The impact of COVID-19 on compliance to amblyopia treatment in a tertiary eye care center

Purpose: To investigate the impact of the coronavirus disease 2019 (COVID?19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children. Methods: The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID?19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open?ended questions for 15 min. The questions were related to patients’ compliance toward amblyopia treatment and the date of follow?up with their practitioners. The data collected were entered on Excel sheets in the participant’s own words and later converted to a transcript for analysis. Results: A total of 217 parents of children with amblyopia who were due for follow?up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia. Conclusion: In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow?up with the eye care practitioner.

Clinical evaluation of vision therapy system 4 combined with traditional comprehensive training for ametropic amblyopia / 中华实验眼科杂志

Objective:To assess the effectiveness of Vision Therapy System 4 (VTS4) combined with traditional comprehensive training for ametropic amblyopia.Methods:A non-randomized controlled clinical study was performed.A total of 168 children aged 4-10 years with ametropic amblyopia were enrolled in The First Affiliated Hospital of Zhengzhou University from January 2018 to March 2021.The children were assigned to conventional comprehensive training combined with Vision Therapy System 4 group (conventional+ VTS4 group) and conventional group according to the preference of their guardian.Patients in conventional+ VTS4 group (84 children) received conventional comprehensive training combined VTS4 and patients in conventional group (84 children) were treated with conventional comprehensive training only, and the intervention was continuously used for over a year.Best corrected visual acuity (BCVA) of the patients converted to the logarithm of the minimum angle of resolution (LogMAR) units was examined by international standard visual acuity chart before and after therapy.Spherical equivalent of the patients was detected by optometry under cycloplegic conditions and skiascopy.Binocular and fusion vision was examined with a synoptiscope.The stereopsis was evaluated using Titmus Stereogram.The ocular axial length (AL) and mean keratometry (Km) were measured with the IOLMaster 500.The basic cure rate, BCVA, reconstruction rate of stereopsis, △SE, △AL and △Km following training were compared to evaluate the effectiveness and myopic shift between two groups.The patients in conventional+ VTS4 group were divided into 4-5 years old group and 6-10 years old group, with 42 cases in each group, and the basic cure rate, BCVA, reconstruction rate of stereopsis were compared to evaluate the therapeutic effect between the two groups.The basic cure was defined as acuity improved to ≥0.9, with reduced myopic diopter and stable therapy outcome over 6 months.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Zhengzhou University (No.2021-KY-0891-002). Written informed consent was obtained from guardians prior to any medical examination.Results:The basic cure rate of conventional+ VTS4 group was 58.33%(49/84), which was significantly higher than 40.48%(34/84) of conventional group ( χ2=5.358, P=0.021). The BCVA in the conventional+ VTS4 group was better than that in conventional group, showing a statistically significant difference ( Z=-2.537, P=0.011). The recovery rates of binocular vision, fusion vision and stereo vision were 87.93%(51/58), 78.33%(47/60) and 70.77%(46/65) in conventional+ VTS4 group, which were higher than 65.57%(40/61), 57.81%(37/64) and 52.86%(37/70) in conventional group, respectively, with significant differences between them ( χ2=8.259, 5.968, 4.566; all at P<0.05). No significant difference was found in △SE, △AL, and △Km between conventional group and conventional+ VTS4 group (all at P>0.05). The basic cure rate was 69.05%(29/42) in the children aged 4-5 years group, which was higher than 47.62%(20/42) in 6-10 years group, respectively, showing a significant difference ( χ2=3.967, P=0.046). Both BCVA and the stereo vision recovery rate in the 4-5 years old group were better than those in the 6-10 years old group ( Z=-2.046, P=0.041; χ2=4.624, P=0.032). Conclusions:A combination therapy of VTS4 and conventional comprehensive training can improve the visual acuity and reconstruct the fusion and stereopsis of children with ametropic amblyopia, without causing additional myopic drift.

Clinical evaluation for atropine penalization in treatment of moderate and severe anisometropic amblyopia / 中华实验眼科杂志

