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Amblyopia affects more than visual acuity. To compare the performances of visual selective attention and numerical processing in children with anisometropic amblyopia and children with normal vision, and investigate whether performance would be improved after visual acuity recovery, we performed 3 visual attention tasks (identifying number location task, numerical comparison task, and specific number comparison task) in children with anisometropic amblyopia, children who had recovered from anisometropic amblyopia, and children with normal vision in 6–8 and 9–11 years groups. The numerical processing ability, visual selective attention, and numerical distance effect were assessed by their reaction time of different tasks. The amblyopia group showed significantly worse visual selective attention than control group. However, the recovered amblyopic group showed worse visual selective attention compared to control group only in 9–11 years group. Children aged 6–8 had a greater numerical distance effect than 9–11 in control group, while there were no significant differences between different age groups in amblyopia and recovered amblyopic children. These findings suggest children with anisometropic amblyopia have not only defective visual selective attention but also different age-related patterns of numerical distance effect. Moreover, the improvement of visual selective attention after early stage of visual acuity recovery is better at younger age. [ABSTRACT FROM AUTHOR]

Abstract Purpose The objective of this study was to evaluate the clinical efficacy of a 4D digital strabismus and amblyopia visual function correction system (4D-DSAAVFCS) in combination with conventional modalities compared with conventional modalities alone in children with anisometropic amblyopia. Methods This nonrandomized controlled study collected data on best-corrected visual acuity (BCVA), simultaneous vision, fusion vision, near stereoscopic vision, the amplitude of P100 wave (graphic evoked visual potentials), and the latency of P100 wave from both eyes at the beginning of the treatment and one year later. The Mann‒Whitney U test was used to compare BCVA contrasts in different subgroups, and the independent samples t test was used to compare the amplitude and latency of P100 wave contrasts in different subgroups. The basic cure rate, simultaneous vision recovery rate, fusion vision recovery rate, and near stereoscopic vision recovery rate contrasts in different subgroups were compared via the chi-square test. Results This study included 393 children (217 boys and 176 girls) aged 3 to 12 years with anisometropic amblyopia who were treated at the Aier Eye Hospital of Wuhan University from January 2020 to December 2022. The children were divided into two groups, the 4D group (263 cases) and the traditional group (130 cases), on the basis of the treatment modality. The children in the traditional group received treatment through the conventional method of occlusion and regular training. Meanwhile, the children in the 4D group received treatment through the traditional method and the 4D-DSAAVFCS. The 4D group was divided into two age groups: 3 ~ 6 years (161 cases) and 6 ~ 12 years (102 cases). The basic cure rate of the 4D group was significantly better than that of the traditional group (χ2 = 4.318, P 0.05 ). After one year of treatment, a statistically significant difference was observed between the 4D group and the conventional group in terms of BCVA, the latency of P100 wave, and the amplitude of P100 wave (U=-1.243, t=-0.853, t=-1.546, all P

Purpose: The objective of this study was to evaluate the clinical efficacy of a 4D digital strabismus and amblyopia visual function correction system (4D-DSAAVFCS) in combination with conventional modalities compared with conventional modalities alone in children with anisometropic amblyopia. Methods: This nonrandomized controlled study collected data on best-corrected visual acuity (BCVA), simultaneous vision, fusion vision, near stereoscopic vision, the amplitude of P100 wave (graphic evoked visual potentials), and the latency of P100 wave from both eyes at the beginning of the treatment and one year later. The Mann‒Whitney U test was used to compare BCVA contrasts in different subgroups, and the independent samples t test was used to compare the amplitude and latency of P100 wave contrasts in different subgroups. The basic cure rate, simultaneous vision recovery rate, fusion vision recovery rate, and near stereoscopic vision recovery rate contrasts in different subgroups were compared via the chi-square test. Results: This study included 393 children (217 boys and 176 girls) aged 3 to 12 years with anisometropic amblyopia who were treated at the Aier Eye Hospital of Wuhan University from January 2020 to December 2022. The children were divided into two groups, the 4D group (263 cases) and the traditional group (130 cases), on the basis of the treatment modality. The children in the traditional group received treatment through the conventional method of occlusion and regular training. Meanwhile, the children in the 4D group received treatment through the traditional method and the 4D-DSAAVFCS. The 4D group was divided into two age groups: 3 ~ 6 years (161 cases) and 6 ~ 12 years (102 cases). The basic cure rate of the 4D group was significantly better than that of the traditional group (χ2 = 4.318, P < 0.05). There were no statistically significant differences in the BCVA, the latency of P100 wave, or the amplitude of P100 wave between the 4D group and the traditional group before treatment (U=-0.117, t=-0.05, all P > 0.05). After one year of treatment, a statistically significant difference was observed between the 4D group and the conventional group in terms of BCVA, the latency of P100 wave, and the amplitude of P100 wave (U=-1.243, t=-0.853, t=-1.546, all P < 0.05). These results suggest that the therapeutic effect was greater in the 4D group than in the conventional group. The recovery rates of simultaneous vision, convergent fusion, divergent fusion, and near stereoscopic vision were significantly greater in the 4D group than in the conventional group (χ2 = 4.344, 4.726, 5.123, and 2.036, respectively; all P < 0.05). Additionally, the basic cure rate of children aged 3 ~ 6 years in the 4D group was significantly greater than that of children aged 6 ~ 12 years (χ2 = 2.365, P < 0.05). In this study, BCVA was significantly lower in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (U = -1.267, P < 0.05). Similarly, the amplitude of P100 wave was also significantly greater in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (t = -1877, P < 0.05). The latency of P100 wave was lower in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (t=-0.998, P < 0.05). Additionally, the recovery rate of near stereoscopic vision was significantly greater in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (χ2 = 4.534, P < 0.05). Conclusion: The combination of the traditional method with the 4D-DSAAVFCS was more effective than the traditional method alone in treating amblyopic children. This approach was particularly helpful in improving the visual acuity of the children and restoring their optic nerve conduction function, simultaneous vision, fusion vision, and near stereoscopic vision. The combination of the traditional method and the 4D-DSAAVFCS is more effective for younger children. [ABSTRACT FROM AUTHOR]

The development of structural and functional magnetic resonance imaging (MRI) techniques over the decades has led to many studies seeking to identify cerebral abnormalities in amblyopia. The cause of reduced visual acuity and other visual characteristics of this common visual disorder cannot be identified by standard ophthalmological examination. As there are several variants of this disease, with fundamental differences in etiology, it is natural to suggest that there are different types of corresponding abnormalities in the brain. Thus, until a general picture of the pathogenesis of amblyopia is obtained, studies on groups of specially selected patients with similar symptomatologies are very important. The present paper presents a study of school-age children with left-sided anisometropic amblyopia. Structural MRI revealed interhemisphere differences in the thickness of the lateral occipital cortex in these patients, while resting-state functional MRI revealed interhemisphere differences in local hemodynamic signal coherence in Brodmann area 17 and in the functional connectivity of area 17 with areas 18 and 19. The results contribute to the creation of a general MRI database on the pathophysiology of amblyopia, clarify some controversial issues, and indicate the feasibility of using resting-state functional MRI in ophthalmology. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate the characteristics of eye movement in children with anisometropic amblyopia, and to compare those characteristics with eye movement in a control group. Methods 31 children in the anisometropic amblyopia group (31 amblyopic eyes in group A, 31 contralateral eyes in group B) and 24 children in the control group (48 eyes in group C). Group A was subdivided into groups Aa (severe amblyopia) and Ab (mild-moderate amblyopia). The overall age range was 6–12 years (mean, 7.83 ± 1.79 years). All children underwent ophthalmic examinations; eye movement parameters including saccade latency and amplitude were evaluated using an Eyelink1000 eye tracker. Data Viewer and MATLAB software were used for data analysis. Results Mean and maximum saccade latencies, as well as mean and maximum saccade amplitudes, were significantly greater in group A than in groups B and C before and after treatment (P

Objective: To investigate the characteristics of eye movement in children with anisometropic amblyopia, and to compare those characteristics with eye movement in a control group. Methods: 31 children in the anisometropic amblyopia group (31 amblyopic eyes in group A, 31 contralateral eyes in group B) and 24 children in the control group (48 eyes in group C). Group A was subdivided into groups Aa (severe amblyopia) and Ab (mild-moderate amblyopia). The overall age range was 6–12 years (mean, 7.83 ± 1.79 years). All children underwent ophthalmic examinations; eye movement parameters including saccade latency and amplitude were evaluated using an Eyelink1000 eye tracker. Data Viewer and MATLAB software were used for data analysis. Results: Mean and maximum saccade latencies, as well as mean and maximum saccade amplitudes, were significantly greater in group A than in groups B and C before and after treatment (P < 0.05). Mean and maximum saccade latencies were significantly different among groups Aa, Ab, and C (P < 0.05). Pupil trajectories in two detection modes suggested that binocular fixation was better than monocular fixation. Conclusions: Eye movement parameters significantly differed between contralateral normal eyes and control eyes. Clinical evaluation of children with anisometropic amblyopia should not focus only on static visual acuity, but also on the assessment of eye movement. [ABSTRACT FROM AUTHOR]

