Refractive features and amblyopia in Duane's Retraction Syndrome: A review of the 582 patients / Características refractivas y ambliopía en el síndrome de retracción de Duane: una revisión de los 582 pacientes

Purpose: To report the visual and refractive characteristics and the prevalence of amblyopia in patients with different types of Duane's Retraction Syndrome (DRS). Method: This retrospective study was performed on hospital records of 582 DRS patients at Farabi Hospital, Iran, from 2012 to March 2022. Results: The mean age of patients was 19.4 ± 11.9 (range, 3–70) years [335 (57.6 %) females and 247 (42.4 %) males (P < .001)]. DRS type I, II, III, and IV were presented in 347 (59.6 %), 148 (25.4 %), 82 (14.1 %), and 5 (0.9 %) patients, respectively. There were 530 (91.1 %) patients with unilateral and 52 (8.9 %) with bilateral involvement. In the unilateral patients, the DRS eyes' corrected distance visual acuity (CDVA) and astigmatism were significantly worse than the Non-DRS Eyes (P < .001). The mean amount of all refractive and visual parameters in bilateral patients' right or left eyes was significantly lower than in unilateral patients' non-DRS eyes (all P < .05). Anisometropia was observed in 75(12.9 %) of the patients. Amblyopia was observed in 18.5 % (98 patients) and 36.5 % (19 patients) of unilateral and bilateral DRS patients, respectively (P < .001). In unilateral patients, amblyopia was found in 57 (16.4 %) patients with Type I, 22 (14.9 %) patients with Type II, 16 (19.5 %) patients with Type III, and 3 (60 %) patients with Type IV. Forty-four (37.6 %) of patients with amblyopia had anisometropia. Conclusion: This large-scale study indicates that DRS types differ in terms of refractive error, visual acuity, and the prevalence of amblyopia and anisometropia. Clinicians should be aware of the clinical features associated with different types of DRS.(AU)

[Ophthalmic disqualification from the military services: Multicentric cross-sectional study]. / Inaptitude ophtalmologique dans les armées : étude épidémiologique multicentrique.

PURPOSE: This article aims to describe the causes of ophthalmological disqualification from the military services detected during specialist consultations conducted at Army Training Hospitals. METHODS: This observational, cross-sectional, multicenter study retrospectively included individuals deemed as "unfit for military service" due to eye diseases identified during the specialist consultation conducted at 3 ATHs between January 2020 and December 2021. The data collected included age, medical and surgical history, reasons for ophthalmological disqualification, uncorrected distance visual acuity, best corrected distance visual acuity and cycloplegic refraction. RESULTS: Over this period, 133 subjects (98 men and 35 women) were included. Thirty-eight candidates (28.6%) were declared unfit due to a refractive error beyond the required limits, including 30 myopic subjects in excess of -10 diopters (D) and 8 hypermetropic subjects over +8 D. Twenty-five candidates (18.8%) were unfit under the age of 21 years due to corneal refractive surgery performed before the required age. Four subjects (3.0%) were unfit due to phakic intraocular lenses. Degenerative conditions were observed in 23 subjects (17.3%), including 21 patients with severe keratoconus. Other causes of incapacity were linked to oculo-orbital trauma in 11 subjects (8.3%), moderate or severe amblyopia in 7 patients (5.3%), congenital causes in 7 subjects (5.3%), inflammatory or infectious diseases in 7 candidates (5.3%), hereditary causes in 6 subjects (4.5%) and undetermined visual dysfunctions in 4 subjects (3.0%). CONCLUSION: The three main causes of ophthalmological disqualification were high ametropia, refractive surgery performed before the required age and keratoconus.

Sensory exotropia versus sensory esotropia: A comparative clinical features study.

