Advances in Amblyopia: What Have We Learned From PEDIG Trials?

Gunton, Kammi B.

doi:10.1542/peds.2012-1622

Cited by 68 publications

(64 citation statements)

References 37 publications

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“…1 It is the most common cause of preventable visual impairment in children with an incidence rate of up to 3.5%. 2 The amblyopic syndrome impacts amblyopes to different extents depending on differing factors, such as the status of binocular functions and the type of amblyopia. Strabismus (an eye turn), anisometropia (differences in refractive errors), or other causative factors, which occlude the visual axis (form deprivation), 1 can challenge the visual system with differing patterns of visual acuity (VA) and contrast sensitivity losses.…”

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confidence: 99%

Spatial and Global Sensory Suppression Mapping Encompassing the Central 10° Field in Anisometropic Amblyopia

Chen

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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Citation: Li J, Li J, Chen Z, et al. Spatial and global sensory suppression mapping encompassing the central 108 field in anisometropic amblyopia. Invest Ophthalmol Vis Sci. 2017;58:481-491. DOI:10.1167/ iovs.16-20298 PURPOSE. We investigate the efficacy of a novel dichoptic mapping paradigm in evaluating visual function of anisometropic amblyopes. METHODS.Using standard clinical measures of visual function (visual acuity, stereo acuity, Bagolini lenses, and neutral density filters) and a novel quantitative mapping technique, 26 patients with anisometropic amblyopia (mean age ¼ 19.15 6 4.42 years) were assessed. Two additional psychophysical interocular suppression measurements were tested with dichoptic global motion coherence and binocular phase combination tasks. Luminance reduction was achieved by placing neutral density filters in front of the normal eye.RESULTS. Our study revealed that suppression changes across the central 108 visual field by mean luminance modulation in amblyopes as well as normal controls. Using simulation and an elimination of interocular suppression, we identified a novel method to effectively reflect the distribution of suppression in anisometropic amblyopia. Additionally, the new quantitative mapping technique was in good agreement with conventional clinical measures, such as interocular acuity difference (P < 0.001) and stereo acuity (P ¼ 0.005). There was a good consistency between the results of interocular suppression with dichoptic mapping paradigm and the results of the other two psychophysical methods (suppression mapping versus binocular phase combination, P < 0.001; suppression mapping versus global motion coherence, P ¼ 0.005).CONCLUSIONS. The dichoptic suppression mapping technique is an effective method to represent impaired visual function in patients with anisometropic amblyopia. It offers a potential in ''micro-''antisuppression mapping tests and therapies for amblyopia.

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Spatial and Global Sensory Suppression Mapping Encompassing the Central 10° Field in Anisometropic Amblyopia

Chen

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…Researchers demonstrated that weekendonly atropine use was as effective as daily use and 2 hours of patching improved moderate to severe amblyopia in children [17]. The PEDIG studies confirmed that the initial choice of treatment was not binding; if a patient did not respond satisfactorily, it was reasonable to prescribe more intense or different treatment [13,18]. Reduced lengths of regimen are also effective, with the potential maximum vision in an amblyopic eye being reached in 3 to 4 months with treatment compliance.…”

Section: Resultsmentioning

confidence: 99%

“…A series of recent randomized controlled treatment trials from the PEDIG have provided a more evidence-based approach to treatment, offering novel evidence that lesser amounts of patching are as effective as more intense regimens and that atropine penalization is often as effective as patching [13][14][15][16]. Researchers demonstrated that weekendonly atropine use was as effective as daily use and 2 hours of patching improved moderate to severe amblyopia in children [17].…”

Section: Resultsmentioning

confidence: 99%

“…Clinicians had to resist combining treatments to allow the effects to build rather than swapping/discontinuing treatment in early stages. In the PEDIG study, treatment was changed only if no or limited improvement occurred at 16 weeks [13]. Individual variability might occur in response to treatment, especially patching without continuous electronic compliance monitoring.…”

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confidence: 99%

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Patching versus weekend atropine for treatment of moderate to severe childhood amblyopia in Fife, Scotland

Jeganathan¹,

Sutherland²,

Skillen³

et al. 2016

New Front Ophthalmol

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Objective: Patching has been the mainstay of amblyopia treatment. The Pediatric Eye Disease Investigation Group's (PEDIG) recent clinical trials have revolutionized our approach to amblyopia treatment and highlighted the effectiveness of atropine as a means to 'penalize' the good eye in amblyopia children. However, to date no published comparative studies in the UK have examined the effectiveness of amblyopia treatment per PEDIG recommendations. Our prospective study aimed to evaluate the efficacy of penalization with patching versus 'weekend' atropine for the treatment of moderate to severe amblyopia in children, served by NHS Fife hospital eye service.Methods: Amblyopic children (3 to 7 years old) with 20/40 to 20/200 visual acuity (VA) were recruited from January 2011 to December 2012. Children either received patch occlusion or 'weekend' atropine penalization based on parental preference after reading an informational document on penalization options and discussing the information with an orthoptist and/or ophthalmologist. Parents and caregivers were then offered their first-choice treatment option. Children who initially received patch therapy but showed poor improvement or compliance were shifted to atropine penalization and vice versa. Success was defined as an increase of 2 or more lines of VA. Results:We examined 158 children (58% males, 42% females). The cause of the amblyopia was squint (73%), anisometropia (47%) and 'mixed' cause (20%). Forty percent of the children received 'weekend' atropine and 60% patching, with an overall success rate of 88% and 49%, respectively. Amongst those patched, 7% showed poor compliance and 4% had limited improvement; they were switched to atropine. Although the final mean VA (0.3 logMAR) was similar between the two modalities, improvement was faster in the 'pure' atropine group (average treatment period of 14.5 weeks versus 26 weeks for patching). Reverse amblyopia occurred in two cases with atropine and optical penalization, but was reversible upon cessation of therapy. Conclusions:Our study demonstrated that intense and extended regimens are not initially needed in amblyopia therapy, concurring with PEDIG findings. 'Weekend' atropine was more effective than patching due to superior patient compliance and treatment response. However, reverse amblyopia occurred with concurrent optical penalization, warranting more vigilant monitoring in this treatment group.

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“…O tratamento da ambliopia é possível se o obstáculo ao desenvolvimento visual normal for removido precocemente. Por isso, justifica-se a importância da detecção precoce e do início do tratamento logo nos primeiros anos de vida 35,36 . Segundo a Academia Americana de Oftalmologia, o melhor momento para tratamento da ambliopia corresponde aos anos da pré-escola A prevalência da cegueira infantil varia de acordo com a situação socioeconômica de cada região 40 .…”

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Rastreamento visual e por photoscreener em escolares do primeiro ano do ensino fundamental

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Advances in Amblyopia: What Have We Learned From PEDIG Trials?

Cited by 68 publications

References 37 publications

Spatial and Global Sensory Suppression Mapping Encompassing the Central 10° Field in Anisometropic Amblyopia

Spatial and Global Sensory Suppression Mapping Encompassing the Central 10° Field in Anisometropic Amblyopia

Patching versus weekend atropine for treatment of moderate to severe childhood amblyopia in Fife, Scotland

Rastreamento visual e por photoscreener em escolares do primeiro ano do ensino fundamental

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