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Asper L, Watt K, Khuu S. Optical treatment of amblyopia: a systematic review and meta-analysis. Clin Exp Optom 2018; 101:431-442. [PMID: 29392811 DOI: 10.1111/cxo.12657] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Despite evidence that amblyopia can often be treated by optical treatment alone, many practitioners still do not use an optical-correction-only phase in amblyopia treatment and some investigators omit this important step in their research. This paper aims to systematically review the evidence for the optical treatment of strabismic, refractive and combined-mechanism amblyopia and to quantify the evidence via a meta-analysis. METHODS A search of online databases MEDLINE, EMBASE, PsycInfo, the Cochrane Library, and bibliographies of review papers, along with subsequent personal communication, resulted in 29 papers that met our inclusion criteria, with 20 providing sufficient data for the calculation of effect sizes. A meta-analysis was performed to determine effect sizes and the heterogeneity thereof. Meta-regression was used to evaluate the contribution of the possible moderating factors of age, duration of optical correction, and initial visual acuity to the heterogeneity of the studies. In addition, effect sizes were analysed in subgroups based on amblyopia aetiology, that is refractive or strabismic or combined, and also in the fellow eyes. RESULTS No evidence of publication bias in the included studies was found using a Galbraith plot. Optical treatment of amblyopia resulted in a large positive effect size of 1.07 (±0.49, 95 per cent confidence limits) on visual acuity, although the heterogeneity was significant (Q = 597.05, I2 = 96.65 per cent, p < 0.0001). Meta-regression indicated that effect sizes significantly decreased with age, increased with treatment duration, and that better initial acuity was associated with higher effect sizes. CONCLUSION Effect sizes were always moderate to large, whether participants were younger or older children, or whether the aetiology was refractive or strabismic. Thus, optical treatment of amblyopia should be considered prior to other treatment in those with refractive error. Improved acuity before initiating other treatment would presumably make occlusion or penalisation less onerous and may improve compliance with further treatment.
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Affiliation(s)
- Lisa Asper
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Kathleen Watt
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Sieu Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Liao M, Zhao H, Liu L, Li Q, Dai Y, Zhang Y, Zhou Y. Training to improve contrast sensitivity in amblyopia: correction of high-order aberrations. Sci Rep 2016; 6:35702. [PMID: 27752122 PMCID: PMC5067678 DOI: 10.1038/srep35702] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/04/2016] [Indexed: 02/05/2023] Open
Abstract
Perceptual learning is considered a potential treatment for amblyopia even in adult patients who have progressed beyond the critical period of visual development because adult amblyopes retain sufficient visual plasticity. When perceptual learning is performed with the correction of high-order aberrations (HOAs), a greater degree of neural plasticity is present in normal adults and those with highly aberrated keratoconic eyes. Because amblyopic eyes show more severe HOAs than normal eyes, it is interesting to study the effects of HOA-corrected visual perceptual learning in amblyopia. In the present study, we trained twenty-six older child and adult anisometropic amblyopes while their HOAs were corrected using a real-time closed-loop adaptive optics perceptual learning system (AOPL). We found that adaptive optics (AO) correction improved the modulation transfer functions (MTFs) and contrast sensitivity functions (CSFs) of older children and adults with anisometropic amblyopia. When perceptual learning was performed with AO correction of the ocular HOAs, the improvements in visual function were not only demonstrated in the condition with AO correction but were also maintained in the condition without AO correction. Additionally, the learning effect with AO correction was transferred to the untrained visual acuity and fellow eyes in the condition without AO correction.
