Effect of Age on Response to Amblyopia Treatment in Children

Abstract

To determine whether age at initiation of treatment for amblyopia influences the response among children 3 to less than 13 years of age with unilateral amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity.Methods: A meta-analysis of individual subject data from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol. Age was categorized (3 to Ͻ5 years, 5 to Ͻ7 years, and 7 to Ͻ13 years) because there was a nonlinear relationship between age and improvement in amblyopic eye visual acuity.Results: Children from 7 to less than 13 years of age were significantly less responsive to treatment than were younger age groups (children from 3 to Ͻ5 years of age or children from 5 to Ͻ7 years of age) for moderate and severe amblyopia (P Ͻ.04 for all 4 comparisons). There was no difference in treatment response between children 3 to less than 5 years of age and children 5 to less than 7 years of age for moderate amblyopia (P =.67), but there was a suggestion of greater responsiveness in children 3 to less than 5 years of age compared with children 5 to less than 7 years of age for severe amblyopia (P =.09).Conclusions: Amblyopia is more responsive to treatment among children younger than 7 years of age. Although the average treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to treatment.

Efficiency of electronically monitored amblyopia treatment between 5 and 16years of age: New insight into declining susceptibility of the visual system

“…A large number of studies agree that there is residual plasticity in amblyopes beyond the once assumed age of 6 or 8 years and even into adulthood (Chen, Song, & Wu, 2003), emphasizing either the importance of age (Fulton & Mayer, 1988;Holmes et al, 2011;Rutstein & Fuhr, 1992;Sattler, 1927) or of compliance (Arnold, Armitage, & Limstrom, 2008;Mintz-Hittner & Fernandez, 2000;Park, Hwang, & Ahn, 2004), or the interdependence of the two (Oliver et al, 1986) for successful treatment. In accordance with the MOTAS/ROTAS studies (Stewart et al, 2004b(Stewart et al, , 2007a(Stewart et al, , 2007b and a meta-analysis of the Amblyopia Treatment Studies (ATS, Holmes et al, 2011), we found decreasing susceptibility of the visual system with age to the enforced use of the amblyopic eye.…”

Inventory of current EU paediatric vision and hearing screening programmes

“…Earlier detection of visual or hearing deficits improve outcome. [1][2][3][4] Vision and hearing screening programmes are based on the same general principles, but vary both within and across European Union (EU) countries, regarding tests used, age of testing, frequency of testing, professions involved in screening, referral procedure, funding, and coverage. Such differences can result in health inequities.…”

Rapid Objective Assessment of Contrast Sensitivity and Visual Acuity With Sweep Visual Evoked Potentials and an Extended Electrode Array

“…The optimal age for treatment is not clear, but a correction before the age of 7 or even 3 years, depending on the study, seems advisable. 9,10 Moreover, while a patient could potentially simulate visual function loss with explicit behavioral tests in cases of hysteria or malingering, 11 he/she would be unable to do so with an implicit electrophysiologic index as measured with sVEP. Second, unlike standard event-related potential (ERP) measures 12 such as the flash potential, the electrophysiologic response of interest confines to a predetermined frequency known by the experimenter, increasing objectivity, 4 and requiring minimal analysis procedures.…”