Robert W Arnold Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, 99508, USACorrespondence: Robert W Arnold, Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche Street &num;280, Anchorage, AK, 99508, USA, Tel +1 (907)561-1917, Fax +1 (907)563-5373, Email eyedoc@alaska.netBackground: To be successful, amblyopia therapeutic techniques must respond when ingenious (shrewd) amblyopic children sabotage treatment effect by discovering ways(1) to alter those therapy aspects they find frustrating.Methods: Her guardian consented to IRB-approved study outside typical FDA enrollment guidelines for CureSight dichoptic therapy. Acuity (EVA) and stereopsis was by PEDIG protocols.Results: A 6-year-old rural Alaska native girl in foster care had previously been diagnosed with anisometropic amblyopia and treated with spectacles and patching but had poor compliance with BCVA 0.9– 1.0 logMAR. She demonstrated exceptional creativity and hyperactivity but had no other medical issues. Atropine was prescribed in addition to her spectacles +5.50+1.00x90 and +0.50+1.00x90, but the patient discovered the rare “Spectacle Flip” method that sabotaged therapeutic impact. She had EVA enrollment acuities of logMAR 0.9 right and − 0.1 left with stereo 400 seconds of arc. After just one month dichoptic therapy 1.5 hours 6 days per week, acuity improved to logMAR 0.7 and − 0.1 with stereo up to 140 second of arc. Four months later acuity was 0.6 right and − 0.2 left. Stereoacuity improved from 400 to 200 arc seconds.Conclusion: Even when conventional compliance methods fail, dichoptic therapy with eye-tracking has the novel and unique potential to improve amblyopia treatment compliance with real-time monitored fixation compliance and confirmation of correct spectacle wear.Clinical Trial Registration: NCT06165705.Plain Language Summary: Dichoptic therapy with eye-tracking improved compliance and achieved de novo acuity and stereo gains in a girl with severe refractory anisometropic amblyopia compounded by the rare complication of topical atropine therapy called “spectacle-flip sabotage&#x201DKeywords: anisometropic amblyopia, compliance, eye tracking, anaglyph

AIM: To explore the brain mechanism of acupuncture for children with anisometropic amblyopia using the voxel-mirror homotopic connectivity (VMHC) analysis method of resting functional magnetic resonance imaging (rs-fMRI) technology based on clinical effectiveness. METHODS: Eighty children with anisometropic monocular amblyopia were randomly divided into two groups: control (40 cases, 1 case of shedding) and acupuncture (40 cases, 1 case of shedding) groups. The control group was treated with glasses, red flash, grating, and visual stimulations, with each procedure conducted for 5min per time. Based on routine treatment, the acupuncture group underwent acupuncture of “regulating qi and unblocking meridians to bright eyes”, Jingming (BL1), Cuanzhu (BL2), Guangming (GB37), Fengchi (GB20) acupoints were taken on both sides, with the needle kept for 30min each time. Both groups were treated once every other day, three times per week, for a total of 4wk. After the treatment, the overall curative effect of the two groups and the latency and amplitude changes of P100 wave of pattern visual-evoked potential were counted. At the same time, nine children with left eye amblyopia were randomly selected from the two groups and were scanned with rs-fMRI before and after treatment. The differences in the brain regions between the two groups were compared and analyzed with VMHC. RESULTS: Chi-square test showed a notable difference in the total efficiency rate between the acupuncture (94.87%) and control groups (79.49%). Regarding the P100 wave latency and amplitude, the acupuncture group had significantly shorter latency and higher amplitude of P100 wave than the control group. Moreover, the VMHC values of the bilateral temporal lobe, superior temporal gyrus, and middle temporal gyrus were notably increased in the acupuncture group after treatment. CONCLUSION: Acupuncture combined with conventional treatment can significantly improve the corrected visual acuity and optic nerve conduction in children with anisometropic amblyopia. Compared with the conventional treatment, the regulation of acupuncture on the functional activities of the relevant brain areas in the anterior cerebellum may be an effective acupuncture mechanism for anisometropic amblyopia.

To evaluate the effect of acupuncture on anisometropic amblyopia (AA) and explore its potential mechanism for children with AA. Seventy-six children with monocular AA were randomized into a conventional treatment group and a combined treatment group of acupuncture and conventional treatment, with 38 patients in each group. In the conventional treatment group, on the base of patching regimen, the red flashing, grating and visual stimulation were delivered. Each approach lasted for 5 min per session and was given once every two days, three times a week, for 4 consecutive weeks. In the acupuncture-combined treatment group, on the base of the regimen of conventional treatment group, acupuncture was applied to Jingming (BL1), Cuanzhu (BL2), Fengchi (GB20) and Guangming (GB37), with needles retained for 20 min per session, once every two days, three times of intervention a week and for 4 consecutive weeks. Before and after treatment, the best corrected vision acuity (BCVA) was observed to evaluate the clinical effect in the two groups. Before treatment started, 15 patients with AA on left side were randomized selected from each group and the resting-state functional magnetic resonance imaging (rs-fMRI) was operated before and after treatment. Simultaneously, eight healthy children with normal visual acuity were recruited to be the normal control group and received one-time rs-fMRI scanning. Based on the activation likelihood estimation (ALE), the visual "what" pathway network was constructed. By analyzing the amplitude of low frequency fluctuation (ALFF) and the regional homogeneity (ReHo), the differences in the regional autonomous function activities in the key brain areas of the "what" pathway were compared among the three groups. (1) Clinical effect: After treatment, BCVA was (0.6 [0.5, 0.6]), higher than that (0.4 [0.3, 0.5]) before treatment, presenting the statistical difference (P < 0.05) in the conventional treatment group. BCVA was (0.6 [0.6, 0.8]), higher than that (0.4 [0.4, 0.5]) before treatment, presenting the statistical difference (P < 0.05) in the acupuncture-combined treatment group. BCVA in the acupuncture-combined treatment group was higher than that of the conventional treatment group (P < 0.05) after treatment. The total effective rate was 86.1% in the acupuncture-combined treatment group, higher than that (65.8%) of the conventional treatment group (P < 0.05). (2) Mechanism: ① ALFF: In comparison with the healthy control group, the ALFF in the primary visual cortex of the "what" pathway for AA children was reduced significantly (P < 0.05), and ALFF in the right fusiform gyrus and the right inferior temporal gyrus increased significantly when compared with the healthy children (P < 0.05). Compared with that before treatment, there was no significant difference in the brain areas of the "what" pathway after treatment in the conventional treatment group (P > 0.05). In the acupuncture-combined treatment group, ALFF in the right inferior occipital gyrus and the right fusiform gyrus of the "what" pathway increased after treatment when compared with that before treatment (P < 0.05). After treatment, in comparison with the conventional treatment group, there was no significant difference in the brain areas of "what" pathway in the acupuncture-combined treatment group (P > 0.05). ② ReHo: ReHo in the right inferior occipital gyrus, the right fusiform gyrus and the right inferior temporal gyrus in the "what" pathway was elevated significantly in AA children when compared with that in the healthy control group (P < 0.05). ReHo of the left inferior occipital gyrus and the left fusiform gyrus increased significantly after treatment when compared with that before treatment in the conventional treatment group (P <0.05). ReHo of the right inferior occipital gyrus, the left and the right fusiform gyrus increased significantly after treatment when compared with that before treatment in the acupuncture-combined treatment group (P < 0.05). After treatment, ReHo of the right inferior temporal gyrus in the "what" pathway in the acupuncture-combined treatment group was significantly higher than that of the conventional treatment group (P < 0.05). The acupuncture combined with conventional treatment improves BCVA and the total effective rate of AA children. The changes in the regional function activity of the brain areas within the "what" pathway were dominated by the compensatory increase of the autonomous activity in the occipital lobe (inferior occipital gyrus) and the temporal lobe (inferior temporal gyrus) in AA children. Both conventional treatment and acupuncture can enhance the intensity of autonomous function activities in the occipital lobe (inferior occipital gyrus) and the temporal lobe (fusiform gyrus / inferior temporal gyrus) in the "what" pathway so as to relieve visual impairment. ReHo in the inferior temporal gyrus in the acupuncture-combined treatment group was higher than that of the conventional treatment group and it suggests that the inferior temporal gyrus may be the key brain area to the improvement of visual function in the "what" pathway. [ABSTRACT FROM AUTHOR]

Abstract Background Amblyopia treatment by occluding the healthy eye is known to be effective during a sensitive critical period. This study aims to clarify the factors for the total occlusion time (TOT) required for the amblyopic eye to achieve a normal visual acuity (VA) level of 1.0 (0.0 logMAR equivalent). This could contribute to an efficient treatment plan for eyes with hyperopic anisometropic amblyopia. Methods Subjects were 58 patients (26 boys and 32 girls; age range, 3.6-9.2, average, 5.8 ± 1.3 years) with hyperopic anisometropic amblyopia. All the subjects had initially visited and completed occlusion therapy with improved VA of 1.0 or better in the amblyopic eye at Kindai University Hospital between January 2007 and March 2017. Using the subjects’ medical records, we retrospectively investigated five factors for the TOT: the age at treatment, the initial VA of the amblyopic eye, refraction of the amblyopic eye, anisometropic disparity, and the presence of microstrabismus. Patient’s VA improvement at one month after treatment was also evaluated to confirm the effect of the occlusion therapy. Results The initial VA of the amblyopic eye ranged from 0.1 to 0.9 (median, 0.4). The TOT ranged from 140 to 1795 (median, 598) hours with an average daily occlusion time of 7 hours. The initial VA of the amblyopic eye and presence of microstrabismus were the significant factors for the TOT (p < 0.01). To achieve VA of 1.0 or better, patients with an initial VA of ≤ 0.3 in the amblyopic eye required a longer TOT. Moreover, patients with concomitant microstrabismus required a 1.7-fold longer TOT compared to those without microstrabismus. Conclusion Longer daily occlusion hours and early start of the treatment will be necessary for patients with poor initial VA or microstrabismus to complete occlusion therapy within the sensitive critical period.

