal deviation greater than 8 PD.

Keywords: Amblyopia, Ocular alignment, Patching

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Figure 1.

Bar graph for proportion of the patients whose distant angle changed by 8 PD or more among the success, stratified by the cause of amblyopia and phase. (A) For cases of decreased angle, and (B) for cases of increased angle; dark grey bar (phase 1: the change occurred between baseline and the time to achieve the same visual acuity in both eyes), and bright grey bar (phase 2: the change occurred during tapering of patching). PD = prism diopter.

Figure 2.

Bar graph for proportion of the patients whose distant angle changed by 8 PD or more among the success, stratified by the type of deviation and phase. (A) For cases of decreased angle, and (B) for cases of increased angle; dark grey bar (phase 1: the change occurred between baseline and the time to achieve the same visual acuity in both eyes), and bright grey bar (phase 2: the change occurred during tapering of patching). PD = prism diopter.

Table 1.

Baseline characteristics of 209 children with unilateral amblyopia

Characteristic	Cause of amblyopia				Overall (n = 209)
Characteristic	Anisometropia (n = 135)	Strabismus (n = 50)	Combined (n = 19)	Deprivation (n = 5)	Overall (n = 209)
Gender (male)	69 (51.1)	25 (50.0)	9 (47.4)	4 (80.0)	107 (51.2)
Age at baseline (years)	6.2 ± 2.0	5.6 ± 3.0	6.3 ± 2.1	5.0 ± 1.7	6.1 ± 2.0
Follow-up (months)	13.2 ± 13.9	10.8 ± 11.9	23.4 ± 19.8	22.4 ± 18.7	13.8 ± 13.9
Severity of amblyopia	25:64:46	5:23:22	2:10:7	4:1:0	36:98:75
(severe:moderate:mild)	(18.5:47.4:34.1)	(10.0:46.0:44.0)	(10.5:52.6:36.8)	(80.0:20.0:0.0)	(17.2:46.9:35.9)
Refractive error	0:25:78:32	18:8:12:12	0:3:14:2	0:1:2:2	18:37:106:48
(emmetropia:myopia:hype-ropia:astigmatism)	(0.0:18.5:57.8:23.7)	(36.0:16.0:24.0:24.0)	(0.0:15.8:73.7:10.5)	(0.0:20.0:40.0:40.0)	(8.6:17.7:50.7:23.0)
Baseline alignment at distance
Type (Ø:exo:eso:vert.)	105:22:8:0	0:28:20:2	0:10:7:2	1:2:2:0	106:62:37:4
	(77.8:16.3:5.9:0.0)	(0.0:56.0:40.0:4.0)	(0.0:52.6:36.8:10.5)	(20.0:40.0:40.0:0.0)	(50.7:29.7:17.7:1.9)
Magnitude	105:30:0	0:0:50	0:0:19	1:1:3	106:31:72
(0:1-8 PD:>8 PD)	(77.8:22.2:0.0)	(0.0:0.0:100.0)	(0.0:0.0:100.0)	(20.0:20.0:60.0)	(50.7:14.8:34.4)
Baseline alignment at near
Type (Ø:exo:eso:vert.)	97:28:10:0	0:28:20:2	0:10:7:2	1:2:2:0	98:68:39:4
	(71.9:20.7:7.4:0.0)	(0.0:56.0:40.0:4.0)	(0.0:52.6:36.8:10.5)	(20.0:40.0:40.0:0.0)	(46.9:32.5:18.7:1.9)
Magnitude	97:38:0	0:0:50	0:0:19	1:1:3	98:39:72
(0:1-8 PD:>8 PD)	(71.9:28.1:0.0)	(0.0:0.0:100.0)	(0.0:0.0:100.0)	(20.0:20.0:60.0)	(46.9:18.7:34.4)
Result of patching	98:37	42:8	16:3	1:4	157:52
(success:failure)	(72.6:27.4)	(84.0:16.0)	(84.2:15.8)	(20.0:80.0)	(75.1:24.9)

Values are presented as number (%) or means ± SD.

Ø= orthotropia; exo = exodeviation; eso = esodeviation; vert. = vertical deviation; PD = prism diopter.

Table 2.

Comparison of clinical characteristics according to results of amblyopia treatment

	Amblyopia treatment		p-value
	Success (n = 157)	Failure (n = 52)	p-value
Gender (male)	74 (47.1)	33 (63.5)	0.054^*
Age at baseline (years)	5.9 ± 1.9	6.4 ± 2.5	0.157^†
Follow-up (months)	12.8 ± 13.7	16.8 ± 14.6	0.073^†
Cause of amblyopia (anisometropia:strabismus:	98:42:16:1	37:8:3:4	0.013^*
combined:deprivation)	(62.4:26.8:10.2:0.6)	(71.2:15.4:5.8:7.7)
Severity of amblyopia (severe:moderate:mild)	17:74:66	19:24:9	<0.001^*
	(10.8:47.1:42.0)	(36.5:46.2:17.3)
Refractive error (emmetropia:myopia:hyperopia:astigmatism)	14:27:78:38	4:10:28:10	0.676^*
	(8.9:17.2:49.7:24.2)	(7.7:19.2:53.8:19.2)
Baseline alignment at distance
Type (Ø:exo:eso:vert.)	83:46:26:2	23:16:11:2	0.762^*
	(52.9:29.3:16.6:1.3)	(44.2:30.8:21.2:3.8)
Magnitude (0:1-8 PD:>8 PD)	83:18:56	23:13:16	0.427^*
	(52.9:11.5:35.7)	(44.2:25.0:30.8)
Baseline alignment at near
Type (Ø:exo:eso:vert.)	75:52:28:2	23:16:11:2	0.645^*
	(47.8:33.1:17.8:1.3)	(44.2:30.8:21.2:3.8)
Magnitude (0:1-8 PD:>8 PD)	75:30:52	23:9:20	0.832^*
	(47.8:19.1:33.1)	(44.2:17.3:38.5)
Change of ocular alignment (no change:decreased:increased)
Distance	138:13:6	39:10:3	0.071^*
	(87.9:8.3:3.8)	(75.0:19.2:5.8)
Near	132:15:10	42:7:3	0.709^*
	(84.1:9.6:6.4)	(80.8:13.5:5.8)

Values are presented as number (%) or means ±

SD.Ø= orthotropia; exo = exodeviation; eso = esodeviation; vert. = vertical deviation; PD = prism diopter.

