The accuracy of binocular fixation preference for the diagnosis of strabismic amblyopia

Procianoy, Letícia; Procianoy, Edson

doi:10.1016/j.jaapos.2010.01.008

Cited by 18 publications

(11 citation statements)

References 14 publications

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“…In contrast, our clinical environment had a high prevalence of strabismic amblyopia. A more recent study 7 reported better sensitivity of fixation preference in strabismic children (73% for deviations ≥10 Δ and 90% for deviations <10 Δ , with corresponding specificities of 78% and 65%). Moreover, fixation preference is still currently accepted as the mainstay of clinical diagnosis of amblyopia for children <3 years of age.…”

Section: Discussionmentioning

confidence: 89%

The clinical profile of amblyopia in children younger than 3 years of age

Birch

Holmes

2010

Journal of American Association for Pediatric Ophthalmology and

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Purpose Amblyopia in children ≥3 years has been well described, but less is known about amblyopia in children <3 years old. Here we describe the clinical characteristics of a large cohort of children with amblyopia <3 years of age and compare them with a previously described PEDIG amblyopic cohort aged 3 to 6 years. Methods 250 consecutive children with amblyopia <3 years were referred by 16 pediatric ophthalmologists. Results The mean age at the initial diagnosis of amblyopia was 1.2 ± 0.7 years. The cause of amblyopia was strabismus in 82%, anisometropia in 5%, and combined mechanism in 13%. Compared to the 3- to 6-year-old cohort, the proportion of amblyopia attributable to strabismus was significantly higher (p < 0.001), while both anisometropia and combined mechanism amblyopia were significantly less common (p < 0.001). Overall, 61% of amblyopia was diagnosed at the same visit in which strabismus and/or anisometropia was initially diagnosed; an additional 21% of amblyopia was diagnosed at the first follow-up visit 1–3 months later. Compared to the 3- to 6-year-old cohort, amblyopic eye refractive error was significantly lower. Conclusions Strabismic amblyopia was diagnosed much more commonly than anisometropic and combined-mechanism amblyopia in children <3 years. Anisometropic amblyopia may be difficult to detect in children <3 years, and/or strabismic amblyopia may be over-diagnosed by fixation preference. Alternatively, anisometropia may develop more commonly after 3 years of age or may require greater duration to cause amblyopia.

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Section: Discussionmentioning

confidence: 89%

The clinical profile of amblyopia in children younger than 3 years of age

Birch

Holmes

2010

Journal of American Association for Pediatric Ophthalmology and

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“…Data collected from clinical cohorts support much higher sensitivity and specificity for detection amblyopia by fixation preference in cohorts of children with strabismus (sensitivity 73%–93%; specificity 78%–97%). (Birch and Holmes, 2010; Kothari et al, 2009; Procianoy and Procianoy, 2010; Sener et al, 2002; Wright et al, 1986) As noted in Section 1.2, 95% of amblyopic children <3 years old have strabismus,(Birch and Holmes, 2010) so we anticipate high sensitivity and specificity of fixation preference in this age range where visual acuity cannot be tested with standard optotypes. Whether small changes in fixation preference can be used to track treatment response remains an open question.…”

Section: Future Directionsmentioning

confidence: 97%

Amblyopia and binocular vision

Birch

2013

Progress in Retinal and Eye Research

399

400

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Amblyopia is the most common cause of monocular visual loss in children, affecting 1.3% to 3.6% of children. Current treatments are effective in reducing the visual acuity deficit but many amblyopic individuals are left with residual visual acuity deficits, ocular motor abnormalities, deficient fine motor skills, and risk for recurrent amblyopia. Using a combination of psychophysical, electrophysiological, imaging, risk factor analysis, and fine motor skill assessment, the primary role of binocular dysfunction in the genesis of amblyopia and the constellation of visual and motor deficits that accompany the visual acuity deficit has been identified. These findings motivated us to evaluate a new, binocular approach to amblyopia treatment with the goals of reducing or eliminating residual and recurrent amblyopia and of improving the deficient ocular motor function and fine motor skills that accompany amblyopia.

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“…2,3 Fixation preference does have reasonable positive and negative predictive value in clinical cohorts with strabismus. 4,5 Furthermore, fixation preference provides only a dichotomous outcome of amblyopic or nonamblyopic and does not provide a quantitative measure of severity of amblyopia for guiding treatment decisions or monitoring response to treatment.…”

mentioning

confidence: 99%