Introduction: This study aimed to explore the functional connectivity of the primary visual cortex (V1) in children with anisometropic amblyopia by using the resting-state functional connectivity analysis method and determine whether anisometropic amblyopia is associated with changes in brain function. Methods: Functional magnetic resonance imaging (fMRI) data were obtained from 16 children with anisometropia amblyopia (CAA group) and 12 healthy children (HC group) during the resting state. The Brodmann area 17 (BA17) was used as the region of interest, and the functional connection (FC) of V1 was analyzed in both groups. A two-sample t test was used to analyze the FC value between the two groups. Pearson's correlation was used to analyze the correlation between the mean FC value in the brain function change area of the CAA group and the best corrected visual acuity (BCVA) of amblyopia. p < 0.05 was considered statistically significant. Results: There were no significant differences in age and sex between the CAA and HC groups (p > 0.05). Compared to the HC group, the CAA group showed lower FC values in BA17 and the left medial frontal gyrus, as well as BA17 and the left triangle inferior frontal gyrus. Conversely, the CAA group showed higher FC values in BA17 and the left central posterior gyrus. Notably, BCVA in amblyopia did not correlate with the area of change in mean FC in the brain function of the CAA group. Conclusion: Resting-state fMRI-based functional connectivity analysis indicates a significant alteration in V1 of children with anisometropic amblyopia. These findings contribute additional insights into the neuropathological mechanisms underlying visual impairment in anisometropic amblyopia. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate and contrast the contrast sensitivity defects present in strabismic and anisometropic amblyopes. And to find out the association of contrast deterioration with the visual acuity of the amblyopic eye, the magnitude of strabismus, and the amount of anisometropia in both groups. METHODS: This cross-sectional study was carried out in the orthoptics unit of a tertiary eye care facility between October 2021 and December 2021. There were 45 patients altogether. In the first phase, the patient's history and ocular examination data were recorded after informed consent. The Pelli-Robson chart was used to measure contrast sensitivity. In the second phase, results were interpreted using the SPSS (Statistical Package for the Social Sciences) version 26.0. RESULTS: Strabismic amblyopes were 24 and anisometropic amblyopes were 21. A significant positive association existed between both groups' contrast sensitivity and visual acuity (P = 0.000). A moderately negative correlation between contrast and anisometropia was statistically significant (P = 0.025) in anisometropic amblyopes. However, no association (P > 0.050) existed between the contrast and magnitude of strabismus in any group. CONCLUSION: The study concluded that contrast sensitivity decreases in both groups, whereas anisometropic amblyopes have poorer contrast than strabismic amblyopes. Excessively decreased contrast sensitivity among anisometropic amblyopes was solely because of the worst amblyopia in this group, whereas the magnitude of strabismus does not affect contrast sensitivity. [ABSTRACT FROM AUTHOR]

Amblyopia affects development of children's monocular vision and binocular function and becomes a largely intractable problem with increasing aging. This study is to investigate the binocular function and evaluate efficacy of digital therapy in children 8–13 years of age with anisometropic amblyopia. The patients in the digital therapy group performed the training with the digital amblyopia therapeutic software. The visual acuity and binocular function (perceptual eye position [PEP], suppression, and stereopsis) were examined at the first visit and 3-month post-treatment. Twenty-three cases in the control group and 25 cases in the digital therapy group were enrolled. The results revealed that 3-month digital therapy can effectively improve corrected distance visual acuity (CDVA) and improve the binocular function, including PEP, suppression, and second-order stereopsis in children with anisometropic amblyopia, 8–13 years of age. Digital therapy for amblyopia can effectively improve monocular CDVA of amblyopic eyes and binocular function in older children with anisometropic amblyopia. [ABSTRACT FROM AUTHOR]

Background: Amblyopia treatment by occluding the healthy eye is known to be effective during a sensitive critical period. This study aims to clarify the factors for the total occlusion time (TOT) required for the amblyopic eye to achieve a normal visual acuity (VA) level of 1.0 (0.0 logMAR equivalent). This could contribute to an efficient treatment plan for eyes with hyperopic anisometropic amblyopia. Methods: Subjects were 58 patients (26 boys and 32 girls; age range, 3.6-9.2, average, 5.8 ± 1.3 years) with hyperopic anisometropic amblyopia. All the subjects had initially visited and completed occlusion therapy with improved VA of 1.0 or better in the amblyopic eye at Kindai University Hospital between January 2007 and March 2017. Using the subjects' medical records, we retrospectively investigated five factors for the TOT: the age at treatment, the initial VA of the amblyopic eye, refraction of the amblyopic eye, anisometropic disparity, and the presence of microstrabismus. Patient's VA improvement at one month after treatment was also evaluated to confirm the effect of the occlusion therapy. Results: The initial VA of the amblyopic eye ranged from 0.1 to 0.9 (median, 0.4). The TOT ranged from 140 to 1795 (median, 598) hours with an average daily occlusion time of 7 hours. The initial VA of the amblyopic eye and presence of microstrabismus were the significant factors for the TOT (p < 0.01). To achieve VA of 1.0 or better, patients with an initial VA of ≤ 0.3 in the amblyopic eye required a longer TOT. Moreover, patients with concomitant microstrabismus required a 1.7-fold longer TOT compared to those without microstrabismus. Conclusion: Longer daily occlusion hours and early start of the treatment will be necessary for patients with poor initial VA or microstrabismus to complete occlusion therapy within the sensitive critical period. [ABSTRACT FROM AUTHOR]

PurposeRecent investigations observed substantial enhancements in binocular balance, visual acuity, and stereovision among older children and adults with amblyopia by patching the amblyopic eye (i.e., inverse patching) for 2 h daily over 2 months. Despite these promising findings, the precise neural mechanisms underlying inverse patching remain elusive. This study endeavors to delve deeper into the neural alterations induced by inverse patching, focusing on steady-state visual evoked potentials (SSVEPs). We specifically investigate the changes in SSVEPs following monocular deprivation of either the fellow eye or the amblyopic eye in older amblyopic children and adults.MethodTen participants (17.60 ± 2.03 years old; mean ± SEM), clinically diagnosed with anisometropic amblyopia, were recruited for this study. Each participant underwent a 120 min patching session on their fellow eye on the first day, followed by a similar session on their amblyopic eye on the second day. Baseline steady-state visual evoked potentials (SSVEPs) measurements were collected each day prior to patching, with post-patching SSVEPs measurements obtained immediately after the patching session. The experimental design incorporated a binocular rivalry paradigm, utilizing SSVEPs measurements.ResultsThe results revealed that inverse patching induced a heightened influence on neural plasticity, manifesting in a reduction of interocular suppression from the fellow eye to the amblyopic eye. In contrast, patching the fellow eye demonstrated negligible effects on the visual cortex. Furthermore, alterations in interocular suppression subsequent to inverse patching exhibited a correlation with the visual acuity of the amblyopic eye.ConclusionInverse patching emerges as a promising therapeutic avenue for adolescents and adults grappling with severe anisometropic amblyopia that proves refractory to conventional interventions. This innovative approach exhibits the potential to induce more robust neural plasticity within the visual cortex, thereby modulating neural interactions more effectively than traditional amblyopia treatments.

Purpose: Amblyopic eyes show impaired visual functions such as poor visual acuity and reduced foveal sensitivity. The purpose of this study was to determine the association between foveal threshold and visual evoked potentials (VEP) in strabismic and anisometropic amblyopia. Methods: Forty-five subjects (age range: 7–28 years, 43.3% female) including 15 strabismic and 15 anisometropic amblyopes, and 15 age-similar control subjects participated in this study. Each subject had pattern visual evoked potentials and foveal threshold recorded in each eye using RetiScan (Roland Consult, Germany) and Humphrey Visual Field Analyzer II (HFA II; Carl Zeiss Meditec Inc., Dublin, CA), respectively. These outcomes were compared among the amblyopic eyes, their fellow eyes, and the control eyes. Results: Compared to the amblyopic eyes (Mean ± SD: 33.4 ± 3.48 dB), the foveal threshold was higher in fellow eyes (37.0 ± 2.04 dB, p = 0.0002) and in control eyes (38.7 ± 0.96 dB, p < 0.0001). Strabismic amblyopes had a lower foveal threshold than anisometropic amblyopes (31.8 ± 3.86 vs. 35.0 ± 2.17 dB, p = 0.005). Relative to the P100 peak time in fellow eyes (1° checks:116.1 ± 9.00 ms; 0.25° checks:118.8 ± 5.67 ms), amblyopic eyes had delayed P100 peak times for both 1° (122.7 ± 11.4 ms, p < 0.0001) and 0.25° (130.4 ± 11.2 ms, p < 0.0001) check sizes. There were also significant differences in P100 peak time between amblyopic and control eyes (1°:122.7 ± 11.4 vs.112.4 ± 5.01 ms, p = 0.15; 0.25°:130.4 ± 11.2 vs.113.9 ± 5.71 ms, p < 0.0001) and between fellow and control eyes (0.25°:118.8 ± 5.67 vs.113.9 ± 5.71 ms, p = 0.009). Amblyopic eyes exhibited lower N75-P100 amplitudes than fellow eyes (1°:12.6 ± 7.96 vs.15.9 ± 8.82 µV, p = 0.01; 0.25°:10.6 ± 6.11 vs. 15.8 ± 10.6 µV, p = 0.001) and control eyes (0.25°: p = 0.0008). Foveal threshold correlated negatively with P100 peak time (1°: r = -0.45, p = 0.002 and 0.25°: r = -0.58, p < 0.0001) and positively with N75-P100 amplitude responses (1°: r = 0.42, p = 0.004 and 0.25°: r = 0.52, p = 0.002). Conclusions: Amblyopic eyes showed reduced pattern VEP amplitudes and delayed peak times with significant associations with the foveal sensitivity. However, the VEP measures overlapped extensively between amblyopic and control eyes with no apparent criterion value for optimal discrimination, suggesting that foveal sensitivity might be a better discriminator of amblyopia than pattern VEP. [ABSTRACT FROM AUTHOR]

