Effectiveness of Laser Refractive Surgery to Address Anisometropic Amblyogenic Refractive Error in Children: A Report by the American Academy of Ophthalmology

Visual training system 4: a promising adjuvant therapy for ocular accommodative function and visual acuity improvement in refractive amblyopia patients

OBJECTIVE

To evaluate the therapeutic effects of Visual Training System 4 (VTS4) as an adjunctive therapy for patients with refractive amblyopia.

METHOD

A total of 82 patients with refractive amblyopia (142 eyes) treated at the Zhongshan Ophthalmic Center of Sun Yat-sen University, were enrolled and divided into two groups based on the treatment protocol. The control group included 40 patients (68 eyes) who received conventional comprehensive treatment, while the observation group was comprised of 42 patients (74 eyes) treated with VTS4 in addition to conventional therapy. The therapeutic effects, best-corrected visual acuity (BCVA), spherical equivalent (SE), ocular accommodative function, and ocular convergence were compared between the two groups.

RESULTS

The total effective rate of visual improvement in the observation group was 86.49%, significantly higher than 66.18% in the control group. BCVA at 3 and 6 months was superior in the observation group compared to the control group (P < 0.05). At 6 months, the normal rate of binocular fusion images in the observation group was 94.59%, higher than 76.47% in the control group. The observation group showed greater improvement in accommodative flexibility and amplitude, and lower accommodative lag compared to the control group. Improvements in negative relative accommodation, positive relative accommodation, and near point of convergence were also more pronounced in the observation group (all P < 0.05). No significant differences were observed in SE, axial length, or corneal curvature within or between the groups before and after treatment (all P > 0.05).

CONCLUSION

VTS4, as an adjunctive therapy for refractive amblyopia, significantly improves visual acuity, enhances accommodative and convergence functions, and demonstrates strong clinical applicability.

Surface ablation laser surgery: Bibliometric and visualized analysis from 2004 to 2023

Surface ablation laser surgery has resurged in popularity recently because of its safety in correcting myopia and favorable postoperative corneal biomechanical properties. This study aimed to investigate the current focal points and future trends in surface ablation laser surgery over the last 2 decades. The Web of Science Core Collection was used as the primary data source to retrieve literature related to surface ablation laser surgery. All records, including full records and reference details, were exported in plain text format. VOSvivewer, CiteSpace, and Pajek were used to perform the bibliometric and visual analyses of the countries/regions, institutions, authors, journals, and keywords of relevant publications. A total of 3415 articles on surface ablation laser surgery were published in 253 journals. These articles were authored by 9681 individuals from 2751 institutions across 79 countries. The United States leads in terms of productivity and influence in this field. The Tehran University of Medical Sciences and Kymion GD were the most productive institutions and authors, whereas the University of Crete and Randleman JB were the most influential. The Journal of Cataract and Refractive Surgery was the most productive and influential in this area, and citation analysis revealed that the top 10 most-cited references focused primarily on postoperative wound healing and wavefront aberration. The keywords were grouped into the following 5 clusters: clinical effects and complications, special indications, iatrogenic corneal ectasia, haze, and pain management. High-frequency keywords in recent years included transepithelial photorefractive keratectomy, retreatment, transepithelial phototherapeutic keratectomy, and biomechanical properties. This bibliometric analysis examined the development trends, global cooperation, research hotspots, and future directions of surface ablation over the past 20 years.

Refractive Surgery in Myopic Children

In this paper, we summarize the current knowledge on refractive surgery performed in the myopic pediatric population. We describe the main concerns about refractive surgery in myopic children and the indications for refractive surgery in this age group. We present a range of surgical procedures that are being used for the management of unilateral/bilateral myopia in children: corneal refractive surgery (PRK, LASEK, LASIK, FS-LASIK and SMILE) and intraocular refractive surgery (phakic intraocular lens implantation, refractive lens exchange or clear lens extraction), with both their advantages and drawbacks. We also describe the various complications and measures to prevent them.

Refractive surgeries in children: Debunking the controversy and assessing the safety and efficacy

New innovations in adults' refractive surgeries have revolutionized the field, offering improved outcomes and enhanced patient experiences. While traditionally considered contraindicated in pediatric populations, emerging research suggests that this notion may not always hold true. Challenges, indications, safety, and other topics will be addressed in this review article.

Brain mechanism of acupuncture for children with anisometropic amblyopia: a resting functional magnetic resonance imaging study based on voxel-mirrored homotopic connectivity

AIM

To explore the brain mechanism of acupuncture for children with anisometropic amblyopia using the voxel-mirror homotopic connectivity (VMHC) analysis method of resting functional magnetic resonance imaging (rs-fMRI) technology based on clinical effectiveness.

METHODS

Eighty children with anisometropic monocular amblyopia were randomly divided into two groups: control (40 cases, 1 case of shedding) and acupuncture (40 cases, 1 case of shedding) groups. The control group was treated with glasses, red flash, grating, and visual stimulations, with each procedure conducted for 5min per time. Based on routine treatment, the acupuncture group underwent acupuncture of "regulating qi and unblocking meridians to bright eyes", Jingming (BL1), Cuanzhu (BL2), Guangming (GB37), Fengchi (GB20) acupoints were taken on both sides, with the needle kept for 30min each time. Both groups were treated once every other day, three times per week, for a total of 4wk. After the treatment, the overall curative effect of the two groups and the latency and amplitude changes of P100 wave of pattern visual-evoked potential were counted. At the same time, nine children with left eye amblyopia were randomly selected from the two groups and were scanned with rs-fMRI before and after treatment. The differences in the brain regions between the two groups were compared and analyzed with VMHC.

RESULTS

Chi-square test showed a notable difference in the total efficiency rate between the acupuncture (94.87%) and control groups (79.49%). Regarding the P100 wave latency and amplitude, the acupuncture group had significantly shorter latency and higher amplitude of P100 wave than the control group. Moreover, the VMHC values of the bilateral temporal lobe, superior temporal gyrus, and middle temporal gyrus were notably increased in the acupuncture group after treatment.

CONCLUSION

Acupuncture combined with conventional treatment can significantly improve the corrected visual acuity and optic nerve conduction in children with anisometropic amblyopia. Compared with the conventional treatment, the regulation of acupuncture on the functional activities of the relevant brain areas in the anterior cerebellum may be an effective acupuncture mechanism for anisometropic amblyopia.