Factors influencing occlusion therapy in refractive amblyopia

Introduction: Amblyopia is an of important cause of preventable blindness and early detection with timely rehabilitation can prevent blindness in childhood age. It also carries a higher risk of vision loss in fellow eye. The most common method of treatment to recover the monocular function involves patching the good eye in an effort to reinforce the amblyopic eye to improve. In our study we evaluated the factors affecting occlusion therapy in amblyopia patients in terms of age, gender, amount of refractive error and the time period of occlusion as the influential factor in rehabilitation of amblyopia. Methods: In this observational study, all patients between 3 years to 25 years who attended the ophthalmic OPD at Sri Siddhartha Medical College, a tertiary health care centre for ocular evaluation and diagnosed with amblyopia were included in the study. The patients were evaluated for Visual acuity on Snellens visual acuity chart and then subjected to Refractive error evaluation on Unique RK 800 Autorefractometer. Anterior segment was evaluated on Slit lamp and Fundus examination was done on Direct and indirect ophthalmoscope. Post refraction and Post treatment visual acuity was evaluated for the patients on Snellens visual acuity chart. Results: Total of 42 patients were studied out of which 16 were males and 26 were females. All patients were between 3- 35 years of age, with maximum patients 20 (47. 6%) in the age group of 6 to 15 years. 21 patients (50%) were having a baseline visual acuity in the range of 3 meter finger counting to 6/36. The commonest refractive error was astigmatism 23(54.8%) amongst whom compound myopic astigmatism was commonest in 9 patients (21.4%). In our study the post correction visual acuity improvement was 6/24 to 6/6 which was found in maximum patients 31 (73.8%), which further improved in the post occlusion visual acuity in 35 patients (83.3%) from 6/24 to 6/6. Conclusion: In this study we found myopic astigmatism as the commonest refractive error in anisometropic amblyopias. Though we found a female preponderance, the gender association was not found significant in the visual recovery or the treatment response. A good improvement following occlusion treatment as well as refractive adaptation period

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The effect of PRK on corneal epithelium thickness and pachmetry in treatment of myopia.

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1285 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Furkaan Majied Hamied ◽

Deyaa Neama Kadhim ◽

Sohaib A Mahmood

Keyword(s):

Refractive Error ◽

Anterior Segment ◽

Thickness Change ◽

Corneal Epithelial ◽

Epithelial Thickness ◽

Refractive Outcomes ◽

Epithelium Thickness ◽

Profile Changes ◽

Corneal Epithelial Thickness ◽

Myopic Astigmatism

In order to facilitate the corneal stromal ablation in photorefractive keratectomy the epithelium is removed so corneal repair associated with changes in epithelium and stroma. To study the corneal epithelial thickness and pachymetry profile changes after photorefractive keratectomy (PRK) for myopia. Retrospective analysis of the postoperative corneal epithelial thickness and pachymetry profile changes in 22 eyes of 12 patients treated with PRK for myopia or myopic astigmatism. Corneal and epithelial thickness maps within the central 6 mm were obtained by anterior segment spectral-domain optical coherence tomography (SD-OCT) preoperatively and at 3 months postoperatively. Correlations between pachymetry,epithelial thickness changes and the amount of correction,were analyzed.Compared to preoperative values,the central 2 mm and the paracentral 2 to 5 mm zone epithelium was 1 ± 2.85 and 1 ± 3.11 μm thicker,respectively,at 3 months postoperatively (P <.05). The spherical equivalent (SE) changed from-2.80 ± 2.028 diopters (D) preoperatively to -0.40 ± 0.42 D at 3 months postoperatively. Females show greater postoperative epithelial thickening, 2.6 ± 3.77 μm,than males,0.34 ± 1.98 μm. There was a trend toward greater epithelial thickening with a larger amount of programmed SE correction, and thinner preoperative epithelium. No correlation between epithelial thickness change and postoperative change in refraction was detected.Negative correlation between between age, refractive error,with the pre and post-operative pachymetry. In general female pachymetry reading is higher than it in male.The corneal epithelial thickness increased after PRK up to 3 months postoperatively. It was affected by the amount of myopia treated, gender, and preoperative epithelial thickness. The refractive outcomes did not affected by the postoperative epithelial thickening. Negative correlation between between age, refractive error, with the pre and post-operative pachymetry. In general female pachymetry reading is higher than it in male.