Purpose : To evaluate macular microvascular changes in the form of foveal avascular zone (FAZ) area and vessel density in the superficial, deep capillary plexuses, and choriocapillaris using optical coherence tomography angiography (OCTA) in children with anisometropic myopic amblyopia before and after treatment. Methods: This prospective observational study included 32 patients younger than 12 years old with anisomyopic amblyopia. OCTA was done before patients' treatment with optical correction with or without patching and was repeated after successful amblyopia treatment. Outcomes included superficial, deep, and choriocapillaris vessel density (VD) and superficial and deep FAZ areas. Results: The study included 13 males (40.6%) and 19 females (59.4%), and the mean age was 9.52 ± 1.33 years. Fifty-three percent (53%) of patients needed only optical correction, and the remaining 47% needed additional patching therapy. After successful treatment, there was a significant improvement in amblyopic eyes in best-corrected visual acuity (p < 0.001), with higher VD values in superficial capillary plexuses (p < 0.001), deep capillary plexuses (p < 0.001), and foveal choriocapillaris (p = 0.030). In the glasses with patching subgroup, the difference between pre-treatment and post-treatment parameters revealed a significant improvement in vessel density in superficial retinal plexuses (foveal and parafoveal; p values 0.023 and < 0.001, respectively) and deep retinal plexuses (whole image, foveal, and parafoveal; p values 0.003, < 0.001, and 0.002, respectively). While amblyopic eyes treated with glasses alone had a significantly greater difference in choriocapillaris foveal VD (p value = 0.022). Conclusion: After effective amblyopia treatment, amblyopic eyes exhibited improved best-corrected visual acuity and better macular perfusion along the superficial, deep vascular density, and choriocapillaris foveal VD. Clinical trial registration: CinicalTrials.gov Identifier: NCT05223153. [ABSTRACT FROM AUTHOR]

Keywords: Anisometropic amblyopia; postural instability; vision therapy EN Anisometropic amblyopia postural instability vision therapy 686 689 4 08/04/23 20230801 NES 230801 Introduction Amblyopia is increasingly recognised as a binocular disorder that includes cerebral visual impairment associated with postural defects.[1] Postural stability is the capability to maintain body equilibrium under dynamic and static conditions.[2] Optimum visual acuity, binocular vision, and ocular motility contribute to postural stability and are disrupted in patients with amblyopia, thus reducing balance control.[2] Active vision therapy includes a series of oculomotor exercises integrating the head, neck, limbs, and entire body with information from sensory modalities.[3] Adult amblyopia is recognised as treatable because of the discovery of plasticity at the synaptic, cellular, and cortical levels, which have been reported to restore defective visual cortical areas in adult after active treatment methods.[4] No studies have described improvement in posture following active vision therapy, although studies have reported poor postural stability in children with amblyopia.[2] Presented here is a case of adult amblyopia with postural instability regaining binocular vision with improved body and head posture after active vision therapy. In conclusion, active vision therapy with motor balance exercises could regain head posture, static and dynamic balance, and restore binocular function in adult anisometropic amblyopia with postural instability. First, an adult patient with anisometropic amblyopia had sufficient motivation to complete active vision therapy exercises, resulting in improved vision. [Extracted from the article]

Abstract Background The aim of this observational study was to identify ocular and visual perceptive risk factors related to treatment results following refractive correction and patching in children with anisometropic amblyopia, who were between the ages of 4 to 14 years old. Methods One-hundred and two children with newly diagnosed anisometropic amblyopia were recruited. Successful treatment of amblyopia was defined as the final best corrected visual acuity (BCVA) better than or equal to 0.1 logMAR and amblyopic eye BCVA within 1 line of the sound eye BCVA by the end of the treatment period. BCVA, cycloplegic refraction, stereoacuity, perceptual eye position (PEP) and interocular suppression were measured. Results Of these patients, 45.10% achieved successful treatment of amblyopia after refractive correction and patching for 10.5 months. The mean age was not significantly different between patients who were successfully and unsuccessfully treated (5.50 ± 1.59 years vs 6.14 ± 2.19 years, respectively). Patients who failed treatment had significantly larger interocular difference of BCVA at the time of initial treatment (successful group: 0.33 ± 0.29 logMAR, unsuccessful group: 0.65 ± 0.35 logMAR) and after refractive adaptation (successful group: 0.15 ± 0.13 logMAR, unsuccessful group: 0.42 ± 0.35 logMAR). They also had higher spherical equivalent (SE) of amblyopic eyes (successful group: 3.08 ± 3.61 D, unsuccessful group: 5.27 ± 3.38 D), bigger interocular difference of SE (successful group: 0.94 ± 2.71 D, unsuccessful group: 3.09 ± 3.05 D), worse stereoacuity (successful group: 2.32 ± 0.37 log seconds of arc, unsuccessful group: 2.75 ± 0.32 log seconds of arc), larger vertical PEP deviation (successful group: 6.41 ± 6.08 pixel, unsuccessful group: 19.07 ± 24.96 pixel) and deeper interocular suppression (successful group: 21.7 ± 19.7%, unsuccessful group: 37.8 ± 27.1%) than those of successfully treated patients. The most influential treatment failure risk factors were larger vertical PEP deviation [adjusted odds ratio (OR) (95% confidence interval) 1.12 (1.02–1.22)] and worse stereoacuity [adjusted odds ratio (OR) (95% confidence interval) 7.72 (1.50–39.85)] in multiple logistic regression analysis. Conclusions Larger vertical PEP deviation and worse stereoacuity were the most influential treatment failure risk factors in children with anisometropic amblyopia. The vertical PEP deviation and stereoacuity, which can reflect interocular interaction, may be useful in predicting the response to therapy.

Aims: The aim was to report the incidence and types of amblyopia in a large series of patients with intermittent exotropia at a single institution. Materials and Methods: The medical records of consecutive patients 4–30 years of age diagnosed with intermittent exotropia at our institution between January 2000 and December 2017 were retrospectively reviewed for amblyopia. Results: A total of 2,058 patients diagnosed with intermittent exotropia during the study met the inclusion criteria. Of these patients, 40 (2%) had amblyopia and were the participants of this study. The mean patient age was 10.6 ± 4.2 years. Amblyopia was anisometropic in 35 (87%) patients and strabismic in 5 (13%) patients. Of the 35 patients with anisometropic amblyopia, 29 (83%) had spherical anisometropia and 6 (17%) had astigmatic anisometropia. There was no statistically significant difference in the number of patients and the mean anisometropia between patients with spherical anisomyopic and anisohyperopic amblyopia, and also between those with astigmatic anisomyopic and anisohyperopic amblyopia. There was no relation between the type of intermittent exotropia and anisometropic amblyopia. None of the patients with strabismic amblyopia had spherical or astigmatic anisometropia but had a preference for fixation with the nonamblyopic eye. There was no statistically significant difference in near and distance deviations between patients with anisometropic and strabismic amblyopia, and between those with anisomyopic and anisohyperopic amblyopia. Conclusions: Amblyopia was observed in 2% of our patients with intermittent exotropia. It was spherical anisometropic in a large majority of patients and strabismic in a few.

AIM: (1) To compare optical coherence tomography (OCT) parameters between amblyopic eyes and fellow eyes in patients presenting with anisometropic amblyopia. (2) To find OCT factors predicting the outcomes of occlusion therapy. MATERIALS AND METHODS: This prospective study was conducted in a tertiary eye care center for a period of 20 months. Fifty-four children diagnosed with anisometropic amblyopic were included in the study. After complete ophthalmic and OCT examination, patients were advised to undergo occlusion therapy with large spectacle patch. Patients were reviewed after 6 months to record improvement in visual acuity and analyze their OCT parameters. Statistical tests used were paired “t” test and independent “t” test. RESULTS: The mean age of 54 study patients was 9.24 ± 2.82 years. For comparison of OCT parameters, they were classified as myopic (22 patients), hypermetropic (24 patients), and astigmatic (8 patients) groups. In the anisomyopic amblyopia group, the mean inner macular thickness was significantly increased in fellow eyes (304.09 ± 11.06 μm) compared to amblyopic eyes (297.59 ± 14.16 μm). In the anisohyperopic amblyopia group, the outer macular thickness significantly increased in amblyopic eyes (286.43 ± 18.63 μm) when compared to fellow eyes (272.62 ± 14.90 μm). In the follow-up visit, 28 patients showed improvement and 6 patients did not show improvement in final best-corrected visual acuity, and the OCT parameters in amblyopic eyes of these two groups did not differ significantly. CONCLUSION: Abnormal experience in early life does not affect the maturation process of retinal layers as evident by OCT parameters, and these parameters cannot predict the outcomes of occlusion therapy.

Aims and Objectives: To determine the choroidal thickness (mainly subfoveal) using spectral domain optical coherence tomography (SD-OCT) in amblyopic eyes and to compare it with the choroidal thickness (CT) of healthy fellow eyes. Materials and Methods: In this prospective study, 140 eyes of 70 patients (aged 5–40 years) with strabismic and anisometropic amblyopia were examined using enhanced depth imaging (EDI) mode in SD-OCT. The CT was measured directly below the fovea and six other locations: 500 μ, 1000 μ, and 1500 μ from fovea in both nasal and temporal quadrants. Results: The mean age of the patients was 22.5 ± 11.2 years. The mean Best Corrected Visual Acuity (BCVA) in the amblyopic eyes was 0.87 ± 0.47 logMAR and 0 ± 0.02 logMAR in control eyes. The average subfoveal CT was 341.73 ± 60.39 μm in the amblyopic eyes and 314.77 ± 48.12 μm in the fellow eyes. Subgroup analysis showed that the patients with anisometropic amblyopia had a significantly thicker choroid as compared to the fellow healthy eyes (P = 0.00), whereas in strabismic amblyopic eyes, this difference was not significantly significant (P = 0.064). Conclusion: Significant choroidal thickening was observed in subjects with amblyopia, which may contribute to the amblyopia pathogenesis and this could be used as a diagnostic parameter for amblyopia. These changes were more pronounced in patients with anisometropic amblyopia than strabismic amblyopia.