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Affiliation(s)
- Meng Liao
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Haoxing Zhao
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, China
- The Key Laboratory on Adaptive Optics, Chinese Academy of Science, Chengdu 610209, China
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qian Li
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yun Dai
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, China
- The Key Laboratory on Adaptive Optics, Chinese Academy of Science, Chengdu 610209, China
| | - Yudong Zhang
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu, China
- The Key Laboratory on Adaptive Optics, Chinese Academy of Science, Chengdu 610209, China
| | - Yifeng Zhou
- CAS Key Laboratory of Brain Function and Disease and School of Life Sciences, University of Science and Technology of China, Hefei 230027, China
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Kirwan C, Nolan JM, Stack J, Dooley I, Moore J, Moore TC, Beatty S. Introduction of a Toric Intraocular Lens to a Non-Refractive Cataract Practice: Challenges and Outcomes. INTERNATIONAL JOURNAL OF OPHTHALMOLOGY AND CLINICAL RESEARCH 2016; 3. [PMID: 27830188 DOI: 10.23937/2378-346x/1410056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To identify challenges inherent in introducing a toric intraocular lens (IOL) to a non-refractive cataract practice, and evaluate residual astigmatism achieved and its impact on patient satisfaction. METHODS Following introduction of a toric IOL to a cataract practice with all procedures undertaken by a single, non-refractive, surgeon (SB), pre-operative, intra-operative and post-operative data was analysed. Attenuation of anticipated post-operative astigmatism was examined, and subjectively perceived visual functioning was assessed using validated questionnaires. RESULTS Median difference vector (DV, the induced astigmatic change [by magnitude and axis] that would enable the initial surgery to achieve intended target) was 0.93D; median anticipated DV with a non-toric IOL was 2.38D. One eye exhibited 0.75D residual astigmatism, compared to 3.8D anticipated residual astigmatism with a non-toric IOL. 100% of respondents reported satisfaction of ≥ 6/10, with 37.84% of respondents entirely satisfied (10/10). 17 patients (38.63%) reported no symptoms of dysphotopsia (dysphoptosia score 0/10), only 3 respondents (6.8%) reported a clinically meaningful level of dysphotopsia (≥ 4/10). Mean post-operative NEI VF-11 score was 0.54 (+/-0.83; scale 0 - 4). CONCLUSION Use of a toric IOL to manage astigmatism during cataract surgery results in less post-operative astigmatism than a non-toric IOL, resulting in avoidance of unacceptable post-operative astigmatism.
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Affiliation(s)
- Clare Kirwan
- Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland; Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland; Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - John M Nolan
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - Jim Stack
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - Ian Dooley
- University College Hospital Limerick, Ireland
| | - Johnny Moore
- Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland
| | - Tara Cb Moore
- Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland
| | - Stephen Beatty
- Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland; Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
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Hao J, Li L, Tian F, Zhang H. Comparison of two types of visual quality analyzer for the measurement of high order aberrations. Int J Ophthalmol 2016; 9:292-7. [PMID: 26949654 DOI: 10.18240/ijo.2016.02.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/04/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the difference and agreement of KR-1W and iTrace for measurement of high order aberrations. METHODS KR-1W and iTrace were respectively used in a group of healthy people (40 volunteers, 32 eyes) to measure the high order aberration (HOA) of corneal, internal and total ocular. The clinical difference and agreement of two instruments were respectively evaluated by paired-samples t-test and Bland-Altman analysis. RESULTS The paired-samples t-test showed that the corneal HOA measured by the two instruments had no statistical differences (P>0.05); but the internal and total ocular HOA had significant statistical differences (P<0.05), and the mean results measured by iTrace were higher than that of KR-1W. However, Bland-Altman analysis revealed that the HOA of corneal and internal were all in 95% limits of agreement; and just one point of total ocular HOA was beyond the 95% limits of agreement. CONCLUSION KR-1W and iTrace were consistent well in the measurement of corneal, internal and total ocular HOA, especially for the cornea.
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Affiliation(s)
- Jing Hao
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin 300384, China; North China University of Science and Technology, Tangshan 063000, Hebei Province, China
| | - Lin Li
- Tangshan Gongren Hospital, Tangshan 063000, HeBei, China
| | - Fang Tian
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Hong Zhang
- Department of Cataract, Tianjin Medical University Eye Hospital, Tianjin 300384, China
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Choi SK, Chang JW. Higher Order Aberration and Astigmatism in Children with Hyperopic Amblyopia. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:53-9. [PMID: 26865804 PMCID: PMC4742646 DOI: 10.3341/kjo.2016.30.1.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/11/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the changes in corneal higher-order aberration (HOA) during amblyopia treatment and the correlation between HOA and astigmatism in hyperopic amblyopia children. Methods In this retrospective study, a total of 72 eyes from 72 patients ranging in age from 38 to 161 months were included. Patients were divided into two groups based on the degree of astigmatism. Corneal HOA was measured using a KR-1W aberrometer at the initial visit and at 3-, 6-, and 12-month follow-ups. Correlation analysis was performed to assess the association between HOA and astigmatism. Results A total of 72 patients were enrolled in this study, 37 of which were classified as belonging to the higher astigmatism group, while 35 were assigned to the lower astigmatism group. There was a statistically significant difference in success rate between the higher and lower astigmatism groups. In both groups, all corneal HOAs were significantly reduced during amblyopia treatment. When comparing the two groups, a significant difference in coma HOA at the 12-month follow-up was detected (p = 0.043). In the Pearson correlation test, coma HOA at the 12-month follow-up demonstrated a statistically significant correlation with astigmatism and a stronger correlation with astigmatism in the higher astigmatism group than in the lower astigmatism group (coefficient values, 0.383 and 0.284 as well as p = 0.021 and p = 0.038, respectively). Conclusions HOA, particularly coma HOA, correlated with astigmatism and could exert effects in cases involving hyperopic amblyopia.
