Abstract
Purpose :
There is limited evidence describing the effects of amblyopia treatment in eyes with coexisting optic nerve pathology (ONP). The purpose of the study was to evaluate the visual acuity outcomes following patching treatment of eyes with coexisting ONP.
Methods :
Retrospective cohort study undertaken at a single university outpatient clinic setting. Clinical records of pediatric patients with a diagnosis of amblyopia coexisting with ONP were reviewed. Baseline presenting visual acuity (B-VA) and final best corrected visual acuity (F-VA) were recorded using Snellen eye charts and converted to their corresponding logMAR values. Primary outcome was the F-VA attained with ≥1 year patching and refractive correction. Secondary outcome was the prevalence of eyes with F-VA ≥20/40. F-VA was categorized into four groups. Difference between F-VA and B-VA was calculated for each eye (Diff-VA). Wilcoxon signed rank sum test was conducted to evaluate Diff-VA for all subjects that had B-VA and F-VA as measured with Snellen chart. Spearman correlation analysis was conducted to analyze the association between B-VA and F-VA.
Results :
The clinical records of 7 eyes of seven patients with a mean baseline age of 6.8±2.6 years (range: 4-10 years) who had ONP, had patching treatment and had Snellen VA tests recorded were included in this study. Optic nerve hypoplasia, optic nerve atrophy, myelinated nerve fibers, and traumatic optic neuropathy were the various etiologies of ONP included. The mean B-VA and F-VA in logMAR were calculated as 0.976±0.509 and 0.723±0.188, respectively. A final Snellen VA of <20/200 was attained in 0%, 20/200–20/60 in 85.7%, and 20/60–20/40 in 14.3% of the eyes. None of the eyes that received amblyopia treatment achieved a F-VA≥ 20/40. The mean Diff-VA for the 7 eyes that had visual acuity measurements available for analysis was -0.252 ± 0.377 (p=0.156). F-VA was not found to be associated with B-VA (rho=0.593; p=0.161).
Conclusions :
Our results suggest that regardless of the underlying pathology, final visual function in amblyopic eyes with coexisting ONP remains between 20/200 and 20/40. Baseline visual function does not appear to be predictive of final visual outcomes in these eyes. Although patching treatment may result in modest increase in visual function, childhood onset ONP appears to confer a poor prognosis for visual function.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.