Abstract
Abstract: :
Purpose: To identify prognostic factors in the treatment of amblyopia caused by anisometropia in children. Methods:A retrospective chart review of pediatric patients treated for anisometropia at a referral based ophthalmology practice. Inclusion criteria was age less than 18 years old at identification of anisometropia and anisometropia identified a difference of greater than 1.5 D of hyperopia or astigmatism or 3.0 D of myopia between the two eyes. 71 patients were included of which 61 had sufficient follow–up for examination. Of the 61 patients followed, all were treated with glasses. 37 patients were further treated with patching and, of these 37, five were treated with atropine penalization. Results:1. The population was divided into three cohorts based on age at presentation: ··Ages 0 to 4 years: Acuity improved from an average of 20/68 to 20/41, a 2.79 line improvement. 11 of 15 (73.3%) finished with an acuity of 20/40 or better. ··Ages 4 to 7 years: Acuity improved from an average of 20/69 to 20/45, a 2.32 line improvement. 15 of 27 (55.6%) finished with an acuity of 20/40 or better. ··Ages 7+ years: Acuity improved from an average of 20/45 to 20/29, a 1.62 line improvement. 15 of 19 (78.9%) finished with an acuity of 20/40 or better. 2. The population was divided into three cohorts based on type of anisometropia: ··Pure Hyperopic: Acuity improved from an average of 20/60 to 20/34, a 2.58 line improvement. 23 of 32 (71.9%) exhibited an acuity of 20/40 or better at their final visit. ··Pure Myopic: Acuity improved from an average of 20/64 to 20/49, a 1.50 line improvement. 6 of 11 (54.5%) exhibited an acuity of 20/40 or better at their final visit. ··Simple or Compound Astigmatism: Acuity improved from an average of 20/62 to 20/41, a 2.01 line improvement. 12 of 18 (66.7%) exhibited an acuity of 20/40 or better at their final visit. Conclusions:1. Based on age, there appears to be no statistical significant difference in degree of improvement between the youngest (ages 0 to 4 years) and middle (4 to 7 years) cohorts. The oldest cohort showed the least improvement, but had the best baseline acuity of all groups. 2. Based on refractive error, the purely hyperopic anisometrope group showed the greatest level of improvement and this was significant to a level of P<0.2. The hyperopes also demonstrated the highest percentage of patients achieving 20/40 or better vision. This indicates that there is a greater benefit to be achieved from aggressively identifying and treating children with anisometropia due to large amounts of hyperopic differences.
Keywords: amblyopia • refraction