Interventions for unilateral refractive amblyopia

Shotton, Kate; Powell, Christine; Voros, Gerasimos M.; Hatt, Sarah R.

doi:10.1002/14651858.cd005137.pub2

Cited by 25 publications

(12 citation statements)

References 22 publications

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“…36 Although there is no treatment for FH, early intervention for deprivational or strabismic amblyopia detected with patching, cycloplegics, and correcting refractive errors would optimize the child’s vision potential, because these interventions have been shown to improve outcomes. 37-39 Thus, early identification of birth-related FH may offer the opportunity to identify potentially modifiable disease that could affect the child's vision potential.…”

Section: Discussionmentioning

confidence: 99%

Retinal and Optic Nerve Hemorrhages in the Newborn Infant

et al. 2016

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Purpose To report the birth prevalence, risk factors, characteristics and location of fundus hemorrhages (FH) of the retina and optic nerve present in newborns at birth. Design Prospective cohort study at Stanford University School of Medicine. Participants All infants who were 37 weeks postmenstrual age or older and were deemed stable by their pediatrician were eligible for screening. Infants who were anophthalmic or had known or suspected infectious conjunctivitis were excluded. Methods Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013 through July 25, 2014 were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test (NEST) study. Maternal, obstetric, and neonatal factors were obtained by reviewing hospital records prior to discharge. The location, retinal layer, and laterality of FH were recorded by one pediatric vitreoretinal specialist. Main Outcome Measures Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics and adverse events. Results The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant. Conclusions Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

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Section: Discussionmentioning

confidence: 99%

Retinal and Optic Nerve Hemorrhages in the Newborn Infant

et al. 2016

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“…Le Cat (1713, reviewed in Ciuffreda et al, 1991) is credited with providing the first accurate description of amblyopia, and anisometropic amblyopia has been identified clinically since 1743 when George Louis Leclerc, Count de Buffon, proposed a treatment for this condition which is as relevant now as it was when it was first proposed: refractive correction and occlusion of the better eye. Anisometropic amblyopia continues to be treated by refractive correction alone or in combination with patching or other therapies that differentially stimulate the two eyes (Ciuffreda et al, 1991; Simons, 2005; Shotton et al, 2008; Taylor, 2012). …”

Section: Introduction and Rationalementioning

confidence: 99%

The relationship between anisometropia and amblyopia

Barrett

Bradley

Candy

2013

Progress in Retinal and Eye Research

143

121

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This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child’s first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after amblyopia secondary to either deprivation or strabismus has emerged, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of ‘pure’ anisometropic amblyopia. Although indirect, the therapeutic impact of refractive correction on anisometropic amblyopia provides strong support for the hypothesis that the anisometropia caused the amblyopia. Direct evidence for the aetiology of anisometropic amblyopia will require longitudinal tracking of at-risk infants, which poses numerous methodological challenges. However, if we are to prevent this condition, we must understand the factors that cause it to develop.

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“…32 The authors of the first review suggested that occlusion in combination with refractive correction is more effective in the treatment of strabismic amblyopia than refractive correction alone. 31 However, due to a lack of data, the effect of age was not reported in this systematic review.…”

Section: Other Reviewsmentioning

confidence: 99%

“…The second Cochrane review concluded that it is unclear whether refractive correction and/or occlusion is more effective for the treatment of refractive amblyopia. 32 In addition, the authors suggested that these uncertainties may be based on the fact that factors like age are not fully understood.…”

Section: Other Reviewsmentioning

confidence: 99%