Abstract
Purpose :
Amblyopia is a major cause of visual impairment among children and young adults. Children with developmental delay (DD) may be at higher risk for developing amblyopia. This study investigated the effect of DD on unsuccessful visual outcomes in patients with strabismic/refractive amblyopia, taking into consideration the impact of race, gender, prematurity, and amblyogenic refractive error (RE) on unsuccessful visual outcomes (UVO).
Methods :
This was a retrospective study at a single academic center. The study included subjects <16 years of age diagnosed with amblyopia between 2006 and 2019. Data collected included patient demographics, DD/prematurity status, visual acuity, RE, and best corrected visual acuity (BCVA) as obtained with Snellen optotypes. Inclusion criteria included receiving at least 1 year of amblyopia treatment and being ≥6 years old at the time of final eye exam. Subjects with <12 months of follow-up, lack of BCVA at final visit, or incomplete baseline exam findings were excluded. UVO was defined as having a BCVA of <20/40 in at least one eye. Chi-square test was used for statistical analysis.
Results :
Of the entire study sample (n=550), DD was present in 8.4% and UVO was detected in 24% of subjects. Participants with DD were 62% more likely to have UVO compared to those without DD (Prevalence ratio [PR]: 1.62, 95%CI: 1.07, 2.44). Prematurity was more frequently observed in patients with DD compared to developmentally intact children (19.0% vs. 6.9%, p=0.002). Racial background (p=0.473), gender (p=0.209), amblyogenic RE (p=0.245) and frequency of children who received amblyopia treatment at later age (≥7 years) (p=0.414) were similar between DD and non-DD groups. Children with DD fared much worse compared to their non-DD counterparts when amblyopia treatment was initiated earlier in life (PR: 1.88, 95% CI: 1.22, 2.90) compared to when the treatment was undertaken at an older age (≥7 years) (PR: 0.72, 95% CI: 0.21, 2.49). The association between DD and UVO was not found to be significantly different among children of Black, Hispanic and White racial backgrounds (Breslow-Day test, p=0.729).
Conclusions :
Children with DD appear to be at increased risk for unfavorable visual outcomes compared to developmentally healthy children following amblyopia treatment, independent of their racial backgrounds. This difference in VO appears to disappear among those who are treated at an older age.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.