PURPOSE: This study aimed to compare the preoperative clinical features of patients with sensory esotropia (ET) and sensory exotropia (XT). METHODS: In a retrospective study, the medical records of 13,252 patients who underwent strabismus surgery were reviewed at the Farabi Eye Hospital, Iran, from 2012 to March 2022. There were 1017 patients with sensory horizontal strabismus whose, in their worse eye, had corrected distance visual acuity (CDVA) equal to or <20/160 tested with the Snellen chart. RESULTS: The mean age of patients was 29.0 ± 12.4 years [574 (56.4%) males and 443 (43.6%) females]. Sensory XT and ET were observed in 717 (70.5%) and 300 (29.5%) patients, respectively (P<.001). The mean CDVA in the strabismic and non-strabismic eyes was 1.40 ± 0.75 and 0.05 ± 0.13, respectively (P<.001). Also, the CDVA in the strabismic eyes was significantly worse in the patients with sensory XT than in the patients with sensory ET (P<.001). Sphere and spherical equivalent (SE) components were more hyperopic in both eyes of patients with sensory ET than sensory XT (P<.001). In sensory ET group, the mean horizontal deviation at far and near was significantly higher than the sensory XT group (both P<.001). The prevalence of moderate and severe amblyopia among all patients with sensory strabismus was 274 (26.9%) and 727 (71.5%), respectively (P<.001). There were 398 (39.1%) patients who needed more than one surgery. CONCLUSION: The frequency of sensory XT was about 2.5 times more than the sensory ET. Most patients with sensory ET were operated at a younger age, had better CDVA, more hyperopic spherical and SE, and higher angle of deviation compared with patients with sensory XT. The chance of reoperation in patients with sensory strabismus was about 40%.

Efficacy of Amblyopia Treatments in Children Up to Seven Years Old: A Systematic Review.

Amblyopia is a neurodevelopmental disorder of the visual system that impairs the vision of millions of children worldwide. Amblyopia is best treated within the sensitive period of visual development when a child is up to seven years of age. Currently, the gold standard for early treatment of childhood amblyopia is patching, with new treatments emerging in recent years. We aim to evaluate the effectiveness of these newly developed treatments for amblyopia in children aged seven years and younger while comparing them to the current industry standard of patching. We searched online databases including PubMed, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and narrative reviews relating to amblyopia treatment in children aged seven and younger. We only included articles and studies completed within the last five years and those written in the English language. After compiling a list of 297 articles, we removed duplicates, articles without an available full text, and those not relevant to our topic. Of the remaining 51 articles, we were left with 22 after reading abstracts and removing further irrelevant articles. We did a quality assessment on the remaining 22 articles and were left with 14 articles for our systematic review after removing eight low-quality articles. Of the 14 articles, we had eight RCTs, two systematic reviews, one comparative interventional study, and three narrative reviews. Seven of the articles contained data reinforcing the effectiveness of patching while comparing it to other treatment modalities. Three of the articles had data supporting spectacle correction, including a novel form called alternative flicker glass which delivers occlusion therapy via a spectacle frame with unique lenses, and ultimately deemed it at least as effective or more than patching. Data from three articles supported the use of surgery to successfully correct the angle of strabismus. Findings from five articles backed the use of pharmacologic therapy, specifically atropine when used alongside patching as a more effective alternative to patching solely. However, levodopa plus patching had no advantage over patching alone. Additionally, seven articles addressed the use of virtual reality (VR) and dichoptic therapy as prospective treatments for childhood amblyopia. VR therapy proved beneficial when used within one week after strabismus surgery. Dichoptic training was also effective in improving amblyopic-eye visual acuity when used on its own or in conjunction with spectacles. Furthermore, dichoptic movie therapy was found to be more effective than patching. Thus, we found multiple highly effective treatments for childhood amblyopia that are as effective or more than patching. Future studies should consider prescribing these treatments to larger cohorts while also performing a cost-benefit analysis for each treatment. In addition, more needs to be learned about the potential adverse side effects of these treatments, especially for pharmaceutical therapy.

Effects of environmental enrichment on GLUT expression in the visual cortex of amblyopic rats.

