Clinical Analysis of Factors Affecting Successful Occlusion Treatment and Visual Recovery Time in Amblyopia

Kyu Young Shim; Dong Cheol Lee; Se Youp Lee

doi:10.3341/jkos.2017.58.11.1254

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Shim, Lee, and Lee: Clinical Analysis of Factors Affecting Successful Occlusion Treatment and Visual Recovery Time in Amblyopia

Original Article

J Korean Ophthalmol Soc 2017;58(11):1254-1259.

Published online: 25 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.11.1254

Clinical Analysis of Factors Affecting Successful Occlusion Treatment and Visual Recovery Time in Amblyopia

Kyu Young Shim, MD, Dong Cheol Lee, MD, Se Youp Lee, MD, PhD

Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea

Address reprint requests to Se Youp Lee, MD, PhD Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: 82-53-250-7304, Fax: 82-53-250-7705 E-mail: lsy3379@dsmc.or.kr

Received 20 April 2017 Revised 22 June 2017 Accepted 23 October 2017

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 factors affecting successful occlusion treatment and visual recovery time in patients with amblyopia when best corrected visual acuity (BCVA) improved up to 1.0 after occlusion.

Methods

Forty-eight patients aged 2 to 13 years old with amblyopia due to refractive errors or strabismus were selected. The duration of treatment needed to achieve a BCVA of 1.0 was compared according to the cause of amblyopia (anisometropia, strabismus, combined), initial BCVA of the amblyopic eye, and the age at treatment, as well as other factors.

Results

The mean age of amblyopic treatment was 5.4 years old and the mean duration of treatment was 22.9 months. The duration of treatment was longer in children whose initial BCVA was lower than 0.2, those with spherical equivalent of the amblyopic eye higher than +3.0D and those older than 6 years old. However, there were no significant differences according to the cause of amblyopia.

Conclusions

The duration of treatment needed to achieve a BCVA of 1.0 was prolonged when the initial BCVA in the amblyopic eye was lower than 0.2, the age at treatment was more than 6 years old, or the spherical equivalent of the amblyopic eye was higher than +3.0D at treatment. These factors can be used to predict the duration of occlusion treatment.

Keywords: Amblyopia, Occlusion, Spherical equivalent, Visual recovery time

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Table 1.

Baseline demographics and clinical characteristics of study subjects

	Age<6 years (n = 28)	Age ≥ 6 years (n = 20)	p-value^†
Mean age(years)	3.93 ± 1.06	7.35 ± 2.98
Initial BCVA in amblyopic eye (logMAR)	0.47 ± 0.26	0.56 ± 0.25	0.82
Initial BCVA in sound eye (logMAR)	0.15 ± 0.15	0.14 ± 0.11	0.32
Interocular difference (logMAR)	0.32 ± 0.29	0.43 ± 0.31	0.47
Type
Anisometropia	17	15
Strabismus	9	2
Combined	2	3
Mild	5	3
Depth
Moderate	16	9
Severe	7	8
Duration of treatment (months)	15.70 ± 5.76	24.80 ± 12.50	0.04^*

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

^* Significant difference between groups

^† The p-values were calculated using Mann-Whitney test.

Table 2.

Characteristics according to the degree of amblyopia

	Degree of amblyopia			p-value^*
	Mild (n = 8)	Moderate (n = 25)	Severe (n = 15)	p-value^*
Initial age (years)	6.00 ± 2.97	4.76 ± 1.94	6.13 ± 1.95	0.70
Duration of therapy (months)	14.64 ± 8.40	20.64 ± 10.44	25.20 ± 13.92	0.09
Duration of therapy (months) (half success)^†	4.44 ± 2.16	5.88 ± 4.92	5.52 ± 2.40	0.80
SE (D)	1.19 ± 2.25	1.17 ± 3.19	2.35 ± 2.07	0.39

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent.

^* The p-values were calculated using Mann-Whitney test

^† The duration of therapy to reach half of initial visual acuity and 1.0.

Table 3.

Characteristics according to spherical equivalent

	Degree of spherical equivalent
	Myopia (<0)	Mild hypermetropia (0≤, <+3.0D)	Severe hypermetropia (≥+3.0D)
No. (%)	18 (37.5)	18 (37.5)	12 (25.0)
Duration of therapy (months)	17.52 ± 8.64	15.72 ± 9.00	28.56 ± 12.24
Duration of therapy (months) (half success)^*	6.60 ± 5.88	4.68 ± 3.12	5.76 ± 2.88
SE (D)	–1.91 ± 2.80	1.61 ± 0.72	4.09 ± 0.76
Initial BCVA in amblyopic eye (logMAR)	0.59 ± 0.27	0.49 ± 0.24	0.42 ± 0.24

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent; BCVA = best corrected visual acuity.

^* The duration of therapy to reach half of initial visual acuity and 1.0.

Table 4.

Suspected risk factors for duration of therapy

Factor	No. (%)	p-value^†	p-value^‡
Age ≥ 6 years	20 (41.6)	0.04^*	0.33
Presence of strabismus	9 (18.8)	0.57	0.72
SE of amblyopic eye ≥ +3.0D	12 (25.0)	0.01^*	0.28
Cylinder of amblyopic eye ≤ 1.5D	22 (45.8)	0.74	0.25
Initial BCVA in amblyopic eye ≤ 0.2	15 (31.2)	0.05^*	0.89
Interocular initial BCVA difference ≥ 0.5	30 (62.5)	0.98	0.46

SE = spherical equivalent; BCVA = best corrected visual acuity.

^* Significant difference between groups

^† The p-values were calculated using Mann-Whitney test: the p-value of duration of therapy

^‡ The p-values were calculated using Mann-Whitney test: the p-value of duration of therapy (half success: the duration of therapy to reach half of initial visual acuity and 1.0).

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