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Jae-do Kim, Kenneth Ciuffreda; Effective amblyopia treatment using near adds spectacle lenses alone. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3988.
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Eye patching remains one of the primary techniques to improve visual acuity (VA) in the amblyopic eye. At times, however, the patient is resistant/non-compliant due to cosmesis. Thus, other practical solutions are important and warranted. The purpose of the present study was to assess the efficacy of an unequal near add alone, thus causing effective optical penalization of the fellow normal eye for monocular amblyopia, or a binocular add alone for binocular amblyopia, to attain clarity of vision in the amblyopic eye at near, and hence remediate the amblyopia in children.
32 functional amblyopes (19 males, 13 females), aged 33-177 months, participated in the study. Initial corrected VA in the amblyopic eye ranged from 0.1 to 0.5 (decimal notation). They were prescribed an unequal add for all near work. Prescription of the near add was based on near retinoscopy to determine the lag of accommodation in each eye (monocular estimated method, MEM). Near adds were equal to the MEM findings (range +0.75 to +2.50D) in the amblyopic eye; +0.5D less than the MEM value in the fellow normal eyes (range plano to 0.50D); and equal to the MEM value for binocular amblyopia (range +0.25 to +1.50D), all over their full (non-cycloplegic) distance refraction. Prism was added, if need, to correct for the near strabismic deviation. No other therapies or patching were incorporated. Follow-up was over a period of 12 to 54 months at approximately 6 month intervals.
Group mean corrected VA significantly increased by 0.38+/-0.15 to a level of 0.92+/-0.14 (paired t-test, p<0.001). Significant improvement was noted in 30 of the 32 subjects (94%). In those with bilateral amblyopia/isometropia, it increased by 0.37+/-0.16 to a level of 0.93+/-0.11; in unilateral amblyopia, it increased by 0.38+/-0.16 to a level of 0.81+/-0.23; and in strabismic amblyopia, it increased by 0.28+/-0.15 to a level of 0.85+/-0.25 (all p<0.001).
Without eye patching or any other therapy, the use of an unequal near spectacle add alone appeared to be an effective treatment for amblyopia in the children. We speculate that the near add enhanced/biased stimulation of the parvocellular system in the amblyopic eye, with effective optical penalization in the fellow normal eye.
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