OBJECTIVE: To investigate the potential changes of glucose metabolism and glucose transporter protein (GLUT) in the visual cortex of formally deprived amblyopic rats, as well as the effects of enriched environments on the levels of nerve conduction and glucose metabolism in the visual cortex of amblyopic rats. METHODS: 36 rats were randomly divided into three groups: CON + SE (n = 12), MD + SE (n = 12) and MD + EE (n = 12). The right eyelids of both MD + SE and MD + EE groups were sutured. After successful modelling, the MD + EE group was maintained in an enriched environment, and the other two groups were kept in the same environment. Pattern visual evoked potentials (PVEP) was used to confirm models' effect, glucose metabolism was analyzed by Micro-PET/CT (18F-FDG), and the protein as well as mRNA expression levels of GLUT were detected by Western Blot and quantitative RT-PCR (quantitative Reverse Transcription-Polymerase Chain Reaction) analyses, site of GLUT expression by immunofluorescence (IF). RESULTS: After suture modelling, both the MD + EE and MD + SE groups objective visual nerve conduction function decreased, the glucose metabolism in the visual cortex was markedly lower. After the enriched environment intervention, it recovered in the MD + EE group. The expression levels of GLUT1 and GLUT3 were increased in the MD + EE group in comparison with the MD + SE group. GLUT1 was primarily expressed on astrocytes and endothelial cells, but GLUT3 was mainly expressed on neurons. CONCLUSION: Enrichment of the environment exhibited a therapeutic effect on amblyopia, which could be related to the enhancement of glucose metabolism and GLUT expression in the visual cortex.

Rehabilitation of amblyopia using a digital platform for visual training combined with patching in children: a prospective study.

PURPOSE: To assess the possible benefits of the use of perceptual learning and dichoptic therapy combined with patching in children with amblyopia over the use of only patching. METHODS: Quasi-experimental multicentric study including 52 amblyopic children. Patients who improved their visual acuity (VA) by combining spectacles and patching were included in patching group (PG: 20 subjects), whereas those that did not improved with patching performed visual training (perceptual learning + dichoptic therapy) combined with patching, being assigned to the visual treatment group (VT: 32 subjects). Changes in VA, contrast sensitivity (CS), and stereopsis were monitored during a 6-month follow-up in each group. RESULTS: Significant improvements in VA were found in both groups at 1 month (p < 0.01). The total improvement of VA was 0.18 ± 0.16 and 0.31 ± 0.35 logMAR in PG and VT groups, respectively (p = 0.317). The Wilcoxon effect size was slightly higher in VT (0.48 vs. 0.54) at 6 months. An enhancement in CS was observed in the amblyopic eye of the VT group for all spatial frequencies at 1 month (p < 0.001). Likewise, the binocular function score also increased significantly in VT group (p = 0.002). A prediction equation of VA improvement at 1 month in VT group was obtained by multiple linear regression analysis (p < 0.001, R2 = 0.747). CONCLUSIONS: A combined treatment of visual training and patching is effective for obtaining a predictable improvement of VA, CS, and binocularity in patching-resistant amblyopic children.

Clinical profile of amblyopia in a tertiary care facility without proper vision screening in Saudi Arabia.

PURPOSE: To evaluate the clinical profile of amblyopia among patients referred to a tertiary care facility in Saudi Arabia. METHODS: All patients between 1 and 14 years presenting to the amblyopia clinic from 2016 to 2020 were retrospectively reviewed. Amblyopia was defined as visual acuity <0.2 LogMAR (20/30) in the worse eye or two-line difference between the two eyes. We classified patients into strabismic, refractive, mixed strabismic, and refractive and deprivation amblyopia. We subclassified our cohort according to age (< and ≥5 years). RESULTS: Three hundred and eighty-three patients (199 male 54%) were seen in our clinic. Seventeen patients were excluded because they did not meet our inclusion criteria. The mean age at presentation was 5.05 ± 2.49 years. Strabismic amblyopia was found in 180 (49%), refractive in 101 (27.6%), mixed in 69 (19%), and deprivation in 16 (4.2%). Anisometropia in 85.25% and isometropia in 14.75%. Hyperopic astigmatism was the most common refractive error in 246 (67.2%). Esotropia was the most common deviation (90%). Strabismic amblyopia was significantly higher in the <5 years group (62.4% vs. 36.7%). While refractive amblyopia was significantly higher in ≥5 years group (38.8% vs. 15.7%) (P < 0.001). CONCLUSION: Strabismic amblyopia was the most commonly diagnosed in our cohort, especially among patients <5 years of age. Refractive amblyopia was more common in older patients and may be under-detected due to the lack of proper vision screening. The implementation of proper vision screening should help in early detection and successful treatment at an early age.

