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Susan A. Cotter, Jonathan M. Holmes, Nicole Foster, Michele Melia, Pediatric Eye Disease Investigator Group; Optical Treatment of Strabismic and Combined Strabismic-Anisometropic Amblyopia. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6338.
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To determine the visual acuity improvement in children with strabismic and combined strabismic-anisometropic (combined-mechanism) amblyopia treated with optical correction alone and to explore factors associated with improvement.
In a prospective multi-center cohort study, 146 children 3 to <7 years old with previously untreated strabismic amblyopia (N=52) or combined-mechanism amblyopia (N=94) were provided with optical treatment in the form of spectacles. The spectacles were worn for the first time at the baseline visit, at which time visual acuity was measured using the Amblyopia Treatment Study HOTV visual acuity protocol; visual acuity was reassessed every 9 weeks thereafter until no further improvement in visual acuity was found. Ocular alignment was assessed at each visit. The main outcome measure was visual acuity 18 weeks after baseline.
Overall, amblyopic eye visual acuity improved a mean of 2.6 lines (95% CI: 2.3 to 3.0), with 75% of children improving ≥2 lines and 54% improving ≥3 lines. Resolution of amblyopia occurred in 32% (95% CI: 24% to 41%) of the children. The treatment effect was greater for strabismic amblyopia than for combined-mechanism amblyopia (3.2 versus 2.3 lines, adjusted P = 0.003). Visual acuity improved regardless of whether eye alignment improved.
Optical treatment alone of strabismic and combined-mechanism amblyopia results in clinically meaningful improvement in amblyopic eye visual acuity for most 3 to < 7-year-old children, resolving in approximately one third without the need for additional treatment. Consideration should be given to prescribing refractive correction as the sole initial treatment for children with strabismic or combined-mechanism amblyopia.
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