Aims and Objectives: To determine the choroidal thickness (mainly subfoveal) using spectral domain optical coherence tomography (SD-OCT) in amblyopic eyes and to compare it with the choroidal thickness (CT) of healthy fellow eyes. Materials and Methods: In this prospective study, 140 eyes of 70 patients (aged 5--40 years) with strabismic and anisometropic amblyopia were examined using enhanced depth imaging (EDI) mode in SD-OCT. The CT was measured directly below the fovea and six other locations: 500 µ, 1000 µ, and 1500 µ from fovea in both nasal and temporal quadrants. Results: The mean age of the patients was 22.5 ± 11.2 years. The mean Best Corrected Visual Acuity (BCVA) in the amblyopic eyes was 0.87 ± 0.47 logMAR and 0 ± 0.02 logMAR in control eyes. The average subfoveal CT was 341.73 ± 60.39 µm in the amblyopic eyes and 314.77 ± 48.12 µm in the fellow eyes. Subgroup analysis showed that the patients with anisometropic amblyopia had a significantly thicker choroid as compared to the fellow healthy eyes (P = 0.00), whereas in strabismic amblyopic eyes, this difference was not significantly significant (P = 0.064). Conclusion: Significant choroidal thickening was observed in subjects with amblyopia, which may contribute to the amblyopia pathogenesis and this could be used as a diagnostic parameter for amblyopia. These changes were more pronounced in patients with anisometropic amblyopia than strabismic amblyopia. [ABSTRACT FROM AUTHOR]

Anisometropic amblyopia is decreased visual acuity in one eye, and treatment consists of wearing complete corrective spectacles. Aniseikonia occurs with complete correction of anisometropia using spectacles. Aniseikonia has been ignored when treating pediatric anisometropic amblyopia because of the prevailing belief that anisometropic symptoms are suppressed by adaptation. However, the conventional direct comparison method for evaluating aniseikonia significantly underestimates the degree of aniseikonia. This study investigated whether the adaptation occurs due to long-term anisometropic amblyopia treatment in patients who have had successful amblyopia treatment using a spatial aniseikonia test with high accuracy and repeatability compared with the conventional direct comparison method. The amount of aniseikonia was not significantly different between the patients with successful amblyopia treatment and individuals with anisometropia without a history of amblyopia. In both groups, the aniseikonia per 1.00 D of anisometropia and the aniseikonia per 1.00 mm of aniso-axial length were comparable. The repeatability of the amount of aniseikonia using the spatial aniseikonia test did not differ significantly between the two groups, indicating a high degree of agreement. These findings suggest that aniseikonia is not adapted to amblyopia treatment and that aniseikonia increases as the difference between spherical equivalent and axial length increases. [ABSTRACT FROM AUTHOR]

Saeed Aljohani,1 Sulaiman Aldakhil,1 Saif H Alrasheed,2,3 Qing-Qing Tan,4 Saleh Alshammeri1 1Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Qassim, Saudi Arabia; 2Department of Optometry, College of Applied Medical Sciences, Qassim University, Qassim, Buraydah, Saudi Arabia; 3Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan; 4Department of Ophthalmology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of ChinaCorrespondence: Saif H Alrasheed, Department of Optometry, College of Applied Medical Sciences, Qassim University, P.O.Box 6688, Qassim, Buraydah, Saudi Arabia, Tel +966505201475, Fax +966-16-3800050, Email s.rasheed@qu.edu.saPurpose: To provide the clinical characteristics of amblyopia in children under 17 years of age in Qassim Region, Saudi Arabia.Patients and Methods: The study was a cross-sectional hospital-based, included 121 children with amblyopia aged between 3 and 17 years, referred from 6 hospitals in Qassim region to the paediatric optometry clinic at Qassim University medical city. Demographics and comprehensive ocular examination including visual acuity (VA), assessment of anterior and posterior segment, cycloplegic refraction (RE), angle of deviation, and cause of amblyopia were collected.Results: The mean age at diagnosis of amblyopia was 8.93 ± 3.67 years. The leading cause of amblyopia was strabismus and anisometropia shared the same percentage at 29.75%, and the combined-mechanism at 18.18%. Amblyopia was more common in males 57.85%, particularly strabismic amblyopia in 66.67% and anisometropic amblyopia in 61.11%, p = 0.408. Amblyopia was more predominant in the age group 6- to 9-year-old, particularly, strabismic amblyopia 44.44%, and amblyopia due to a combined mechanism of 36.36%, p = 0.066. The degree of hyperopia was not varied by the cause of amblyopia (P = 0.401), with slightly high hyperopia found in ametropic and strabismic amblyopia. Conversely, hyperopic astigmatism was significantly associated with amblyopia P = 0.020, with a high degree of hyperopic astigmatism found in meridional amblyopia and ametropic amblyopia.Conclusion: The commonest types of amblyopia in children were attributed to strabismus and anisometropia. Causes of amblyopia differed by age group with strabismus, anisometropia, and combined mechanism accounting for most children aged 6- to 9-years and strabismus for children aged less than 6 years. Hyperopic and myopic astigmatism were significantly associated with anisometropia and meridional amblyopia. Therefore, efforts should be made for early diagnosis and management of childhood amblyopia and uncorrected refractive errors to avoid their impact on quality of life.Keywords: amblyopia, anisometropic amblyopia, meridional amblyopia, Saudi Arabia, hyperopic astigmatism, uncorrected refractive errors, visual impairment

Abstract Background Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. Methods We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. Discussion The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. Trial registration This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.

Abstract Objectives To observe and compare the difference in retinal perfusion using optical coherence tomography angiography (OCTA) between anisometropic amblyopia in children and fellow eyes as well as age-matched controls. Methods A total of 16 children with anisometropic amblyopia and 19 age-matched healthy subjects were enrolled. All participants underwent OCTA examination, with 3 mm × 3 mm and 6 mm × 6 mm scans in the macular region. Perfusion parameters of the superficial retinal layer were measured by built-in software, including the macular foveal avascular zone (FAZ) area, perimeter and circularity, as well as the vessel length density (VLD) and perfusion density (PD) of the foveal, parafoveal and perifoveal regions. Results Among the 16 patients with anisometropic amblyopia, the FAZ area was significantly higher in diseased eyes (P = 0.027) than in fellow eyes. The VLD and PD of the foveal average and the VLD of the nasal quadrant of the perifoveal region in anisometropic amblyopic eyes were significantly lower than those in fellow eyes (P

Abstract Purpose: To evaluate the effect of interocular axial length (AL) difference on outcomes of treatment for anisometropic amblyopia in comparison with normal participants. Methods: In this historical cohort study, 83 patients with anisometropic amblyopia were divided into two age groups, 70 children (mean, 7.86 ± 1.56 and range, 5–15 years) and 13 adults (mean, 26.46 ± 10.87 and range, 16–45 years). The control group consisted of 43 non-amblyopic children and 17 non-amblyopic adults. Treatment outcomes after a period of one year were defined as successful or unsuccessful when posttreatment amblyopic corrected distance visual acuity (CDVA) was reported as ≤ 0.9 versus CDVA ≤ 0.8, respectively. AL was measured using a Lenstar LS900 (Haag-Streit AG, Switzerland). Results: Fifty-nine patients showed satisfactory treatment outcomes (55 children and 4 adults), while unsuccessful treatment outcomes were observed in 24 patients (15 children and 9 adults). The mean of amblyopia treatment duration was 1.24 ± 0.76 years. The mean of interocular AL difference in all patients, control, successful and unsuccessful treatment outcome groups were 0.49 ± 0.70mm (range, 0.00–3.89 mm), 0.12 ± 0.07 mm (range, 0.02–0.41), 0.33 ± 0.23 mm (range, 0.00–0.99 mm), and 1.81 ± 0.80 mm (range, 1.14–3.89 mm), respectively. In both age groups, the mean of interocular AL difference in patients with unsuccessful treatment outcomes was greater than those with successful treatment outcomes and that of the control group (P < 0.001). Conclusion: The results of this study suggest that the outcome of anisometropic amblyopia treatment may depend on the interocular AL difference.

