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Eva M. Aring, Marie Fällmar, Anders Sjöström; A Description Of Children With Amblyopia Treatment Failure At An Ordinary Orthoptic-clinic. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6345.
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To describe children with amblyopia treatment failure at an ordinary orthoptic clinic and to review the records six months after the study for BCVA registration.
Thirty three children, 16 girls and 17 boys (mean age 6.8 years) without increase in BCVA though ongoing treatment during at least 6 months, underwent an orthoptic investigation including; BCVA, cycloplegic refraction, binocular functions and cover test. 24 age-matched healthy children served as controls.
All but four had heterotropia. Microtropia, diagnosed with 4PD test, was seen in 18/29. Simultaneous perception with Bagolini was more common than total suppression 21/30 vs. 9/30 (p=0.04). With the Titmus test, 10/31 could see the fly and an additional nine had median stereo acuity of 100". High hyperopia (>4D SE) n=18 and astigmatism (>1,5D) n=8 were more frequently seen in the study group compared to controls 0/24 vs. 0/24 (p= 0.001 and 0.016). Three children had myopia (>0.5D SE) and 10 had anisometropia compared to no one among controls (p=0.26 respectively p=0.0032). Low BCVA (>1.0 log MAR) at treatment start was noted in 9 children and three children had treatment start > 6 years of age. Eight of 33 children had an increase in BCVA 6 months after they had participated in the study and three of these eight had no longer amblyopia (9%).
Small deviations with gross binocularity, high hyperopia, astigmatism, and low initial BCVA are common in children with amblyopia treatment failure at an ordinary orthoptic clinic. In addition, in at least 9% bad compliance may be the cause.
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