Comparison of contrast sensitivity among strabismic and anisometropic amblyopes and its association with disease-related parameters.

PURPOSE: To evaluate and contrast the contrast sensitivity defects present in strabismic and anisometropic amblyopes. And to find out the association of contrast deterioration with the visual acuity of the amblyopic eye, the magnitude of strabismus, and the amount of anisometropia in both groups. METHODS: This cross-sectional study was carried out in the orthoptics unit of a tertiary eye care facility between October 2021 and December 2021. There were 45 patients altogether. In the first phase, the patient's history and ocular examination data were recorded after informed consent. The Pelli-Robson chart was used to measure contrast sensitivity. In the second phase, results were interpreted using the SPSS (Statistical Package for the Social Sciences) version 26.0. RESULTS: Strabismic amblyopes were 24 and anisometropic amblyopes were 21. A significant positive association existed between both groups' contrast sensitivity and visual acuity (P = 0.000). A moderately negative correlation between contrast and anisometropia was statistically significant (P = 0.025) in anisometropic amblyopes. However, no association (P > 0.050) existed between the contrast and magnitude of strabismus in any group. CONCLUSION: The study concluded that contrast sensitivity decreases in both groups, whereas anisometropic amblyopes have poorer contrast than strabismic amblyopes. Excessively decreased contrast sensitivity among anisometropic amblyopes was solely because of the worst amblyopia in this group, whereas the magnitude of strabismus does not affect contrast sensitivity.

Design and evaluation of a web-based electronic health record for amblyopia.

Introduction: Amblyopia, or lazy eye, is a type of visual impairment in which the eyesight is not complete, even with the use of glasses. For the treatment of this disease, accurate and continuous examinations are needed. Nowadays, patient-centered care, by relying on web-based electronic records for amblyopia, has the potential to reduce treatment costs, increase the quality of care, and improve the safety and effectiveness of treatment. Therefore, the purpose of this study is to design and evaluate an Electronic Health Record (EHR) for patients with amblyopia. Methods: The present study is applied developmental research. Using a Morgan table as a sampling tool, a straightforward random sampling technique selected 150 records from 1,500 records that were free of flaws. The design of the electronic version proceeded in a cascading manner so that after the design of each part, it was presented to the amblyopia experts, and if approved, the next part was designed. To design this EHR, the C# programming language and MySQL database were used. A system evaluation was performed by entering and recording patient information. For this purpose, the standard Questionnaire of User Interaction Satisfaction (QUIS), consisting of 18 questions, was used. Results: According to the amblyopia EHR data elements, the data of physician and patient, examinations, website members, and members' roles were determined. After defining the fields and classes that explain the tables, the EHR was designed. The usability evaluation of the system showed that the mean selection of very good and good options by the users of EHRs was over 90%, indicating the patients' acceptance of web-based EHRs. Conclusion: The design of an EHR for amblyopia is an effective step toward integrating and improving the information management of these patients. It will also enable the storage and retrieval of patients' information to reduce and facilitate the control of amblyopia complications.

Evaluation of cycloplegic and noncycloplegic performance of spot vision screener in detection of amblyopia risk factors using 2021 AAPOS guidelines.