Background: The aim of this observational study was to identify ocular and visual perceptive risk factors related to treatment results following refractive correction and patching in children with anisometropic amblyopia, who were between the ages of 4 to 14 years old. Methods: One-hundred and two children with newly diagnosed anisometropic amblyopia were recruited. Successful treatment of amblyopia was defined as the final best corrected visual acuity (BCVA) better than or equal to 0.1 logMAR and amblyopic eye BCVA within 1 line of the sound eye BCVA by the end of the treatment period. BCVA, cycloplegic refraction, stereoacuity, perceptual eye position (PEP) and interocular suppression were measured. Results: Of these patients, 45.10% achieved successful treatment of amblyopia after refractive correction and patching for 10.5 months. The mean age was not significantly different between patients who were successfully and unsuccessfully treated (5.50 ± 1.59 years vs 6.14 ± 2.19 years, respectively). Patients who failed treatment had significantly larger interocular difference of BCVA at the time of initial treatment (successful group: 0.33 ± 0.29 logMAR, unsuccessful group: 0.65 ± 0.35 logMAR) and after refractive adaptation (successful group: 0.15 ± 0.13 logMAR, unsuccessful group: 0.42 ± 0.35 logMAR). They also had higher spherical equivalent (SE) of amblyopic eyes (successful group: 3.08 ± 3.61 D, unsuccessful group: 5.27 ± 3.38 D), bigger interocular difference of SE (successful group: 0.94 ± 2.71 D, unsuccessful group: 3.09 ± 3.05 D), worse stereoacuity (successful group: 2.32 ± 0.37 log seconds of arc, unsuccessful group: 2.75 ± 0.32 log seconds of arc), larger vertical PEP deviation (successful group: 6.41 ± 6.08 pixel, unsuccessful group: 19.07 ± 24.96 pixel) and deeper interocular suppression (successful group: 21.7 ± 19.7%, unsuccessful group: 37.8 ± 27.1%) than those of successfully treated patients. The most influential treatment failure risk factors were larger vertical PEP deviation [adjusted odds ratio (OR) (95% confidence interval) 1.12 (1.02–1.22)] and worse stereoacuity [adjusted odds ratio (OR) (95% confidence interval) 7.72 (1.50–39.85)] in multiple logistic regression analysis. Conclusions: Larger vertical PEP deviation and worse stereoacuity were the most influential treatment failure risk factors in children with anisometropic amblyopia. The vertical PEP deviation and stereoacuity, which can reflect interocular interaction, may be useful in predicting the response to therapy. [ABSTRACT FROM AUTHOR]

Purpose: To report retinal nerve fiber layer thickness (RNFLT) in eyes with amblyopia compared with contralateral healthy eyes. Methods: In this cross-sectional study, we included patients with anisometropic amblyopia, strabismic amblyopia, and mixed amblyopia. All subjects underwent complete ophthalmic examination, including RNFLT measurement with time-domain OCT (Stratus OCT) and scanning laser polarimeter (GDX VCC). A paired “t” test was used to compare average and quadrant-wise RNFL thickness between the amblyopic and contralateral normal eyes. In addition, an analysis of variance test was used to compare various RNFL thickness parameters between the three groups. Results: A total of 33 eyes of 33 subjects with anisometropic amblyopia, 20 eyes of 20 subjects with strabismic amblyopia, and 38 eyes of 38 subjects with mixed amblyopia were included. In the anisometropic amblyopia group, the average RNFLT in the amblyopic eye was 98.2 μm and 99.8 μm in the fellow normal eye (P = 0.5), the total foveal thickness was 152.82 μm (26.78) in the anisometropic eye and 150.42 μm (23.84) in the fellow eye (P = 0.38). The difference between amblyopic and contralateral normal eye for RNFL and macular parameters was statistically insignificant in all three groups. The RNFL thickness in four quadrants was similar in the amblyopic and non-amblyopic eye between all three groups and statistically non-significant. Conclusion: Our study showed that RNFL thickness was similar in amblyopic and non-amblyopic eyes between all three amblyopia groups.

Purpose: To report retinal nerve fiber layer thickness (RNFLT) in eyes with amblyopia compared with contralateral healthy eyes.Methods: In this cross-sectional study, we included patients with anisometropic amblyopia, strabismic amblyopia, and mixed amblyopia. All subjects underwent complete ophthalmic examination, including RNFLT measurement with time-domain OCT (Stratus OCT) and scanning laser polarimeter (GDX VCC). A paired "t" test was used to compare average and quadrant-wise RNFL thickness between the amblyopic and contralateral normal eyes. In addition, an analysis of variance test was used to compare various RNFL thickness parameters between the three groups.Results: A total of 33 eyes of 33 subjects with anisometropic amblyopia, 20 eyes of 20 subjects with strabismic amblyopia, and 38 eyes of 38 subjects with mixed amblyopia were included. In the anisometropic amblyopia group, the average RNFLT in the amblyopic eye was 98.2 μm and 99.8 μm in the fellow normal eye (P = 0.5), the total foveal thickness was 152.82 μm (26.78) in the anisometropic eye and 150.42 μm (23.84) in the fellow eye (P = 0.38). The difference between amblyopic and contralateral normal eye for RNFL and macular parameters was statistically insignificant in all three groups. The RNFL thickness in four quadrants was similar in the amblyopic and non-amblyopic eye between all three groups and statistically non-significant.Conclusion: Our study showed that RNFL thickness was similar in amblyopic and non-amblyopic eyes between all three amblyopia groups. [ABSTRACT FROM AUTHOR]

Abstract Background Myopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort. Methods This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed. Results The study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was − 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity “CDVA” (P value

ObjectiveTo identify factors associated with visual acuity regression following successful treatment of anisometropic amblyopia.Design and methodThis was a retrospective cohort study. Database records for 100 and 61 children with anisometropic amblyopia who met at least one criterion for successful treatment proposed by the Pediatric Eye Disease Investigator Group (PEDIG) and had at least 1 year of follow-up data available after the criterion was met were analyzed. The study sample was split into two groups, those who regressed within 1 year of successful treatment (no longer met any of the PEDIG criteria for successful treatment) and those who did not. A two-step analysis involving a least absolute shrinkage and selection operator (LASSO) regression and a logistic regression were used to identify predictor variables for increased risk of regression. A broad range of clinical, perceptual, and demographic variables were included in the analyses.ResultsSixty-eight (42.5%) children regressed within 1 year of successful treatment. Among the 27 predictor variables considered within the statistical modeling process, the three most important for predicting treatment regression were the extent of amblyopic eye visual acuity improvement, age at first hospital visit and sex. Specifically, lower risk of regression was associated with larger amblyopic eye visual acuity improvement with treatment, younger age at initiation of treatment and female sex.ConclusionPatients who received treatment at a younger age and responded well to treatment had a lower risk of treatment regression. This pattern of results suggests that early detection of amblyopia and strategies that enhance treatment adherence may reduce the risk of treatment regression. The higher risk of regression in boys than girls that we observed may reflect known sex differences in brain development and /or sex differences in environment within our sample of children from South China.

PurposeTo investigate the development of refraction in anisometropic amblyopia who had been with patching therapy.MethodsWe retrospectively reviewed 37,528 medical records of the amblyopes who had been treated with patching therapy between July 2003 and January 2020 at the School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University. We included unilateral anisometropic amblyopia with a follow-up length of not < 2 years. In total, 371 cases were enrolled and followed up for a mean of 4.76 ± 2.11 years. The subjects were then divided into different groups and periods according to their initial spherical equivalent (SE) refractive error and best-corrected visual acuity (BCVA) of the amblyopic eye. Linear mixed-effects models were fitted to calculate the annual change of SE.ResultsThe annual changes in SE were −0.32 (−0.35 to −0.30) and −0.16 (−0.19 to −0.14) D/yr for the amblyopic eye and the fellow eye, respectively. The annual changes in SE of amblyopic eyes during the treatment period and the successfully treated period were −0.36 (−0.43 to −0.29; 95% CI) and −0.27 (−0.32 to −0.23; 95% CI) D/yr, respectively; the annual SE changes of the fellow eye during the treatment period and the successfully-treated period were −0.07 (−0.14 to −0.01; 95% CI) and −0.18 (−0.22 to −0.14; 95% CI) D/yr, respectively.ConclusionThe amblyopic eye experienced a significantly greater degree of refractive error changes than the fellow eye and underwent a continuous refractive error reduction before and after 7 years old. After the patching therapy was terminated, emmetropization in the amblyopic eye remained synchronized, whereas the refractive error change was increased in the fellow eye.

Purpose:To study the efficacy of supplemental occlu-pad therapy with partial occlusion in children with refractive anisometropic amblyopia. Methods: Thirty-one children who did not improve after partial occlusion of 6 h for 6 months were supplemented with the use of occlu-pad for 1 h per day and three such sessions in a week. Results: The mean age was 6.8+/-1.4 years (range 5–9 years). A significant improvement of 3.2+/-1.3 lines in visual acuity was noticed at the end of 3 months of starting this supplemental therapy in children. Out of 31 children, 26 children improved at least 2 lines or more at the end of 3 months. All children (n = 9) having anisohyperopic amblyopia improved at the end of 3 months. Conclusion: Occlu-pad is useful in supplementing occlusion therapy in cases of refractive amblyopia and is more effective in anisohyperopic amblyopia.

PURPOSE: Refractive correction and patching is the timetested mainstay of treatment for anisometropic amblyopia within the critical period of visual development. Binocular therapies using dichoptic training which overcome suppression by balancing the contrast between two eyes has been increasingly gaining ground. We evaluated the efficacy of dichoptic training in the adult population with anisometropic amblyopia. This study aims to evaluate the effectiveness of dichopticbased active vision therapy, using "VisuoPrime" software as primary intervention, in adults with anisometropic amblyopes. MATERIALS AND METHODS: A prospective interventional study in adults (18-40 years) with anisometropic amblyopia was conducted from August 2019 to March 2020. METHODS: Twentynine subjects with anisometropic amblyopia played binocular games through "VisuoPrime" software 30 min daily for 6 weeks. Bestcorrected visual acuity (BCVA) and binocularity was assessed at 1 and 3 months. Student's paired ttest, Wilcoxon signedrank sum test and MannWhitney tests were used. Statistical package of SPSS version 20.0 was used for analysis, considering P < 0.05 as statistically significant. RESULTS: BCVA of the amblyopic eye improved from 0.60 ± 0.40 logMAR to 0.45 ± 0.29 logMAR and 0.38 ± 0.23 logMAR at 1 and 3 months, respectively (P = 0.0001). Near acuity improved from 0.21 ± 0.14 to 0.14 ± 0.08 logMAR and 0.1 ± 0.04 logMAR at 1 and 3 months respectively (P < 0.0001). Improvement in stereopsis was observed in 24% of subjects which maintained at 3 month followup. CONCLUSION: Dichopticbased active vision therapy using "VisuoPrime" software was effective as a primary modality in adults with anisometropic amblyopia. [ABSTRACT FROM AUTHOR]

