Abstract
Purpose: :
To evaluate changes in accommodative accuracy in children with unilateral amblyopia undergoing patching treatment.
Methods: :
Accommodative response was measured in 17 children 3 to 9 years of age with unilateral amblyopia (10 anisometropic, 2 strabismic, 5 mixed). Wearing their optimal refractive correction, subjects viewed a broadband spatial amplitude spectrum cartoon presented on an LCD screen at 2, 3, and 4 diopter stimulus positions while accommodative response was recorded using an automated Nott retinoscopy system. Data were collected at enrollment and at each standard-of-care follow-up visit. Average accommodative response across the three dioptric stimuli for the amblyopic and fellow eyes under monocular viewing conditions was calculated.
Results: :
The mean follow-up was 21 weeks (range 5 to 42). Average amblyopic eye visual acuity (VA) improved with patching treatment from 0.40 logMAR at enrollment (range 1 to 0.2) to 0.21 logMAR (range 0.8 to 0) at the most recent follow-up visit. Mean accommodative lag changed from 1.82 D (SD ± 0.54) to 1.48 D (± 0.57) in the amblyopic eye (p=0.05) and changed from 1.01 D (± 0.44) to 0.78 D (± 0.58) in the fellow eye (p=0.02) under monocular viewing conditions.
Conclusions: :
We previously reported that children with unilateral amblyopia showed clinically significant lags of accommodation in the amblyopic eye under monocular viewing conditions (Wong et al, ARVO, 2011). Children with unilateral amblyopia undergoing patching treatment did not show a clinically significant improvement in accommodative accuracy in their amblyopic eyes after a mean follow-up of 5 months. Although more improvement might be found with additional treatment, suboptimal retinal image quality during patching treatment could potentially impact the efficacy of treatment. Measurement of accommodative response should be considered for children with amblyopia who show minimal improvement in VA with patching treatment, to determine whether they have focused retinal images at near during treatment. If not, these children may benefit from treatment to improve retinal image quality during amblyopia therapy.
Keywords: amblyopia • accommodation