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Affiliation(s)
- Seung Kwon Choi
- Department of Ophthalmology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ji Woong Chang
- Department of Ophthalmology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Miller JM, Harvey EM, Schwiegerling J. Higher-order aberrations and best-corrected visual acuity in Native American children with a high prevalence of astigmatism. J AAPOS 2015; 19:352-7.e1. [PMID: 26239206 PMCID: PMC4811022 DOI: 10.1016/j.jaapos.2015.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/07/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether higher-order aberrations (HOAs) in children from a highly astigmatic population differ from population norms and whether HOAs are associated with astigmatism and reduced best-corrected visual acuity. METHODS Subjects were 218 Tohono O'odham Native American children 5-9 years of age. Noncycloplegic HOA measurements were obtained with a handheld Shack-Hartmann sensor (SHS). Signed (z06s to z14s) and unsigned (z06u to z14u) wavefront aberration Zernike coefficients Z(3,-3) to Z(4,4) were rescaled for a 4 mm diameter pupil and compared to adult population norms. Cycloplegic refraction and best-corrected logMAR letter visual acuity (BCVA) were also measured. Regression analyses assessed the contribution of astigmatism (J0) and HOAs to BCVA. RESULTS The mean root-mean-square (RMS) HOA of 0.191 ± 0.072 μm was significantly greater than population norms (0.100 ± 0.044 μm). All unsigned HOA coefficients (z06u to z14u) and all signed coefficients except z09s, z10s, and z11s were significantly larger than population norms. Decreased BCVA was associated with astigmatism (J0) and spherical aberration (z12u) but not RMS coma, with the effect of J0 about 4 times as great as z12u. CONCLUSIONS Tohono O'odham children show elevated HOAs compared to population norms. Astigmatism and unsigned spherical aberration are associated with decreased acuity, but the effects of spherical aberration are minimal and not clinically significant.
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Affiliation(s)
- Joseph M Miller
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, Arizona; College of Public Health, The University of Arizona, Tucson, Arizona; College of Optical Sciences, The University of Arizona, Tucson, Arizona.
| | - Erin M Harvey
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, Arizona; College of Public Health, The University of Arizona, Tucson, Arizona
| | - Jim Schwiegerling
- Department of Ophthalmology and Vision Science, The University of Arizona, Tucson, Arizona; College of Optical Sciences, The University of Arizona, Tucson, Arizona
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Retinal Nerve Fibre Layer and Macular Thicknesses in Adults with Hyperopic Anisometropic Amblyopia. J Ophthalmol 2015; 2015:946467. [PMID: 26064676 PMCID: PMC4439507 DOI: 10.1155/2015/946467] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/16/2015] [Accepted: 04/22/2015] [Indexed: 12/29/2022] Open
Abstract
Objectives. This study compared the macular and retinal nerve fibre layer (RNFL) thicknesses and optic nerves of eyes with reduced vision due to anisometropia with the contralateral healthy eyes in adults using optical coherence tomography (OCT). Methods. This cross-sectional study was conducted in Atatürk State Hospital, Sinop, Turkey. Macular and RNFL thicknesses, optic nerve disc area, cup area, and horizontal and vertical cup-to-disc ratios obtained using a NIDEK RS-3000 SLO spectral domain OCT device were compared between the amblyopic and fellow eyes in 30 adults with anisometropic amblyopia 18–55 years old who were seen in our clinic with unilateral poor vision. Results. The mean macular thickness was 266.90 ± 23.22 µm in the amblyopic eyes and 263.90 ± 22.84 µm in the fellow eyes, and the mean RNFL thickness was 111.90 ± 12.9 and 109.70 ± 9.42 µm, respectively. The two thicknesses did not differ significantly between the amblyopic and fellow eyes. There were also no significant differences between the eyes in disc area, cup area, and horizontal-vertical cup/disc ratios. Conclusion. There does not seem to be a difference in macular thickness, peripapillary RNFL, or optic disc structures between the amblyopic and fellow eyes in adults.
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