Background: Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. Methods: We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. Discussion: The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. Trial registration: This protocol was registered with ClinicalTrials.gov (NCT04819386) on 29 March 2021. [ABSTRACT FROM AUTHOR]

Our previous study has shown impaired blood oxygen level-dependent (BOLD)/functional magnetic resonance imaging (fMRI) activation of the visual attention network in strabismic amblyopia (SA). However, there has been no comparison of resting state fMRI activation and functional connectivity (FC) in brain regions of interest (ROIs) along the visual attention network including visual cortex (V1), intraparietal sulcus (IPS), and frontal eye fields (FEFs) during closed eye resting across the SA (n = 20, 13LE), or anisometropic amblyopes (AA) (n = 20, 13LE) groups. Hence, we compared, gray matter volume (GMV), amplitude of low frequency fluctuations (ALFFs), regional homogeneity (ReHo), and FC in the left and right hemisphere ROIs of the visual attention network in SA, AA, and healthy controls (HCs) (n = 21). Correlation analyses of corrected visual acuity (cVA) of amblyopic eye and MRI results were also performed and showed that the LogMAR cVA of the amblyopic eye positively correlated with right zALFF and zReHo FEF of SA and right IPS of AA only. GMV of both left and right hemisphere V1 areas was significantly greater but ALFF was significantly lower for SA compared to AA and HC groups. zALFF and zReHo analyses in the AA and SA groups indicated significantly higher activation than that in the HC group in the right FEF and IPS but lower than that in the HC group in the left FEF, and only the SA group showed lower activation in both V1 areas than the HC group. FC values of the right FEF–left V1, right FEF–right V1, and right FEF–right IPS pathways in the SA and AA groups were also significantly higher than those in the HC group whereas all other FC values were non-significant. Thus, this study indicates that even during resting-state the visual attention network function is impaired in SA and AA participants with only right hemisphere FEF showing significant activation in SA and IPS in AA suggesting that the slower saccade activation times characteristic of amblyopic eyes lead to the dominant eye controlling activation of the visual attention network. [ABSTRACT FROM AUTHOR]

Our previous study has shown impaired blood oxygen level-dependent (BOLD)/functional magnetic resonance imaging (fMRI) activation of the visual attention network in strabismic amblyopia (SA). However, there has been no comparison of resting state fMRI activation and functional connectivity (FC) in brain regions of interest (ROIs) along the visual attention network including visual cortex (V1), intraparietal sulcus (IPS), and frontal eye fields (FEFs) during closed eye resting across the SA (n = 20, 13LE), or anisometropic amblyopes (AA) (n = 20, 13LE) groups. Hence, we compared, gray matter volume (GMV), amplitude of low frequency fluctuations (ALFFs), regional homogeneity (ReHo), and FC in the left and right hemisphere ROIs of the visual attention network in SA, AA, and healthy controls (HCs) (n = 21). Correlation analyses of corrected visual acuity (cVA) of amblyopic eye and MRI results were also performed and showed that the LogMAR cVA of the amblyopic eye positively correlated with right zALFF and zReHo FEF of SA and right IPS of AA only. GMV of both left and right hemisphere V1 areas was significantly greater but ALFF was significantly lower for SA compared to AA and HC groups. zALFF and zReHo analyses in the AA and SA groups indicated significantly higher activation than that in the HC group in the right FEF and IPS but lower than that in the HC group in the left FEF, and only the SA group showed lower activation in both V1 areas than the HC group. FC values of the right FEF–left V1, right FEF–right V1, and right FEF–right IPS pathways in the SA and AA groups were also significantly higher than those in the HC group whereas all other FC values were non-significant. Thus, this study indicates that even during resting-state the visual attention network function is impaired in SA and AA participants with only right hemisphere FEF showing significant activation in SA and IPS in AA suggesting that the slower saccade activation times characteristic of amblyopic eyes lead to the dominant eye controlling activation of the visual attention network.

Our sense of depth perception is mediated by spatial filters at different scales in the visual brain; low spatial frequency channels provide the basis for coarse stereopsis, whereas high spatial frequency channels provide for fine stereopsis. It is well established that monocular blurring of vision results in decreased stereoacuity. However, previous studies have used tests that are broadband in their spatial frequency content. It is not yet entirely clear how the processing of stereopsis in different spatial frequency channels is altered in response to binocular input imbalance. Here, we applied a new stereoacuity test based on narrow-band Gabor stimuli. By manipulating the carrier spatial frequency, we were able to reveal the spatial frequency tuning of stereopsis, spanning from coarse to fine, under blurred conditions. Our findings show that increasing monocular blur elevates stereoacuity thresholds 'selectively' at high spatial frequencies, gradually shifting the optimum frequency to lower spatial frequencies. Surprisingly, stereopsis for low frequency targets was only mildly affected even with an acuity difference of eight lines on a standard letter chart. Furthermore, we examined the effect of monocular blur on the size tuning function of stereopsis. The clinical implications of these findings are discussed.

Background: Clinicians must be aware of phenotypic variability in neurofibromatosis type 1 (NF 1) presentations. There is perhaps a limited understanding on progression of NF 1 in prepubertal years and the subsequent threat to vision. Progressively increasing myopia may go unnoticed under a severely ptotic eyelid that gathers attention, due to a disfiguring mass in patients with NF 1. High myopia may result in recalcitrant amblyopia if not tackled early with multidisciplinary management. Clinical Description: A 12 year old girl had a history of progressively increasing left upper eyelid ptosis due to an upper eyelid mass, first noticed at the age of 1 year and eventually resulted in severe ptosis by the age of 5 years. However, this went unnoticed until she was diagnosed with NF 1 at the age of 12 years. Best corrected visual acuity was 6/6 (Plano) in the right eye (OD) and counting finger 2 m with − 15.0 diopter spheres in the left eye (OS). Peripheral fundus examination was normal in both eyes. Levo elevation and abduction were limited OS. Hypotropia, pulsatile proptosis, and depression of the globe were clinically attributable to enlargement of orbital tissues and lid problems. Contrast enhanced computed tomography scan revealed plexiform NF with extraconal extensions. Axial length was 21.94 mm OD and 28.92 mm OS. B scan ultrasound revealed a posterior staphyloma OS. Management: The patient underwent a debulking surgery of the eyelid mass which on histopathological examination confirmed plexiform NF. Surgery resulted in a cosmetic reduction in ptosis; however, any intervention was relatively too late to rehabilitate the left eye. Conclusions: Eye care certainly has its regional differences. High axial myopia may result in low VA and recalcitrant amblyopia that may go unrecognized and comes with management challenges to the attending ophthalmologist and allied specialties dealing with these cases of NF 1.

Purpose: To evaluate the effect of interocular axial length (AL) difference on outcomes of treatment for anisometropic amblyopia in comparison with normal participants. Methods: In this historical cohort study, 83 patients with anisometropic amblyopia were divided into two age groups, 70 children (mean, 7.86 ±1.56 and range, 5--15 years) and 13 adults (mean, 26.46 ±10.87 and range, 16--45 years). The control group consisted of 43 non-amblyopic children and 17 non-amblyopic adults. Treatment outcomes after a period of one year were defined as successful or unsuccessful when posttreatment amblyopic corrected distance visual acuity (CDVA) was reported as ≤0.9 versus CDVA ≤0.8, respectively. AL was measured using a Lenstar LS900 (Haag-Streit AG, Switzerland). Results: Fifty-nine patients showed satisfactory treatment outcomes (55 children and 4 adults), while unsuccessful treatment outcomes were observed in 24 patients (15 children and 9 adults). The mean of amblyopia treatment duration was 1.24 ± 0.76 years. The mean of interocular AL difference in all patients, control, successful and unsuccessful treatment outcome groups were 0.49 ± 0.70mm (range, 0.00--3.89 mm), 0.12 ± 0.07 mm (range, 0.02--0.41), 0.33 ± 0.23 mm (range, 0.00--0.99 mm), and 1.81 ± 0.80 mm (range, 1.14--3.89 mm), respectively. In both age groups, the mean of interocular AL difference in patients with unsuccessful treatment outcomes was greater than those with successful treatment outcomes and that of the control group (P <0.001). Conclusion: The results of this study suggest that the outcome of anisometropic amblyopia treatment may depend on the interocular AL difference. [ABSTRACT FROM AUTHOR]

Leila Sharbatoghli,1 Hassan Hashemi,2 Alireza Mohamadi,3 Ebrahim Jafarzadehpur,3 Abbasali Yekta,4 Ali Mirzajani,3 Mehdi Khabazkhoob5 1Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran; 2Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran; 3Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; 4Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 5Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, IranCorrespondence: Ebrahim JafarzadehpurRehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, IranTel +98 21 88651515Fax +98 21 88651514Email jafarzadehpour.e@iums.ac.irPurpose: The aim of this study is to evaluate the effect of active vision therapy in adults with anisometropic amblyopia.Methods: In this study, 20 adults with anisometropic amblyopia aged from 17– 35 years old were treated for five sessions (one session per week) with vision therapy techniques which include accommodative rock, vergence rock, and saccadic training. Moreover, computerized vision therapy was performed by Optosys® software. Also, patients had been given a daily program for home training, including accommodative and vergence rock, and Optosys® software. Best corrected visual acuity (BCVA) was measured before and after treatment.Results: Comparison of data using t-test showed that BCVA significantly improved after the vision therapy period. Initial BCVA (Log MAR) was 0.37± 0.04 (mean±standard deviation) which improved to 0.14± 0.03 after treatment. The correlation between initial BCVA and the amount of improvement showed that the worse the pre-treatment visual acuity was, the greater improvement that occurred.Conclusion: The improvement of visual acuity in adult anisometropic amblyopes showed that there are some degrees of plasticity in the visual system of amblyopic patients even in adulthood. Thus, therapists should give the chance of treatment to adult amblyopes.Keywords: anisometropic amblyopia, plasticity, visual acuity, adult

