The outcome of treatment for amblyopia and the factors that affect this are not well understood. A major reason for this has been the exclusion from previous large studies of a sometimes unknown number of patients because of failure to comply with treatment. This paper analyses the outcome of amblyopia treatment in a retrospective review of the orthoptic records of a cohort of 961 children treated for amblyopia at seven centres who first attended in 1983. The final visual acuity was recorded by Snellen or matching methods in 894 children (93%). Of these, 48% achieved 6/9 or better, 35% less than 6/9 but better than or equal to 6/18, and 17% achieved less than 6/18. The outcome was best for pure anisometropic amblyopia, intermediate for pure strabismic amblyopia and least good for mixed strabismic and anisometropic amblyopia with a final visual acuity of 6/10.2, 6/12.8 and 6/14.8 respectively. While the age at start of treatment did not correlate with final visual acuity both poor initial visual acuity and poor compliance were associated with poor outcome. The main factor affecting the outcome of amblyopia treatment is the initial visual acuity. Comparison with the literature suggests that the results of treatment in this country may be falling far short of what would be possible in ideal circumstances with unlimited resources.
SUMMARYThe results of a long term follow up of all patients from a single health district started on occlusion for amblyopia in 1983 are reported.Three hundred and sixty-eight patients started treat ment, their average age was four years seven months, the average amount of daily occlusion was 1.5 hours and the average length of follow up was 31 months. 37 % of cases achieved a final visual acuity of 6/9 or better and another 33% a visual acuity of 6/12 or 6/18. 23% did not achieve 6/18 and treatment of these patients was regarded as fail ure. Data for the remainder (7%) were incomplete.The success rate of occlusion treatment varied little with the age of starting treatment. The group with com bined strabismus and anisometropia responded least well to treatment.
SUMMARYThis study reports the presentation of 961 children who underwent amblyopia treatment at seven orthoptic centres in the United Kingdom. We confirmed previous authors' findings of a small but significant increased inci dence of left-sided compared with right-sided amblyopia overall. For pure anisometropic amblyopia this differ ence was very marked and a possible pathophysiological mechanism is proposed. The mean age of presentation for anismetropic, strabismic and mixed amblyopia was 5.6, 3.3 and 4.4 years, respectively. Neither sex nor race affected the age of presentation. Despite their older age, children with pure anisometropic amblyopia had the best initial visual acuity, with 25 % of anisometropes having an initial visual acuity of less than 6/18 compared with 39% of strabismics and 50% of mixed amblyopes. Categorical data were analysed using the chi-squared (X 2 ) test. Proportions were analysed using the Normal approxi mation to the Binomial distribution. Continuous data were analysed with regression analysis using SAS7• RESULTSOverall, 535 children had strabismic amblyopia (55%), 164 had pure anisometropic amblyopia (17%) and 262 had mixed anisometropic and strabismic amblyopia (27%) (Table I). There was a wide range in the proportion of patients with each type of amblyopia at the different centres (X 2 = 21.1,p = 0.05), with only 7% of the patients presenting with anisometropic amblyopia at centre B compared with 24% at centre C (Table I). Left anisometropic amblyopia was more common (lOS cases) than right anisometropic amblyopia (59 cases). For pure anisometropia this was so at each centre studied and was highly significant (p = 0.0003). For mixed aniso metropic and strabismic amblyopia there was a less marked but still significant preponderance of left amblyo pia (115 right, 147 left; p = 0.(48), while for pure strabis mic amblyopia there was no significant difference (252 right, 283 left; p = 0. 18).The mean age of first attending the orthoptic depart ment for strabismic amblyopia was 3.3 years. Mixed stra bismic and anisometropic amblyopia presented over 1 year later at 4.4 years. Pure anisometropes presented latest
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