Effect of Amblyopia Treatment on Macular Thickness in Eyes With Myopic Anisometropic Amblyopia.

PURPOSE: To determine whether abnormal macular thickness in myopic anisometropic amblyopia differed after amblyopia treatment. Furthermore, to investigate whether effect of treatment on macular thickness was associated with subject age or improvement in stereoacuity. METHODS: Seventeen children (mean age: 9.0 [±3.0] years, ranging from 5.7-13.9 years) with myopic anisometropic amblyopia (visual acuity [VA] in amblyopic eyes: 20/80-20/400) were recruited and treated with 16-week refractive correction, followed by an additional 16-week refractive correction and patching. Macular thickness, best-corrected VA, and stereoacuity were measured both before and after amblyopia treatment. Factorial repeated-measures analysis of variance was performed to determine whether macular thickness in amblyopic eyes changed after amblyopia treatment. RESULTS: Mean baseline VA in the amblyopic eye was 1.0 ± 0.3 logMAR and improved to 0.7 ± 0.3 after amblyopia treatment (P < 0.0001). The interaction between eye and amblyopia treatment was statistically significant for average foveal thickness (P = 0.040). There was no treatment effect on fellow eyes (P = 0.245); however, the average foveal thickness in the amblyopic eye was significantly reduced after amblyopia treatment (P = 0.049). No statistically significant interactions were found for the other macular thickness parameters (P > 0.05). CONCLUSIONS: Abnormal central macula associated with myopic anisometropic amblyopia tended to be thinner following amblyopia treatment with no significant changes in peripheral macular thickness.

A prospective pilot study of treatment outcomes for amblyopia associated with myopic anisometropia.

OBJECTIVES: To determine the efficacy of refractive correction alone and patching treatment with near activities on amblyopia associated with myopic anisometropia in children aged 4 to less than 14 years. The associations of visual acuity (VA) improvement with age,degree of anisometropia, patching compliance, presence of strabismus, and presence of eccentric fixation were also investigated. METHODS: Seventeen amblyopic children were recruited(range of VA in the amblyopic eye, 20/80 to 20/400). Visual acuity was assessed at 4, 8, 12, and 16 weeks while participants wore spectacles and/or contact lenses for full refractive correction. Patching treatment was initiate dat the 16-week visit. The primary outcome was VA after 16 weeks of refractive correction alone and final VA after 16 weeks of patching. RESULTS: The mean (SD) baseline VA in the amblyopiceye was 0.96 (0.27) logMAR, which improved to a mean(SD) of 0.84 (0.24) logMAR with refractive correction and to a mean (SD) of 0.71 (0.30) logMAR after the addition of patching (P.001). Comparing the final VA with the baseline VA, we found that VA improvement averaged 2.59 lines. The final VA in the amblyopic eye was associated with the baseline VA in the amblyopic eye(P.001), the magnitude of anisometropia (P.001),and the level of patching compliance (P=.04). The improvement in VA with patching was inversely associated with participants' age (P=.03) and presence of eccentric fixation (P=.02). CONCLUSION: Both refractive correction and patching significantly improved the VA of the amblyopic eye associated with myopic anisometropia, with 88% of participants' eyes improving 2 lines or more. Further improvement in VA was observed when patching plus near activities was added to refractive correction and patients were followed for 16 more weeks. We recommend that clinicians treat myopic anisometropic amblyopia with refractive correction and patching plus near activities.

A prospective study of macular thickness in amblyopic children with unilateral high myopia.

PURPOSE: To compare macular thickness of the normal fellow eye to that of the amblyopic eye using optical coherence tomography (OCT) in children with unilateral high myopia. Relationships between macular thickness and magnitude of myopic anisometropia, axial length, and visual acuity (VA) were investigated. METHODS: Thirty-one children with a mean age of 9.56 years were recruited. Macular thickness, axial length, best-corrected VA, and refraction were measured. Paired t-test was performed to compare the macular thickness of the amblyopic eye to that of the fellow eye. Partial correlations were used to test the relationships between interocular difference in macular thickness and anisometropia, axial length, and VA. RESULTS: Average (± SD) LogMAR VA in the amblyopic eye was 0.96 ± 0.31. Mean spherical equivalent in amblyopic eyes was -10.79 ± 3.40 diopters. A statistically significant difference in macular thickness was found between amblyopic and fellow eyes, with amblyopic eyes having greater foveal thickness but reduced inner and outer macular thickness. Only the nasal outer macular thickness had a statistically significant association with the magnitude of anisometropia. CONCLUSIONS: Amblyopic children with unilateral high myopia tend to have a thicker fovea and thinner inner and outer macula in the amblyopic eye compared to the normal fellow eye. The findings indicate that anatomic changes may be present in the retinas of amblyopic children with unilateral high myopia. Future study is warranted to determine whether the mechanism of the macular changes is due to high myopia, amblyopia, or a combination of the two.