Zerrin Bayraktar, Seren Pehlivanoglu, Sukru Bayraktar, Sinan Albayrak, Muharrem Karakaya Department of Ophthalmology, Ozel Gaziosmanpasa Hospital, Yeni Yuzyil University School of Medicine, Istanbul, TurkeyCorrespondence: Zerrin Bayraktar Sahrayicedit Mah, Cami Sok, No. 30 Emintas Camlik Sitesi A, Blok D 10, Kadıkoy, Istanbul 34734, TurkeyTel +90 5337618977Email zerrinbayraktar@yahoo.comBackground: Inter-ocular symmetry of macular vascular anatomy in healthy subjects has been well documented in previous optical coherence tomography angiography (OCTA) studies. In our present study, we have demonstrated that the presence of anisometropic amblyopia in one eye does not alter this unique feature significantly. We investigated whether the presence of unilateral anisometropic amblyopia due to moderate amounts of hyperopia and/or astigmatism would have any significant influence on measurements of retinal thickness (RT) and superficial vessel density (SVD) in adult subjects.Subjects and methods: In the study group, both eyes of 21 adult subjects with unilateral anisometropic amblyopia were enrolled. Only one eye of an age-matched control group including 33 subjects was randomly selected. RT and SVD were measured in foveal and parafoveal retinal areas and compared in amblyopic eyes, their fellow eyes and in the control group. Inter-ocular symmetry of RT and SVD in amblyopic and fellow eyes were investigated by using correlation analysis.Results: There were statistically significant inter-ocular correlations of foveal and parafoveal RT in amblyopic and fellow eyes (P < 0.0001, for both). Foveal and parafoveal RT of the control group were not statistically different from amblyopic eyes (P = 0.072 and P = 0.46, respectively). There was no difference between foveal SVD of amblyopic eyes and control group (P = 0.10) and a significant inter-ocular correlation was found between amblyopic and fellow eyes (P = 0.029).Conclusion: For our adult subjects, none of the investigated OCTA parameters of the amblyopic eyes were found to be statistically different from those of age-matched controls. The preservation of inter-ocular symmetry in the amblyopic and fellow eyes implies that the influence of anisometropic amblyopia in one eye would be relatively small and negligible on routine OCTA examination.Keywords: anisometropic amblyopia, hyperopia, optical coherence tomography angiography, inter-ocular symmetry

Introduction: Amblyopia always presents with monocular and binocular dysfunction. In this study, we aim to investigate the efficacy of alternative occlusion using liquid crystal glasses versus continuous occlusion therapy using traditional patches for treating amblyopia. Methods: Eligible subjects with anisometropic amblyopia were randomized into 2 groups: alternative flicker glass (AFG) or patching group. In the AFG group, subjects were instructed to wear the flicker glasses for 1 h a day. The AFG is a lightweight spectacle frame with liquid crystal lenses that provide direct square-wave alternating occlusion, which were preprogrammed at a temporal frequency of 7 Hz. In the patching group, the patients were prescribed to wear traditional patches for 2 h a day. The best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and stereoacuity were measured at the baseline and 3 and 12 weeks. Results: In this pilot study, a total of 40 children were recruited, with 20 in the AFG group. Mean BCVA improved by 0.17 ± 0.14 logMAR (95% CI = 0.10–0.23) in the AFG group and 0.18 ± 0.18 logMAR (95% CI = 0.09–0.26) in the patching group from baseline to 12 weeks. The improvement in BCVA in both groups was significant (both p < 0.01), while there was no significant difference between the groups (p = 0.82). The CSF of both low and high spatial frequencies exhibited significant improvement at 12 weeks in the AFG group (p < 0.01, respectively) and just had a significant improvement at low spatial frequency in the patching group (p < 0.01). The stereoacuity significantly improved by 504.00 ± 848.00 (95% CI = 107.12 to 900.88) arc seconds in the AFG group (p < 0.05), while it was 263.50 ± 639.55 (95% CI = –35.82 to 562.82) arc seconds in the patching group (p > 0.05). Conclusion: Alternative flicker glass was effective in improving both monocular and binocular function, which was most likely achieved by reducing suppression and promoting binocular fusion. This therapy exhibited promise as an alternative method for amblyopia treatment. [ABSTRACT FROM AUTHOR]

Purpose: While much is known about the psychosocial impacts of strabismus, little is known about the effects of non‐strabismic amblyopia on quality of life (QoL). The aim of this study was to explore the long‐term impacts of anisometropic amblyopia. Methods: A phenomenological qualitative investigation was carried out on a sample of adults with anisometropic amblyopia. Subjects participated in in‐depth telephone interviews and described how their eye condition affected different aspects of their life. The interviews were audio‐recorded, transcribed verbatim and analysed iteratively to form emergent themes. Results: Sixteen participants took part in the study (median age: 21.5 years; range: 18–36 years; 11 male and 5 female). Six themes emerged: (1) symptoms experienced by participants, (2) concerns and apprehensions, (3) emotional impacts, (4) activity limitations, (5) hassle and inconveniences and (6) economic and career implications. Symptoms reported by participants ranged from glare to difficulty concentrating. They were extremely concerned about the safety of their better eye and lived with several doubts and anxieties. Negative emotions such as grief and disappointment due to eye care negligence in childhood was apparent. Guilt and regretful feelings were present in those who did not comply with past treatment. Participants expressed several limitations in driving, reading, mobility (e.g., using stairs) and tasks requiring high resolution. Reported inconveniences associated with coping with their eye condition included having to travel across the country in search of a cure for their amblyopia. Economic impacts ranged from costs associated with accessing eye care and management to career choices being compromised. Conclusion: Lived experiences of people with anisometropic amblyopia indicate that the QoL impacts are multifaceted and substantial, even in the absence of strabismus. The results have the potential to influence patient‐practitioner relationship by opening newer horizons to communication and care while managing adult amblyopes. [ABSTRACT FROM AUTHOR]

Background: Myopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort.Methods: This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses "ICLs" (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed.Results: The study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was - 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity "CDVA" (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow-up visits had a mean ± SD of 14.67 months ±16.56 (range of 1 to 54 months). The results showed a refractive stability, with statistically insignificant improvements in the patients' visual acuity and refractive status on evaluating the enrolled pediatrics during the follow-up visits compared to the first postoperative visits. No postoperative complications were encountered. Worthy of mention is that there was a significant (80%) non-compliance with the prescribed postoperative occlusion therapy.Conclusions: The present study, with the longest reported follow-up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting myopic anisometropic amblyopia in pediatrics. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases with failed conventional therapy to guard against anisometropic amblyopia. [ABSTRACT FROM AUTHOR]

Abstract Background Amblyopia is generally considered a neurodevelopmental disorder that results from abnormal visual experiences in early childhood and may persist to adulthood. The neural basis of amblyopia has been a matter of interest for many decades, but the critical neural processing sites in amblyopia are not entirely understood. Although many functional neuroimaging studies have found abnormal neuronal responses both within and beyond V1, few studies have focused on the neurophysiologic abnormalities in the visual cortex from the viewpoint of potential structural reorganization. In this study, we used a well-validated and highly accurate surface-based method to examine cortical morphologic changes in the visual cortex using multiple parameters (including cortical thickness, surface area, volume and mean curvature). Results The cortical thicknesses of the bilateral V1, left V2, left ventral V3, left V4 and left V5/MT+ in patients were significantly thinner than that in controls. The mean curvature of the bilateral V1 was significantly increased in the patients compared with the controls. For the surface area and gray matter volume, no significant differences were found between patients and controls in all region of interests. The cortical thicknesses of the bilateral V1 were both negatively correlated with the amount of anisometropia. No significant correlations were found between any other surface parameters and clinical variables. Conclusion In addition to cortical thickness, the altered mean curvature of the cortex may indicate neuroanatomic impairments of the visual cortex in patients with anisometropic amblyopia. Moreover, the structural changes were bilateral in the primary visual cortex but were unilateral in the secondary and more senior visual cortex.

Purpose: To observe efficacy of Virtual reality technology as a potential treatment for improving vision in anisometropic amblyopia without the need of occlusion or penalization. Study Design: Experimental case series. Place and Duration of Study: Isra University Hospital, Hyderabad, from Nov 2020 to Oct 2021. Methods: Patients (more than 12 years of age), with Anisometropic amblyopia, were included in this study. Patients with history of strabismus, cataract or any active ocular surface disease were excluded. Unaided visual acuity, pinhole test and best-corrected visual acuity were recorded, before and after treatment. LogMAR chart was used for this purpose. Crowding phenomenon was also checked. Anterior segment and posterior segment examination was done to rule out any organic cause of disease. A head mounted device-virtual reality glasses (HMD-VR) was used 40 min daily for 03 months to improve visual acuity. All the data was recorded on a proforma. SPSS version 22.0 was used for data analysis and P-value of <0.05 was considered significant. Result: Mean age of the patients was 24.2 years (range 14 - 35 years). Out of 14 registered cases, 08 (57.1%) patients showed improvement after 08 weeks of initiation of treatment with VR glasses. Two (14.3%) patients showed improvement after 12 weeks and two showed no improvement, while two (14.3%) patients lost to follow up. After applying paired t test the value of p was < 0.001, which was statistically significant. Conclusion: This HMD VR glasses seems to be an effective option for treatment in adults with anisometropic amblyopia. [ABSTRACT FROM AUTHOR]