Elektronisch erfasste Okklusionstherapie bei über 7-jährigen Amblyopen: Visusanstieg noch nach mehr als 4 Monaten?

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.

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“…Conversely, other authors have reported significant improvement in amblyopic eye visual acuity in children older than 7 years. 19, 20 …”

Section: Discussionmentioning

confidence: 99%

Effect of Age on Response to Amblyopia Treatment in Children

Holmes¹

2011

Arch Ophthalmol

289

172

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“…Crowded Landolt ring charts with optotype separation 2.6 minarc (Oculus, Wetzlar, Germany) presented at 40 cm distance were used for all patients. Occlusion was recorded using more recent versions of the ODM developed in the Netherlands (Simonsz et al, 1999), which were tested and applied for continuous recording in several previous studies (Awan, Proudlock, & Gottlob, 2005;Chopovska et al, 2005;Fronius, Bachert, & Lüchtenberg, 2009;Fronius et al, 2006;Kracht et al, 2010). Being taped to the occlusion patch, they measure the temperature difference between the patch on the eye and the surroundings.…”

Section: Participant Inclusion and Assessmentmentioning

confidence: 99%

“…Some of these data were also analyzed in the context of methodological studies assessing the practicability of continuous electronic recording of occlusion in patients of various ages (Chopovska et al, 2005;Fronius, Bachert, & Lüchtenberg, 2009;Fronius et al, 2006;Kracht et al, 2010). The periods of 1 and 4 months were chosen for the present analysis in order to include the rapid initial changes as well as the time span during which most of the improvement occurs according to previous reports (Kracht et al, 2010;Pediatric Eye Disease Investigator Group, 2003;Stewart et al, 2007b). This is a period during which hardly any changes in prescription are necessary, and during which the majority of the patients may be followed without too many drop-outs.…”

Section: Data Analysis Statisticsmentioning

confidence: 99%

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

et al. 2014

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The notion of a limited, early period of plasticity of the visual system has been challenged by more recent research demonstrating functional enhancement even into adulthood. In amblyopia ("lazy eye") it is still unclear to what extent the reduced effect of treatment after early childhood is due to declining plasticity or lower compliance with prescribed patching. The aim of this study was to determine the dose-response relationship and treatment efficiency from acuity gain and electronically recorded patching dose rates, and to infer from these parameters on a facet of age dependence of functional plasticity related to occlusion for amblyopia. The Occlusion Dose Monitor was used to record occlusion in 27 participants with previously untreated strabismic and/or anisometropic amblyopia aged between 5.4 and 15.8 (mean 9.2) years during 4months of conventional treatment. Group data showed improvement of acuity throughout the age span, but significantly more in patients younger than 7years despite comparable patching dosages. Treatment efficiency declined with age, with the most pronounced effects before the age of 7years. Thus, electronic recording allowed this first quantitative insight into occlusion treatment spanning the age range from within to beyond the conventional age for patching. Though demonstrating improvement in over 7year old patients, it confirmed the importance of early detection and treatment of amblyopia. Treatment efficiency is presented as a tool extending insight into age-dependent functional plasticity of the visual system, and providing a basis for comparisons of effects of patching vs. emerging alternative treatment approaches for amblyopia.

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“…Follow-up examinations were performed every 4 weeks in the first 4 months, then at the sixth, ninth and twelfth month. The extended time span of 12 months was chosen due to the eccentric fixation of the amblyopic eye and the large age span also including older children [31,36]. Visual acuity test and orthoptic assessment, including measuring the angle of squint (using cover/uncover and alternate cover test with prisms), examining binocular vision and assessing fixation of both eyes were executed on every followup examination.…”

Section: Study Design and Patient Inclusionmentioning

confidence: 99%

Electronically monitored occlusion therapy in amblyopia with eccentric fixation

Mehmed

Fronius

Pohl

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.

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Elektronisch erfasste Okklusionstherapie bei über 7-jährigen Amblyopen: Visusanstieg noch nach mehr als 4 Monaten?

Cited by 11 publications

References 15 publications

Effect of Age on Response to Amblyopia Treatment in Children

Effect of Age on Response to Amblyopia Treatment in Children

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

Electronically monitored occlusion therapy in amblyopia with eccentric fixation

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