^* Chi-square test;

^† Independent t-test.

Table 3.

Proportion of the patients whose distant deviation changed by 8 PD or more, grouped by baseline characteristics and results of patching

	No.	Change		No change	p-value^*
	No.	Decreased	Increased	No change	p-value^*
Overall	209	23 (11.0)	9 (4.3)	177 (84.7)
Cause of amblyopia					0.012
Anisometropia	135	10 (7.4)	6 (4.4)	119 (88.1)
Strabismus	50	10 (20.0)	0 (0.0)	40 (80.0)
Combined	19	2 (10.5)	1 (5.3)	16 (84.2)
Deprivation	5	1 (20.0)	2 (40.0)	2 (40.0)
Severity of amblyopia					0.351
Severe	36	5 (13.9)	3 (8.3)	28 (77.8)
Moderate	98	12 (12.2)	5 (5.1)	81 (82.7)
Mild	75	6 (8.0)	1 (1.3)	68 (90.7)
Results of patching					0.071
Success	157	13 (8.3)	6 (3.8)	138 (87.9)
Failure	52	10 (19.2)	3 (5.8)	39 (75.0)
Age at baseline					0.696
<5 years	58	4 (6.9)	2 (3.4)	52 (89.7)
5 to 7 years	107	12 (11.2)	5 (4.7)	90 (84.1)
>7 years	44	7 (15.9)	2 (4.5)	35 (79.5)
Type of refractive error					0.972
Emmetropia	18	2 (11.1)	1 (5.6)	15 (83.3)
Myopia	37	4 (10.8)	2 (5.4)	31 (83.8)
Hyperopia	106	12 (11.3)	5 (4.7)	89 (84.0)
Astigmatism	48	5 (10.4)	1 (2.1)	42 (87.5)
Type of baseline alignment					<0.001
Orthotropia	106	0 (0.0)	5 (4.7)	101 (95.3)
Exodeviation	62	15 (24.2)	4 (6.5)	43 (69.4)
Esodeviation	37	8 (21.6)	0 (0.0)	29 (78.4)
Vertical dev.	4	0 (0.0)	0 (0.0)	4 (100.0)
Magnitude of baseline align	ment				<0.001
No deviation	106	0 (0.0)	6 (5.7)	100 (94.3)
1-8 PD	31	0 (0.0)	1 (3.2)	30 (96.8)
>8 PD	72	23 (31.9)	2 (2.8)	47 (65.3)

Values are presented as number (%).

dev. = deviation; PD = prism diopter.

^* Chi-square test.

Table 4.

Proportion of the patients whose near deviation changed by 8 PD or more, grouped by baseline characteristics and results of patching

	No.	Change		No change	p-value^*
	No.	Decreased	Increased	No change	p-value^*
Overall	209	22 (10.5)	13 (6.2)	174 (83.3)
Cause of amblyopia					0.209
Anisometropia	135	10 (7.4)	9 (6.7)	116 (85.9)
Strabismus	50	7 (14.0)	2 (4.0)	41 (82.0)
Combined	19	4 (21.1)	1 (5.3)	14 (73.7)
Deprivation	5	1 (20.0)	1 (20.0)	3 (60.0)
Severity of amblyopia					0.280
Severe	36	5 (13.9)	4 (11.1)	27 (75.0)
Moderate	98	12 (12.2)	7 (7.1)	79 (80.6)
Mild	75	5 (6.7)	2 (2.7)	68 (90.7)
Results of patching					0.709
Success	157	15 (9.6)	10 (6.4)	132 (84.1)
Failure	52	7 (13.5)	3 (5.8)	42 (80.8)
Age at baseline					0.309
<5 years	58	5 (8.6)	1 (1.7)	52 (89.7)
5 to 7 years	107	10 (9.3)	8 (7.5)	89 (83.2)
>7 years	44	7 (15.9)	4 (9.1)	33 (75.0)
Type of refractive error					0.776
Emmetropia	18	1 (5.6)	1 (5.6)	16 (88.9)
Myopia	37	4 (10.8)	4 (10.8)	29 (78.4)
Hyperopia	106	12 (11.3)	7 (6.6)	87 (82.1)
Astigmatism	48	5 (10.4)	1 (2.1)	42 (87.5)
Type of baseline alignment					0.002
Orthotropia	98	0 (0.0)	6 (6.1)	92 (93.9)
Exodeviation	68	15 (22.1)	7 (10.3)	46 (67.6)
Esodeviation	39	7 (17.9)	0 (0.0)	32 (82.1)
Vertical dev.	4	0 (0.0)	0 (0.0)	4 (100.0)
Magnitude of baseline alignment					<0.001
No deviation	98	0 (0.0)	8 (8.2)	90 (91.8)
1-8 PD	39	0 (0.0)	1 (2.6)	38 (97.4)
>8 PD	72	22 (30.6)	4 (5.6)	46 (63.9)

Values are presented as number (%).

dev. = deviation; PD = prism diopter.

^* Chi-square test.

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