PURPOSE: This research evaluates the effectiveness of the Spot Vision Screener (SVS) before and after cycloplegia to detect amblyogenic refractive errors in children. METHODS: Children ages 3 to 10 years old were screened by the SVS before and after cycloplegia. Sensitivity, specificity, positive and negative predictive value, paired t-test, Bland-Altman plot and receiver operating characteristic area under the curve were evaluated by comparing the results of the SVS (v3.0.05) measurements with the results of the cycloplegic Topcon autorefractometer according to the 2021 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. RESULTS: Both eyes of 211 patients aged 3 to 10 years old were included. Regarding the amblyopia risk factors, the noncycloplegic SVS had 65.7 % sensitivity, 94.9 % specificity, 81.2 % positive predictive value and 89.3 % negative predictive value. The SVS's sensitivity increased from 65.7 % to 81.9 % with cycloplegia compared to noncycloplegic SVS results. The sensitivity detection of hyperopia was improved from 4.2 % to 100 % after cycloplegia. Areas under the receiver operator characteristic curve for noncycloplegic SVS and cycloplegic SVS were 0.506 (95 % CI, 0.395 to 0.646, p = 0737) and 0.905 (95 % CI, 0.915 to 0.971, p < 0.001) for hyperopia, respectively. Using the +1.64 D revised cutoff criteria for hyperopia increased sensitivity from 4.2 % to 78 %. CONCLUSION: Noncycloplegic SVS measurements showed relatively high specificity in detecting amblyopia risk factors. The fact that noncycloplegic measurements have a very low sensitivity for hyperopia is an important weakness of the SVS, especially because hyperopia is the most frequently encountered refractive error in very young children. It should be noted that amblyogenic hyperopia may be overlooked by an SVS without cycloplegia.

[Bibliometric study and analysis of citation networks of visual screening in primary care]. / Estudio bibliométrico y análisis de redes de citación de los screening visuales en atención primaria.

AIM: Screenings make it possible to detect anomalies that can be treated and identify patients who require referral to a specialist. The objective is to identify the different areas of research and determine the most cited publications on screening in primary care. METHODS: An analysis of publications and visualization of citation networks has been carried out using the Citation Network Explorer software. The bibliographic search was carried out with the Web of Science (WOS) database using the search term: "screening AND (vision OR eye OR ocular OR visual)". RESULTS: We analyzed 16707 publications in all fields, 23919 citation networks have been found. The number of publications has increased, with 2021 being the year with the highest number. The majority are scientific articles and the predominant language is English. The most cited article is a global meta-analysis on the prevalence of glaucoma, showing the importance of screening for its early detection since it is essential to avoid blindness. Using the clustering function we found 8 groups with a significant number of publications where we have bibliography on certain eye diseases: glaucoma, diabetic retinopathy, pediatric amblyopia, keratoconus and dry eye. CONCLUSIONS: The main areas of study in relation to screening are the detection of diseases such as glaucoma, retinopathy of prematurity, keratoconus and dry eye. As well as the detection through visual analysis of childhood amblyopia and vision loss in elderly patients. It also gives importance to performing ocular motility tests in problems of acquired brain damage.

Comparison of photorefraction by Plusoptix A12 and cycloplegic autorefraction in children.

BACKGROUND: Plusoptix photoscreeners are capable of measuring refractive errors of children from 1 meter distance, without cyloplegia. We aimed to compare refractive data obtained from the newest version of Plusoptix (model 12) with cycloplegic autorefraction. METHODS: We examined 111 consecutive children aged 3-7 years first by Plusoptix A12C under manifest condition and subsequently for cycloplegic refraction by Topcon KR-1 tabletop autorefractometer. Sphere, spherical equivalent, cylinder and axis of astigmatism measured by the two methods were analyzed to determine correlation, agreement and differences. RESULTS: Binocular examination of 111 children aged 4.86±1.27 years revealed good agreement between refractive data obtained by Plusoptix and cycloautorefraction, according to Bland-Altman plots. Significant (p < 0.001) and strong correlation was found between all refractive measurements (Pearson's r value of 0.707 for sphere, 0.756 for pherical equivalent, and 0.863 for cylinder). Plusoptix mean sphere, spherical equivalent and cylinder were 1.22, 0.56, and -1.32 D, respectively. Corresponding values for cycloautorefraction were 1.63, 1.00, and -1.26 D. The difference between axis of cylinder measured by the two methods was < 10° in 144 eyes (64.9%). CONCLUSIONS: Considering the significant agreement and correlation between Plusoptix photoscreener and cycloplegic autorefraction, the need for cycloplegic drops in refractive examination of children may be obviated. The mean difference between cylinder measurements are considerably trivial (0.06 D), but sphere is approximately 0.4 D underestimated by Plusoptix compared to cycloautorefraction, on average.

