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Jasrajbir S. Baath, Michael D. O'Connor, WB Jackson; Can Refractive Surgery Treat Amblyopia In Adults?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5780.
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1. To compare pre-operative versus post-operative best spectacle-corrected visual acuity (BSCVA) in amblyopic adults undergoing refractive surgery. 2. To identify pre-operative and post-operative refractive findings that might explain any improvements in visual acuity.
A retrospective chart review identified 22 patients with a possible diagnosis of amblyopia who had been treated by our refractive surgery service. From these patients, we identified eyes in which a diagnosis of amblyopia was specifically noted in the chart or which met strict selection criteria for a diagnosis of amblyopia. Based on these criteria, we identified 11 eyes of 11 patients with amblyopia. Pre- and post-refractive surgery data including demographics, clinical examinations, and refractive surgery data (including Wavescan) were collected and analyzed.
The BSCVA of amblyopic eyes improved significantly following refractive surgery (from a mean logmar value of 0.18 (SD 0.05) to 0.06 (SD 0.07), p<0.05). Pre-operative refractive error was higher in amblyopic eyes compared to fellow non-amblyopic eyes (p>0.05). Of the 11 patients, 9 also had refractive surgery in their fellow non-amblyopic eye, and there was no statistically significant difference in the pre- and post-refractive surgery BSCVA in these eyes. Baseline higher order aberrations were not different between amblyopic and non-amblyopic eyes. Simliarly, there was no significant difference between amblyopic and non-amblyopic eyes in the change in higher order aberrations after refractive surgery (including total higher order aberrations, spherical aberration, coma, and trefoil).
Unexpectedly, refractive surgery significantly improved best spectacle-corrected visual acuity in adult amblyopic eyes in our series. The improvement could not be explained by changes in higher order aberrations. Instead, these findings suggest that improved image quality in amblyopic eyes after refractive surgery may stimulate changes in visual processing, resulting in refractive ‘amblyopia therapy’. This is consistent with recent literature demonstrating the effectiveness of amblyopia therapy in adults. Change in image size post-operatively could not be excluded as a factor in the BSCVA improvement but is unlikely to play a large role given the lack of high ammetropes in our study.
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