Abstract
Purpose :
To determine the influence of accommodation and bifocal wearing in the efficacy of atropine treatment of hyperopic anisometropic amblyopia
Methods :
Thirty-five children aged 4 to 8 years old with moderate to mild hyperopic anisometropic amblyopia (visual acuity in the amblyopic eye 0.6 logMAR or better) were assigned to treatment with atropine in the sound eye only (n= 19) or atropine in the sound eye plus bifocal in the amblyopic eye (n= 16). Accommodation was measured using dynamic retinoscopy and WAM5500 before starting treatment. Visual acuity, eye alignment, stereoacuity, and contrast sensitivity were determined before and after 6 months of treatment. Main outcome measure was lines of improvement in visual acuity of the amblyopic eye. Secondary outcome measures were change in stereoacuity and contrast sensitivity. Statistical methods included unpaired t test and multiple regression analysis of potential predictors.
Results :
Symmetrical accommodation was identified in 11 children, whereas accomodation was altered in the amblyopic eye of 24 children (anti-accommodation in 3). Dynamic retinoscopy was unable to detect accomodative impairment in 7 of 24 children (anti-accommodation found in 1). Accommodative gain was significantly better (p<0.01) in the sound eye (0.8 ± 0.1) than in the amblyopic eye (0.48 ± 0.29). Improvement in visual acuity of the amblyopic eye was significantly better (p=0.04) in the atropine plus bifocal (3.3 ± 0.9 logMAR lines) than in the atropine only group (2.6 ± 0.8 logMAR lines). Improvement in stereoacuity was not significantly different in the two groups (p= 0.3) and difference in contrast sensitivity change was in the limit of significance (p= 0.05). Significant predictors of improvement in visual acuity of the amblyopic eye were age (p=0.02), difference in lines of visual acuity (p<0.01) and spherical equivalent (p=0.01) between the two eyes, accommodative gain (p=0.04) and bifocal wearing of the amblyopic eye (p= 0.03).
Conclusions :
Bifocal wearing in the amblyopic eye may be advantageous for the treatment of hyperopic anisometropic amblyopia with atropine, but longer follow-up and larger sample size may be required for a definitive conclusion
This is a 2020 ARVO Annual Meeting abstract.