Cost-effectiveness of screening for amblyopia among kindergarten children in China.

Objective: Current cost-effectiveness analyses of amblyopia screening are mainly from western countries. It remains unclear whether it is cost-effective to implement a preschool amblyopia screening programme in China. Our study aimed to evaluate the cost-effectiveness of a hypothetical kindergarten-based amblyopia screening versus non-screening among 3-year-old children. Methods: We developed a decision tree combined with a Markov model to compare the cost and effectiveness of screening versus non-screening for 3-year-old children from a third-party payment perspective. The primary outcomes were quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Costs were obtained from expert opinions in different regions of China. Transition probabilities and health utilities were mainly based on published literature and open sources. Sensitivity analyses were performed to assess the impact of parameters' uncertainty on results. Results: Base-case analysis demonstrated that the ICER of screening versus non-screening was $17,466/QALY, well below the WTP threshold ($38,223/QALY) for China. One-way sensitivity analysis showed that the prevalence of amblyopia, the transition probability per year from untreated amblyopia to healthy, and the discount rate were the top three factors. The likelihood of cost-effectiveness of screening compared with non-screening was 92.56%, according to probabilistic sensitivity analysis. Scenario analysis also indicated that ICER was lower than the WTP threshold even if the time horizon was shortened or the screening was delayed to the age of 4 or 5. Conclusions: Amblyopia screening could be considered a cost-effective strategy compared to non-screening for 3-year-old children in China. Screening for children at the age of 4 or 5 may even yield better results.

Knowledge and Awareness Regarding Amblyopia Among Parents in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Introduction Amblyopia is an abnormal development of usually one eye, leading to permanent decreased vision in the affected eye if not treated early. The condition is primarily caused by strabismus, cataract, anisometropic refractive error, or genetic factors and can manifest from birth to seven years of age, with a worldwide prevalence of 1.75%. This study examines parental knowledge of amblyopia in an effort to improve its early detection and intervention. Improving awareness can have a direct impact by lowering the incidence of untreated amblyopia and its related visual impairment. This study can also help healthcare professionals understand how to communicate with parents about amblyopia more effectively. Materials and methods This cross-sectional study included 417 parent participants from Riyadh, Saudi Arabia, selected through random sampling while ensuring representation from various governorates. The data was collected using an online questionnaire distributed by different social media platforms (Twitter, WhatsApp, and Telegram) to the parents of all governorates, and the sample was selected randomly. It was meticulously cleaned using Excel and analyzed with IBM Statistical Package for the Social Sciences (SPSS) version 29 (IBM Corp., Armonk, NY). Results Our results showed a predominant understanding of amblyopia as "poor vision in one or both eyes" (19.1%) as well as the role of eye movement or brain-eye coordination in the condition. Only 51.3% of parents were aware of lazy eye. Notably, the internet and doctors were the primary sources of information about amblyopia. Only 8.9% of the participants were aware that amblyopia cannot be treated after 10 years of age. Understanding the causes of amblyopia mainly included genetic factors and refractive errors. Sociodemographic factors such as gender, educational level, family history of eye disease, and having a child with a lazy eye significantly influenced the parents' awareness levels of amblyopia. Conclusion Our study underscores the need for targeted educational initiatives to improve the knowledge and awareness of amblyopia among parents in Riyadh, Saudi Arabia. By addressing misconceptions, enhancing access to accurate information, and fostering a deeper understanding of amblyopia and its management, we can work toward ensuring timely diagnosis and appropriate interventions, ultimately reducing the prevalence and impact of amblyopia in the community.

