June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Recovery from Amblyopia in Adulthood: A Meta-Analysis
Author Affiliations & Notes
  • Madison Echavarri-Leet
    Massachusetts Institute of Technology Picower Institute for Learning and Memory, Cambridge, Massachusetts, United States
  • Hannah H Resnick
    Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Daniel Bowen
    Massachusetts Institute of Technology Picower Institute for Learning and Memory, Cambridge, Massachusetts, United States
    Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
  • Deborah Goss
    Howe Library, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Mark F Bear
    Massachusetts Institute of Technology Picower Institute for Learning and Memory, Cambridge, Massachusetts, United States
  • Eric D Gaier
    Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
    Massachusetts Institute of Technology Picower Institute for Learning and Memory, Cambridge, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Madison Echavarri-Leet National Institute of Health (F31 EY033996)), Code F (Financial Support); Hannah Resnick None; Daniel Bowen None; Deborah Goss None; Mark Bear R01-EY029245 , Code F (Financial Support), Luminopia Inc., Code I (Personal Financial Interest); Eric Gaier Stoke Therapeutics Inc. , Code C (Consultant/Contractor), K08 EY030164 , Code F (Financial Support), Luminopia Inc., Code I (Personal Financial Interest), Luminopia, Inc., Code P (Patent)
  • Footnotes
    Support  NIH F31 EY033996-01
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 1454. doi:
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    • Get Citation

      Madison Echavarri-Leet, Hannah H Resnick, Daniel Bowen, Deborah Goss, Mark F Bear, Eric D Gaier; Recovery from Amblyopia in Adulthood: A Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2023;64(8):1454.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Effectiveness of traditional amblyopia therapies is largely restricted to childhood, but recovery in adulthood is known to occur following removal or vision-limiting disease of the fellow eye (FE). Descriptions of this phenomenon are limited to case reports and small series, leaving knowledge gaps related to the incidence and clinical features of amblyopic eye (AE) recovery in adulthood. To address these gaps, we performed a meta-analysis of published cases. Regarding clinical features, we hypothesized that (1) FE retinal ganglion cell (RGC) injury is associated with better AE recovery, (2) strabismus blunts AE gains and (3) AE improvement is directly associated with the degree of FE vision loss.

Methods : A systematic review of 3 literature databases yielded 23 reports containing 109 original descriptions of patients ≥18 years with unilateral amblyopia and FE injury. Two meta-analyses were performed: (1) incidence: 3 case series (42 patients) reporting qualifying patients agnostic to recovery; (2) clinical features of recovery (hypotheses 1-3): 101 patients with any quantifiable AE best-corrected visual acuity (BCVA) improvement.

Results : Incidence: 32/42 (76%) and 29/42 (69%) adult amblyopic patients experienced ≥1 and ≥2 logMAR lines of AEBCVA improvement with FE disease.

Clinical Features: Among those with AE BCVA improvement, median change in AE BCVA was 5.0 (range 0.5–19.2) logMAR lines. Recovery occurred across amblyopia types and FE pathologies, contrary to hypotheses 1 and 2. FE disorders directly affecting FE RGCs demonstrated shorter latencies to AE BCVA recovery by 4 months (p<0.0124). Multivariate regression analysis revealed younger age, worse baseline AE BCVA, and worse nadir FE BCVA (supporting hypothesis 3) were independently associated with the greater gains in AE BCVA (p values<0.006).

Conclusions : The adult brain harbors the neuroplastic capacity necessary for clinically meaningful recovery. AE gains are greater with worse FE BCVA impariment and faster with disorders affecting RGCs. These results support the potential therapeutic utility of temporary retinal inactivation in adults with amblyopia.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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