Optic nerve heads in pediatric African Americans using retinal tomography.

PURPOSE: To characterize optic nerve head (ONH) parameters including symmetry between the eyes in healthy African American children using the Heidelberg retinal tomograph II, and to determine if there are associations between these parameters and age, refractive error, or gender. METHODS: The ONHs of 146 African American children aged 6 to 17 years without ocular disease were imaged with the Heidelberg retinal tomograph II. Mean values for 11 ONH parameters were determined as was their relationship to age, gender, and refractive error. Interocular symmetry of the parameters was determined. RESULTS: The mean (+/-standard deviation) disc area, rim area, and cup area were 2.18 +/- 0.57 mm2, 1.63 +/- 0.40 mm2, and 0.52 +/- 0.37 mm2, respectively. The mean linear cup-to-disc (C/D) ratio was 0.45 +/- 0.15, and mean cup depth was 0.22 +/- 0.10 mm. The mean retinal nerve fiber layer thickness was 0.26 +/- 0.07 mm. The ONH parameters were not related to age or refractive error. With the exception of the C/D area ratio and linear C/D ratio, which were greater in boys than in girls, ONH parameters were not related to gender. Most parameters were strongly correlated between the right and left eyes. The average interocular differences in disc area, cup area, rim area, linear C/D ratio, and mean retinal nerve fiber layer thickness were 0.09 +/- 0.31 mm2, 0.04 +/- 0.22 mm2, 0.06 +/- 0.40 mm2, 0.02 +/- 0.11, and 0.00 +/- 0.06 mm2, respectively. CONCLUSIONS: ONH parameters were not related to age and refractive error, and only C/D area ratio and linear C/D ratio were greater in boys than girls in a clinical sample of African American children. These measures of normative ONH parameters and range of interocular differences may be helpful in clinical pediatric eye care to facilitate identification of African American children with abnormal optic discs.

Patient literacy levels within an inner-city optometry clinic.

BACKGROUND: This study compares the literacy levels of patients seeking primary optometric care at the Illinois Eye Institute, located in a Chicago inner-city neighborhood, to the literacy demands of available near point cards and patient educational materials. METHODS: The revised large print Slosson Oral Reading Test was administered to 100 primary care patients 10 to 15 minutes after the instillation of mydriatic eye drops. In addition, the Flesch-Kincaid Grade Level was calculated using the Spelling and Grammar component of the Microsoft Word software package 2003 (Microsoft, Redmond, Washington) for available near point testing cards and patient education materials used in this clinic from the American Optometric Association and the National Eye Institute. RESULTS: A total of 37.4% of patients read 1 standard deviation or more below their age-expected levels. A total of 46.5% of patients read at or below an eighth-grade level. The literacy demands of the tested near point cards ranged from 2nd grade to 12th grade. The literacy demands of patient education materials ranged from 7th grade to 12th grade. CONCLUSIONS: About one third to almost one half of the 100 patients in this sample from the Illinois Eye Institute optometry clinic read below their age-expected level. Therefore, near point testing materials and patient education materials may not be written at a suitable reading level to be effective in this population. Clinicians who provide eye care for patients in inner city settings should consider communicating important information using nonwritten methods to those patients with low literacy levels.

Unusual eye movements in a patient with complex partial seizure disorder.

BACKGROUND: A complex partial seizure can cause a variety of visual system signs and symptoms, including visual hallucinations, dilated pupils, and changes in vision. Little information is known about the influence of this disorder on the visual system during nonseizure moments. This case report examines the unusual eye movements-during these nonseizure times-of a patient diagnosed with complex partial seizure disorder. CASE REPORT: An 8-year-old boy was referred to the clinic by his pediatric neurologist for a comprehensive examination to rule out a visual cause for the abnormal eye movements observed by the patient's mother. Ocular examination revealed periodic, spontaneous, versional eye movements to the left and right, accompanied by a small widening of the fissures and turning of the head. No vergence or accommodative problems were detected, but Developmental Eye Movement (DEM) and Visagraph testing showed mild dysfunction. Ocular health was unremarkable, while radiology studies and neurological evaluation yielded no observable pathology. CONCLUSION: Complex partial seizure disorder can affect the visual system in a wide variety of ways. The precise role, if any, that complex partial seizure disorder plays in ocular motility control during nonseizure moments is unknown. The most-plausible etiology of the observed ocular movements in this patient is the presence of a tic disorder. Patients with unknown eye movement disorders deserve a thorough evaluation, including a search for systemic causes.