Dichoptic Rescue for Spectacle-Flip Sabotage of Anisometropic Amblyopia Therapy.

Background: To be successful, amblyopia therapeutic techniques must respond when ingenious (shrewd) amblyopic children sabotage treatment effect by discovering ways(1) to alter those therapy aspects they find frustrating. Methods: Her guardian consented to IRB-approved study outside typical FDA enrollment guidelines for CureSight dichoptic therapy. Acuity (EVA) and stereopsis was by PEDIG protocols. Results: A 6-year-old rural Alaska native girl in foster care had previously been diagnosed with anisometropic amblyopia and treated with spectacles and patching but had poor compliance with BCVA 0.9-1.0 logMAR. She demonstrated exceptional creativity and hyperactivity but had no other medical issues. Atropine was prescribed in addition to her spectacles +5.50+1.00x90 and +0.50+1.00x90, but the patient discovered the rare "Spectacle Flip" method that sabotaged therapeutic impact. She had EVA enrollment acuities of logMAR 0.9 right and -0.1 left with stereo 400 seconds of arc. After just one month dichoptic therapy 1.5 hours 6 days per week, acuity improved to logMAR 0.7 and -0.1 with stereo up to 140 second of arc. Four months later acuity was 0.6 right and -0.2 left. Stereoacuity improved from 400 to 200 arc seconds. Conclusion: Even when conventional compliance methods fail, dichoptic therapy with eye-tracking has the novel and unique potential to improve amblyopia treatment compliance with real-time monitored fixation compliance and confirmation of correct spectacle wear. Clinical Trial Registration: NCT06165705.

Dichoptic therapy with eye-tracking improved compliance and achieved de novo acuity and stereo gains in a girl with severe refractory anisometropic amblyopia compounded by the rare complication of topical atropine therapy called "spectacle-flip sabotage".

[The effect of pleoptic treatment on the stability of visual fixation in children and adolescents with amblyopia of various degrees]. / Vliyanie pleopticheskogo lecheniya na stabil'nost' zritel'noi fiksatsii u detei i podrostkov s ambliopiei po dannym mikroperimetrii.

PURPOSE: This study assesses the effect of pleoptic treatment on the stability of visual fixation in children and adolescents with amblyopia of various degrees. MATERIAL AND METHODS: The effect of the treatment in 35 children (35 eyes) with amblyopia of various degrees was evaluated using the MP-1 Microperimeter. The stability was determined by two criteria - number of fixation point hits in the 2° zone and the width of the field of fixation. Children underwent a standard course of treatment. RESULTS: There was an improvement in the stability of visual fixation after treatment. The number of fixation point hits in the 2° zone increased from 44.8±4.1% to 52.6±3.8%. At the same time, the width of the field of fixation after treatment decreased from 6.5±0.7° to 5.2±0.5°. Visual acuity with correction in children with amblyopia correlates with the number of fixation point hits in the 2° zone (direct high correlation "+0.7") and width of the field of fixation (inverse high correlation "-0.7") both before and after the treatment. CONCLUSION: Stabilization of visual fixation was observed in patients with amblyopia of varying degrees after the pleoptic treatment.

Recovery of node of ranvier structure in optic nerve under visual deprivation.

Neural activity can increase the length of nodes of Ranvier (NOR) and slow impulse transmission; however, little is known about the biologically and clinically important recovery process. Sensory deprivation promotes neural plasticity in many phenomena, raising the question of whether recovery of NOR morphology is influenced by sensory deprivation. The results show that NOR gap length recovery in mouse optic nerve was not affected significantly by binocular visual deprivation imposed by maintaining mice in 24 hr dark for 30 days compared to mice recovering under normal visual experience. The findings provide insight into the cellular mechanism of NOR plasticity.