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Efficacy of LASIK and LASEK methods in achieving the predicted result in excimer laser correction of myopia and myopic astigmatism

Archive of Ukrainian Ophthalmology ◽

10.22141/2309-8147.8.3.2020.220450 ◽

2021 ◽

Vol 8 (3) ◽

pp. 19-23

Author(s):

N.G. Zavgorodnia ◽

Yu.Yu. Doroshenko ◽

T.S. Zavgorodnia ◽

I.O. Poplavska ◽

K.O. Kostrovska ◽

...

Keyword(s):

Visual Acuity ◽

Excimer Laser ◽

Anterior Segment ◽

Young Patients ◽

Surgical Techniques ◽

Social Significance ◽

Uncorrected Visual Acuity ◽

Working Age ◽

The Difference ◽

Myopic Astigmatism

Excimer laser correction of refraction anomalies has entered ophthalmological practice as one of the most effective surgical techniques, which allows us to correct refractive errors by changing corneal curvature, including with myopia and myopic astigmatism. Usually, such correction is applied in young patients of working age that acquires special social significance and requires the use of the most accurate and safe technologies, which would guarantee the achievement of a rapid effect with the shortest period of rehabilitation. The results of surgical treatment of 60 patients (103 eyes) with myopia of various degrees and myopic astigmatism were analyzed. Among patients, there were 28 men (41 %) and 32 women (59 %) aged 18 to 47 (mean of 25.0 ± 2.5) years. They were divided into 2 groups. The first group consisted of 29 people (50 eyes) who underwent vision correction by laser-assisted in situ keratomileusis (LASIK). All patients underwent standard ophthalmological examinations (visometry, autorefractometry, biomicroscopy, direct ophthalmoscopy, tonometry, perimetry) and refractive diagnosis, which included corneal topography with pachymetry (Orbscan, Bausch + Lomb Inc., USA), aberrometry (Zywave, Bausch + Lomb Inc., USA), anterior segment optical coherence tomography (Visante OCT, Carl Zeiss Meditec, Germany) and optical biometry by optical biometer IOLMaster (Carl Zeiss Meditec, Germany). The refractive result achievement was assessed on day 1, as well as 1 month, 6 months and 1 year after surgery. All surgeries were performed on an excimer laser Allegretto WaveLight EX500 (Alcon, USA). One month after excimer laser correction by the LASIK method, the expected result of visual acuity was achieved in 46 eyes (80.7 %), and when using the laser epithelial keratomileusis (LASEK) technique — in 31 eyes (58.5 %) that indicates a longer rehabilitation period. Six months later, the predicted visual acuity without correction in the group where surgery was performed by LASEK was achieved in 46 eyes (86.8 %), while in the group operated by LASIK — in 50 eyes, 100 % (the difference is not reliable, p > 0.05). One year after excimer laser correction, uncorrected visual acuity, regardless of the degree of myopia, was 0.92 ± 0.04 U in the first group at maximum visual acuity with correction in these eyes before surgery 0.86 ± 0.05 U (the difference is not significant, p > 0.05) and 0.74 ± 0.10 U in the second group at the maximum indicators of corrected visual acuity before surgery of 0.92 ± 0.03 U (the difference is significant, p < 0.05). A slightly larger difference in the achieved results of maximum uncorrected visual acuity before surgery when performing excimer laser correction by the LASEK method is explained by the development of subepithelial fibroplasia in 3.77 % of cases, which affected the average end result.

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Proportion of Non-Compliance and Factors Affecting It in Children Undergoing Occlusion Therapy for Amblyopia

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2020/589 ◽

2020 ◽

Vol 7 (48) ◽

pp. 2879-2884

Author(s):

Pravitha M. Kumar ◽

Naina Jabeen Hyder ◽

Shaji A ◽

Sunil M.S ◽

Pappa P

Keyword(s):

