Electronically monitored occlusion therapy in amblyopia with eccentric fixation

Purpose Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.

Successful Combination Therapy for Amblyopia Secondary to Micro-Esotropia And Anisometropia

Background: Micro-esotropia is a small-angle esodeviation typically less than nine prism diopters. Patients with this ocular condition often develop amblyopia due to the presence of a constant unilateral strabismus and an anisometropic refractive error in the deviated eye. Current treatment methods for strabismic and refractive amblyopia include spectacle correction, patching, and vision therapy (VT). Case Summary: A 9-year-old Asian female presented with a constant left primary micro-esotropia with unsteady eccentric fixation, contributing to mild amblyopia and frequent suppression in the left eye. She also had a hyperopic anisometropic refractive error. Combination treatment of in-office VT with short-term patching therapy (two hours per day) was administered, with the goal of improving her binocularity, fixation, and visual acuity. Conclusions: Amblyopia results from binocular dysfunction, therefore monocular patching therapy alone will not improve the underlying issue. VT is necessary to actively treat binocularity and subsequently improve visual acuity, while short-term patching can be used in combination to effectively target monocular accommodation and fixation.

Evaluation of strabismus in 0-18 years of age group in tertiary health care hospital: A prospective cross-sectional observational study

The main objective of the study was to study the pattern of strabismus, determine the type of refractive error and measure the angle of deviation, determine streoacuity by WFDT in 0-18 years of age group. This was a prospective cross-sectional observational study. Total 50 patients were taken. Patients of 0-18 years of age presenting with squint included in study. Patients were evaluated for VA, both distance and near vision without glasses as well as BCVA tested. Anterior segment evaluation using slit lamp, cycloplegic refraction using atropine (0-9 years) or cyclopentolate (10-18 years), fundus examination, PBCT, WFDT test done. In study, total 50 subjects of 0-18 years of age group was taken. In them boys were more than girls. 49(98%) had comitant strabismus and 1(2%) had incomitant strabismus. 32(64%) had esotropia and 18(36%) had exotropia. Among esotropia 11(34.37%) had accommodative esotropia, 13(40.62%) had partially accommodative, 7(21.87%) had non accommodative, 1(3.12%) had restrictive esotropia. Among exotropia 9(50%) had basic exotropia, 6(33.33%) had divergence excess and 3(16.66%) had convergence insufficiency. 14(28%) had amblyopia. 32(64%) had hypermetropia and 18(36%) had Myopia. 33(64%) had central fixation and 12(24%) had eccentric fixation. In binocularity, 6(12%) had ARC, 25(50%) had unilateral suppression, 10(20%) had alternate suppression.Comitant squint was more common than incomitant squint. Among comitant squint, esotropia was more common than exotropia.

Eye Movements in Macular Degeneration

In healthy vision, the fovea provides high acuity and serves as the locus for fixation achieved through saccadic eye movements. Bilateral loss of the foveal regions in both eyes causes individuals to adopt an eccentric locus for fixation. This review deals with the eye movement consequences of the loss of the foveal oculomotor reference and the ability of individuals to use an eccentric fixation locus as the new oculomotor reference. Eye movements are an integral part of everyday activities, such as reading, searching for an item of interest, eye–hand coordination, navigation, or tracking an approaching car. We consider how these tasks are impacted by the need to use an eccentric locus for fixation and as a reference for eye movements, specifically saccadic and smooth pursuit eye movements. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Clinical Study of Concomitant Strabismus.

Background and Objectives: Strabismus is a condition in which there is misalignment of visual axes of two eyes. Concomitant strabismus is a condition in which the angle of deviation is constant in all the directions of gaze. Concomitant strabismus is further classified as convergent, divergent, hyperdeviation and hypodeviation. Major presenting complaints include cosmetic blemish, diminution of vision, asthenopic symptoms like headache, eye strain and diplopia. This study was conceptualized to study the clinical and ophthalmological profile of patients with concomitant strabismus, in order to generate evidence to manage this condition more effectively. Material and Methods : This cross-sectional, observational study was conducted over a period of two years in 120 patients with concomitant strabismus. Ocular history and visual acuity were recorded. Cover, cover-uncover, alternate cover test, Hirschberg test, Krimsky test and examination by synaptophore were done. Refraction and fundus examination was also done. Result: Majority of the patients were under 5 years of age (46.6%) with male to female ratio of 2:3. Convergent squint was more common (71.6%) with majority of patients having moderate degree of deviation (58.8%). Hypermteropia was more commonly associated with squint (65%) more so with convergent squint. Eccentric fixation was present in only 10% of the cases. Conclusion: Convergent concomitant squint is more common type with majority of patients having moderate degree of deviation. Hypermetropia is more commonly associated with concomitant squint. Appropriate refraction and timely intervention can help in preventing amblyopia in young children