Objective@#To evaluate the effect of atropine penalization for treatment of moderate and severe anisometropic amblyopia.@*Methods@#Retrospective cohort study was performed.Eighty moderate and severe anisometropic amblyopia pediatric patients aged 4-7 years old were enrolled from December 2011 to November 2017 in Tianjin Eye Hospital and Beijing Children's Hospital.The subjects were divided into atropine penalization group and patching group according to the treatment, with 25 cases of moderate amblyopia and 15 cases of severe amblyopia in each group.The best corrected visual acuity (BCVA) of amblyopia in atropine penalization group and patching group before treatment, 2 months, 4 months, 6 months and 8 months after treatment were compared.The binocular visual function of each group was compared before and after treatment.The compliance and complications were also recorded.This study adhered to the Declaration of Helsinki, and was approved by the Ethics Committee of Tianjin Eye Hospital (2016-42) and Beijing Children's Hospital (2019-k-33).@*Results@#There were significant differences in BVCA between the two groups before and after treatment in cases with moderate amblyopia (Fgroup=3.104, P=0.032; Ftime=4.342, P=0.013); The BCVA of atropine penalization group was better than that of patching group at 2, 4, 6 and 8 months after treatment, the differences were statistically significant (all at P<0.05). There were significant differences in BCVA between the two groups before and after treatment in cases with severe amblyopia (Fgroup=3.149, P=0.016; Ftime=5.094, P=0.024); The BCVA of atropine penalization group was better than that of patching group at 2, 4, 6 and 8 months after treatment, the differences were statistically significant (all at P<0.05). The effective rates of stereopsis reconstruction in atropine penalization group were significantly higher than those in patching group in both moderate and severe amblyopia cases, and the differences were statistically significant (both at P<0.05). The compliance rate of moderate amblyopia in atropine penalization group was 96% (24/25), which was significantly higher than 76% (19/25) in patching group, the difference was statistically significant (χ2=4.153, P=0.042). The compliance rate of severe amblyopia in atropine penalization group was 100% (15/15), which was also significantly higher than 67% (10/15) in patching group, the difference was statistically significant (χ2=6.000, P=0.014). During the follow-up period, there were 4 cases with photophobia in the atropine penalization group.No adverse reaction was observed in the patching group.@*Conclusions@#Compared with patching, atropine penalization is an effective method in treatment of moderate and severe amblyopia, with the advantage in rapid improvement of visual acuity, stereopsis recovery and compliance of treatment.Atropine penalization is worthy for clinical application.

Treatment of amblyopia emerging from plasticity of the visual cortex and binocular vision / 中华实验眼科杂志

Amblyopia is a developmental visual disorder,which is accompanied by physiological changes in the visual cortex.Many studies that focused on the treatments of amblyopia and improvment of therapeutic effects in teenagers and adults have been paid more and more attention.Recent studies reveal that a threshold level of neurotransmitters,such as γ-aminobutyric acid (GABA),norepinephrine (NE),acetylcholine,5-hydroxytryptamine (5-HT) and dopamine,is required to open the critical period.Meanwhile,the content of specific extracellular matrix,such as extracellular protease tissue plasminogen activator (tPA) and cross-linked chondroitin sulphate proteoglycans (CSPGs),exhibits dynamic changes over the time course of the critical period,which plays a key role in synaptic modifications.Clinical studies show that suppression and deficits in visual attention towards signal from the amblyopia eye may be important factors in physiological mechanism of amblyopia,which support a basis for non-invasive brain stimulation and perceptual learning as new effective treatments.This paper described the recent advances in plasticity of visual cortex and binocular vision in the field of amplyopia treatment,especially in teenagers and adults.

A comparative study on visual acuity and stereopsis outcomes between perceptual learning based on cloud services and conventional therapy for amblyopia / 中华实验眼科杂志

Background Amblyopia is a developmental disorder of spatial vision that results in both monocular and binocular deficits.Conventional therapy for amblyopia which focuses on monocular training can improve visual acuity.However,how to improve the binocular function,especially stereopsis is rarely studied.Objective This study was to evaluate the outcome of perceptual learning based on cloud services of improving stcreopsis and visual acuity for amblyopia.Methods A randomized-controlled clinical study was performed.One hundred and seven amblyopic patients (178 eyes) with the age of 5-18 years old were recruited in The Second Affiliated Hospital of Anhui Medical University from July 2013 to March 2014.The patients were randomized into the perceptual learning group and the conventional therapy group.A perceptual learning based on cloud services with computer under the best corrected visual acuity was carried out in the perceptual learning group with 30-day duration as a course for 5-6 cycles,and training feedback data was obtained after each cycle for the regulation of following treatment.The dominant eye was covered during the training process.In the conventional therapy group,a training regimen of health eye covering that combined with eyesight training of amblyopic eye was performed.The stereopsis and visual acuity of the patients were estimated after training.Written informed consent was obtained from the parents or custodians of the children before entering the cohort.Results The total effective rate of visual acuity improvement is significantly higher in the perceptual learning group than that in the conventional therapy group after training (Z =6.368,P=0.012).The mean stereopsis value of the amblyopic eyes in the perceptual learning group and the conventional therapy group was (127±53) and (174±67) after training,which was significantly higher than (273 ±95) and (311 ±103) before training,respectively,and the increasing range of the mean stereopsis was considerably larger in the perceptual learning group than that in the conventional therapy group(t=12.329,9.557,15.649;all at P＜0.05).In the perceptual learning group,the improving range of mean stereopsis was larger in the severe or moderate amblyopic eyes than that in the mild amblyopic eyes,and the improving range of mean stereopsis in ametropic amblyopia was larger than that in anisometropic amblyopia (all at P ＜ 0.05).Conclusions Both perceptual learning based on cloud services and conventional therapy can improve stereopsis and visual acuity in amblyopic eyes.However,perceptual learning based on cloud services can improve the treating compliance of children.

To enhance the therapeutic efficacy on amblyopia with classical therapies / 眼科

There are many methods adopted in the treatment of amblyopia.Now many accessory therapies are enhanced instead of classical therapies,such as application of some therapeutic instruments for amblyopia,acupuncture and Chinese traditional medicine. We still suggest treating amblyopia with classical therapies:correction of refractive errors,occlusion and penalization.In this way,we may avoid attending to trifles and neglect the essentials,and miss the opportunity of treatment.(Ophthalmol CHN,2006,15:292-293)