Visual Acuity ◽

Negative Impact ◽

Visual Outcome ◽

Learning Ability ◽

Final Visual Acuity ◽

Cross Sectional ◽

Factors Affecting ◽

Occlusion Therapy ◽

Study Results

BACKGROUND The term amblyopia literally means dullness of vision. It is defined as unilateral or bilateral reduction of visual acuity due to pattern vision deprivation or abnormal binocular interaction for which no ocular causes can be detected by ocular examination and can be reversed by therapeutic measures. The study was undertaken to estimate the proportion of non-compliance and factors affecting it in children undergoing occlusion therapy for amblyopia. METHODS The study was designed as a hospital based cross sectional study. Children aged 5 - 12 years undergoing occlusion therapy for amblyopia due to strabismus, anisometropia or both, who had been prescribed occlusion for a period of minimum 3 months were included in the study. Children with developmental or neurological disorders and other ocular conditions causing visual impairment, whose parents were not willing to participate in the study or follow up, and uncooperative children were also excluded from the study. RESULTS 52.5 % were non-compliant to occlusion therapy, 31.1 % were partially compliant and only 16.4 % were compliant. 38.5 % had final visual acuity in the range of 6 / 60 - 6 / 24 and 6 / 18 – 6 / 12, 20 % had 6 / 9 - 6 / 6. Different variables were assessed against compliance to check for any association. Significant association was found between compliance to occlusion and socioeconomic status (p = .006), visual acuity at presentation (p = .026), type of amblyopia (p = .038) and final visual acuity (p < .01) and association with educational status were found to be borderline (p = .059). CONCLUSIONS Occlusion therapy for amblyopia is a long drawn process which needs strict compliance and regular follow up. Compliance is a major factor affecting final visual outcome. Poor compliance leads to unsuccessful amblyopia therapy which in turn can have negative impact on child’s learning ability and psychosocial wellbeing. For this reason it is critical that care givers leave the clinic with clear knowledge of how and why patching is being recommended and its importance in improving child’s vision. KEYWORDS Amblyopia, Occlusion, Compliance

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Prevalence and causes of blindness and vision impairment: magnitude, temporal trends and projections in South and Central Asia

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312292 ◽

2018 ◽

Vol 103 (7) ◽

pp. 871-877 ◽

Cited By ~ 11

Author(s):

Vinay Nangia ◽

Jost B Jonas ◽

Ronnie George ◽

Vijaya Lingam ◽

Leon Ellwein ◽

...

Keyword(s):

Visual Acuity ◽

Macular Degeneration ◽

South Asia ◽

Refractive Error ◽

Vision Loss ◽

Temporal Trends ◽

Vision Impairment ◽

Age Related Macular Degeneration ◽

Uncertainty Interval ◽

Age Related

BackgroundTo assess prevalence and causes of vision loss in Central and South Asia.MethodsA systematic review of medical literature assessed the prevalence of blindness (presenting visual acuity<3/60 in the better eye), moderate and severe vision impairment (MSVI; presenting visual acuity <6/18 but ≥3/60) and mild vision impairment (MVI; presenting visual acuity <6/12 and ≥6/18) in Central and South Asia for 1990, 2010, 2015 and 2020.ResultsIn Central and South Asia combined, age-standardised prevalences of blindness, MSVI and MVI in 2015 were for men and women aged 50+years, 3.72% (80% uncertainty interval (UI): 1.39–6.75) and 4.00% (80% UI: 1.41–7.39), 16.33% (80% UI: 8.55–25.47) and 17.65% (80% UI: 9.00–27.62), 11.70% (80% UI: 4.70–20.32) and 12.25% (80% UI:4.86–21.30), respectively, with a significant decrease in the study period for both gender. In South Asia in 2015, 11.76 million individuals (32.65% of the global blindness figure) were blind and 61.19 million individuals (28.3% of the global total) had MSVI. From 1990 to 2015, cataract (accounting for 36.58% of all cases with blindness in 2015) was the most common cause of blindness, followed by undercorrected refractive error (36.43%), glaucoma (5.81%), age-related macular degeneration (2.44%), corneal diseases (2.43%), diabetic retinopathy (0.16%) and trachoma (0.04%). For MSVI in South Asia 2015, most common causes were undercorrected refractive error (accounting for 66.39% of all cases with MSVI), followed by cataract (23.62%), age-related macular degeneration (1.31%) and glaucoma (1.09%).ConclusionsOne-third of the global blind resided in South Asia in 2015, although the age-standardised prevalence of blindness and MSVI decreased significantly between 1990 and 2015.

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“OCULAR MANIFESTATIONS OF DIABETES MELLITUS IN RELATION TO THE DURATION OF DIABETES AND GLYCAEMIC CONTROL – A STUDY AT A TERTIARY HEALTH CARE CENTRE”

10.36106/paripex/6800276 ◽

2021 ◽

pp. 5-7

Author(s):

Vishnu Devaraj ◽

Phani Kumar Sarkar ◽

Shivam Gupta ◽

Dipanjali Majumder

Keyword(s):

