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

Abstract

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.

Findings of Anisometropic Amblyopia in Children

“…In earlier randomized trials of patching and pharmacological treatment optimum spectacle correction was required for a minimum of 4 weeks prior to enrollment. [13][14][15][16] The results of the present study suggest that in these previous trials, some of the visual acuity improvement was due to optical treatment of amblyopia with spectacles. Although this would have the effect of reducing the statistical power to detect a treatment group difference, these trials were highly powered and this effect of spectacles therefore should not alter the primary conclusions of those studies.…”

“…When diagnosed and treated early in life, the visual loss may be reversed, which supports the need for early identification and treatment of anisometropia. Visual acuity improvement with refractive correction alone in children with anisometropic amblyopia has been observed in both retrospective and pilot studies (14,15 (16). They have termed this effect "refractive adaptation," but we prefer to refer to it as optical treatment of amblyopia.…”

Ambliyopi ve Tedavisi

“…Bunun nedeni anizometropinin şaşılığa göre ambliyopiye yol açması için daha uzun zaman gerektirmesi olabilir. 8 Otuz yaş üzeri nüfusta ise ambliyopi prevalansı Çin'de %2,8 bulunmuş olup en sık neden anizometropidir. 9 Ülkemizde Güneydoğu Anadolu bölgesinde yapılan bir çalışmada okul çağı çocukları arasında ambliyopi oranı %2,6 olarak bulunmuş ve en sık nedeni…”

Amblyopia and binocular vision

“…(Birch and Holmes, 2010; Pediatric Eye Disease Investigator Group, 2002a) Both studies included children with strabismic, anisometropic, or combined-mechanism amblyopia referred by multiple community- and university-based pediatric ophthalmologists. In the Pediatric Eye Disease Investigator Group (PEDIG) study, we assessed the clinical characteristics of 409 children age 3–6.9 years with moderate amblyopia who were enrolled in a multicenter randomized study of amblyopia treatment.…”