Detection of significant vision conditions in children using QuickSee wavefront autorefractor.

PURPOSE: This study evaluated the ability of QuickSee to detect children at risk for significant vision conditions (significant refractive error [RE], amblyopia and strabismus). METHODS: Non-cycloplegic refraction (using QuickSee without and with +2 dioptre (D) fogging lenses) and unaided binocular near visual acuity (VA) were measured in 4- to 12-year-old children. Eye examination findings (VA, cover testing and cycloplegic retinoscopy) were used to determine the presence of vision conditions. QuickSee performance was summarised by area under the receiver operating characteristic curve (AUC), sensitivity and specificity for various levels of RE. QuickSee referral criteria for each vision condition were chosen to maximise sensitivity at a specificity of approximately 85%-90%. Sensitivity and specificity to detect vision conditions were calculated using multiple criteria. Logistic regression was used to evaluate the benefit of adding near VA (6/12 or worse) for detecting hyperopia. A paired t-test compared QuickSee without and with fogging lenses. RESULTS: The mean age was 8.2 (±2.5) years (n = 174). RE ranged up to 9.25 D myopia, 8 D hyperopia, 5.25 D astigmatism and 3.5 D anisometropia. The testability of the QuickSee was 94.3%. AUC was ≥0.92 (excellent) for each level of RE. For the detection of any RE, sensitivity and specificity were 84.2% and 87.3%, respectively, using modified Orinda criteria and 94.5% and 78.2%, respectively, using the American Academy for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the detection of any significant vision condition, the sensitivity and specificity of QuickSee were 81.1% and 87.9%, respectively, using modified Orinda criteria and 93% and 78.6%, respectively, using AAPOS criteria. There was no significant benefit of adding near VA to QuickSee for the detection of hyperopia ≥+2.00 (p = 0.34). There was no significant difference between QuickSee measurements of hyperopic refractive error with and without fogging lenses (difference = -0.09 D; p = 0.51). CONCLUSIONS: QuickSee had high discriminatory power for detecting children with hyperopia, myopia, astigmatism, anisometropia, any significant refractive error or any significant vision condition.

Correlation of Refractive Error with Anisometropia Development in Early Childhood.

PURPOSE: This study aims to investigate the relationship between the type and severity of refractive error and anisometropia development in preschool children. DESIGN: Retrospective cohort study. METHODS: Data from Maccabi Healthcare Services, Israel's second-largest Health Maintenance Organization (HMO), were analyzed. The study included all isometropic children aged 1-6 years, re-examined for refraction at least two years following their initial examination between 2012 and 2022. Anisometropia was defined as a ≥1 diopter interocular difference in spherical equivalent. Relationships were assessed using logistic regression models adjusted for key sociodemographic factors. RESULTS: Among 33,496 isometropic children (51.2% male, mean age 3.2 ± 1.5 years), the prevalences of emmetropia, myopia, and hyperopia were 26.7% (n=8,944), 4.2% (n=1,397), and 69.1% (n=23,155), respectively. Over a mean follow-up period of 5.1 ± 2.4 years, 2,593 children (7.7%) were diagnosed with anisometropia. Adjusted odds ratios (ORs) for anisometropia gradually increased with baseline refractive error severity, reaching 13.90 (5.32-36.34) in severe myopia and 4.19 (3.42-5.15) in severe hyperopia. This pattern was also evident in cylindrical anisometropia, where ORs increased with greater baseline astigmatism, peaking at 12.10 (9.19-15.92) in children with high astigmatism (≥ 3 D). Associations remained consistent in sensitivity and subgroup analyses including across both genders and when using a stricter anisometropia criterion. CONCLUSION: Children aged 1-6 years, initially without anisometropia but showing increasing severity of myopia, hyperopia, or astigmatism, are more likely to develop anisometropia. This underscores the importance of follow-up refractive measurements within this population to promptly diagnose and treat anisometropia and prevent potential visual complications.