Diabetes Mellitus ◽

Glycaemic Control ◽

Diabetic Patient ◽

Blood Vessels ◽

Vision Loss ◽

Anterior Segment ◽

Health Care Centre ◽

Ocular Manifestations ◽

Department Of Ophthalmology ◽

Considerable Morbidity

BackGround: Diabetes mellitus results in considerable morbidity and mortality, affecting about 180 million people worldwide.The primary complications of diabetes due to damage in small blood vessels include damage to the eyes, kidneys,and nerves.Damage to the eyes,known as diabetic retinopathy,is caused by damage to the blood vessels in the retina of the eye,and can result in gradual vision loss and eventual blindness.Usually,a diabetic patient seeks the advice of ophthalmologist only when the ocular condition is in the advance stage.It is therefore,essential to examine the fundus and anterior segment of eye of every diabetic patient periodically at regular intervals,to detect early cases.This study was done to analyze the relation of duration and glycaemic control of diabetes to ocular manifestations among patients attending AGMC & GBP Hospital. Materials and Methods: This crossectional study was carried out on patients of Department of Ophthalmology at AGMC & GBP Hospital from October 2017 to April 2019.A total 85 adult subject (both male and females) of all age group were included in this study.Detailed eye examination and blood investigation like blood sugar and HbA1C was done. Results: The study showed that 26 (30.6%) patients had mild NPDR, 11(12.9%) patients had moderate NPDR, 8(9.4%) patients had severe NPDR, 2(2.4%) patients had PDR and 38(44.7%) patients had normal retina in right eye. 22(25.9%) patients had mild NPDR,10(11.8%) patients had moderate NPDR,7(8.2%) patients had severe NPDR,1(1.2%) patient had PDR and 45(52.9%) patients had no retinopathy left eye.

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Refractive Error in Juvenile Patients Presenting with Nystagmus at Tertiary Care Hospital of Karachi

Journal of Bahria University Medical and Dental College ◽

10.51985/zdvz6566 ◽

2021 ◽

Vol 11 (03) ◽

pp. 112-115

Author(s):

Kanwal Perveen ◽

Nasir Ahmed ◽

Khalida Perveen ◽

Tauseef Mehmood

Keyword(s):

Refractive Error ◽

Demographic Data ◽

Tertiary Care ◽

Anterior Segment ◽

P Value ◽

Ocular Motility ◽

Care Hospital ◽

Pupillary Reflex ◽

Special Clinic ◽

Myopic Astigmatism

Objective: To evaluate the types of refractive errors in nystagmus patients among the age (5-15 years) patients. Study Design and Setting: An observational cross-sectional study was conducted at Pediatric department of Al-Ibrahim Eye Hospital, Karachi from June 2018 to March 2019. Methodology: A total of 55 patients (110 eyes) were selected from study setting. The protocol for examination for all patients were evaluated at the special clinic of Orthoptics includes the demographic data, educational status, history of onset, type of nystagmus. The anterior segment was examined with a slit-lamp to exclude any other ocular disease. Orthoptic assessment includes cover uncover test, Hirschberg, ocular motility, prism cover test and pupillary reflex test, to observe any associated deviation. All the patients were examined after obtaining a fully informed consent. After the proper diagnosis of nystagmus patient was recruited as per inclusion and exclusion criteria with no restrictions of gender. All the observations were noted on a Proforma, Data analysis was done by using SPSS version 20. P-value <0.05 was considered as statistically significant. RESULTS: A total of 55 patients, 29 male (52.7%) and 26 female (47.3%) were selected. This study shows out of 55 patients (110 eyes), 46 (42%) eyes had myopic astigmatism, while 33 (30%) eyes were found hyperopic astigmatism, 20 (18%) eyes were observed hyperopic and 11 (10%) eyes were observed myopic. CONCLUSION: Most common type of refractive error in nystagmus was myopic astigmatism. The refractive correction should be encouraged in children with nystagmus; improvement in visual function is likely to occur

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Amblyopia of refractive origin: a clinical evaluation

Faridpur Medical College Journal ◽

10.3329/fmcj.v9i1.23621 ◽

2015 ◽

Vol 9 (1) ◽

pp. 35-36

Author(s):

Khandaker Anowar Hossain ◽

Md Abdur Rashid ◽

AKM Rafiqul Islam

Keyword(s):

Visual Acuity ◽

Visual System ◽

Refractive Error ◽

Female Ratio ◽

Medical College ◽

Department Of Ophthalmology ◽

Lazy Eye ◽

Myopic Astigmatism ◽

Association Medical ◽

Decrease In Visual Acuity

Amblyopia is defined as unilateral or bilateral decrease in visual acuity without any organic ocular lesion. It generally develops during the first decade of life when the visual system is vulnerable to deprivation. Unilateral amblyopia is more common than bilateral and the amblyopic eye is called lazy eye. This study was carried out in Faridpur Medical College & Hospital (FMCH) and Diabetic Association Medical College & Hospital (DAMCH) Faridpur, in the department of Ophthalmology from January - 2010 to December 2012 with a view to establish that anisometropic (Refractive) amblyopia is more in patients with astigmatism with the rule of both hypermetropic & myopic types also astigmatism against the rule in hypermetropic patients but simple myopia is not associated with amblyopia. Clinically diagnosed 110 patients of amblyopia of refractive origin were selected. Age of the patients was 6 to 15 years with male & female ratio 1.2:1. There was no pathology in the eyes except refractive error. Refraction done all the cases and found the following results: 26 cases (23.63%) of simple myopic astigmatism with the rule, 19 cases (17.27%) of compound myopic astigmatism with the rule, 10 cases (9.09%) of simple hypermetropia, 38 cases (34.54%) of simple hypermertopic astigmatism with the rule and 17 cases (15.45%) of compound hypermetropic astigmatism againt the rule. No case of simple myopia was associated with amblyopia. Amblyopia was more in patients with astigmatism with the rule of both hypermetropic and myopic types and also astigmatism against the rule in hypermetropic patients but simple myopia was not associated with amblyopia.Faridpur Med. Coll. J. 2014;9(1): 35-36

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Factors Affecting Visual Outcome in Post-Operative Cases of Lens Induced Glaucoma - A Prospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/154 ◽

2021 ◽

Vol 8 (13) ◽

pp. 784-789

Author(s):

Disilva Davis ◽

Remadevi S ◽

Accamma Mamman

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Vision Loss ◽

Visual Outcome ◽

P Value ◽

Delayed Presentation ◽

Elderly Age ◽

Factors Affecting ◽

Postoperative Visual Acuity ◽

The Impact

BACKGROUND Lens induced glaucoma is common in India. By early identification and removal of cataract, vision loss due to lens induced glaucoma can be prevented. Of the 12.5 million blind people in India, 50 - 80 % is due to cataract. In developing countries like India financial, cultural, and psychosocial constraints still exist to access excellent surgical services. This study was undertaken to determine factors affecting postoperative visual acuity in patients with lens induced glaucoma and to estimate the proportion of cases attaining good visual acuity. METHODS This prospective cohort study was conducted in 85 cases of lens induced glaucoma admitted in Regional Institute of Ophthalmology during a period of 1 year from May 2018 - April 2019. All patients underwent a complete ophthalmic examination preoperatively as well as postoperatively. All patients underwent cataract surgery and postoperatively patients were followed up regularly at 1 day, 1 week and 4 week and were evaluated. RESULTS Majority of patients were in the age group of 70 - 79 years (35.3 %). Females outnumbered males by 13 %. Most of the patients had a preoperative intraocular pressure between 21 – 30 mmHg (37.6 %). On analysis of the impact of duration of symptom on postoperative visual acuity, 70.4 % patients attained visual acuity > 6 / 24 when presented within 3 days. This was statistically significant with a P value of 0.011. When preoperative visual acuity was hand movements vision or better, 79.2 % patients attained visual acuity > 6 / 24 and it was significant with a P-value of < 0.01. CONCLUSIONS Delayed presentation, elderly age and sustained rise in preoperative intraocular pressure are the factors leading to poor visual prognosis. As majority of the patients were pseudophakic in the fellow eye, it is necessary to council all patients regarding timely surgery in the second eye at the time of discharge. KEYWORDS Cataract, Secondary Glaucoma, Visual Outcome

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Approach to: Acute vision loss

McGill Journal of Medicine ◽

10.26443/mjm.v19i1.492 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Sangeetha Santhakumaran

Keyword(s):

Primary Care ◽

Visual Acuity ◽

Vision Loss ◽

Anterior Segment ◽

Retinal Disease ◽

Care Physician ◽

Temporary Reduction ◽

Optic Nerve Disease ◽

Eye Disorders ◽

Nerve Disease

Acute vision loss is the temporary reduction of visual acuity or visual field, lasting from a few minutes to a few days. The etiologies of acute vision loss may be divided into anterior segment disease, retinal disease, optic nerve disease, or neurovascular disease. It is recommended to refer all presentations of acute vision loss for ophthalmologic consultation; however, the primary care physician plays an important role in determining the urgency of referral. The following article describes an approach to narrowing the differential diagnosis of acute vision loss, using relevant ocular history and physical exam findings. The features of common eye disorders relating to acute vision loss and their treatments are also discussed.

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