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      Reduction of Deviation Angle During Occlusion Therapy: In Partially Accommodative Esotropia with Moderate Amblyopia

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          Abstract

          Purpose

          To evaluate changes in ocular alignment in partially accommodative esotropic children age ranged from 3 to 8 years during occlusion therapy for amblyopia.

          Methods

          Angle measurements of twenty-two partially accommodative esotropic patients with moderate amblyopia were evaluated before and at 2 years after occlusion therapy.

          Results

          Mean deviation angle with glasses at the start of occlusion treatment was 19.45±5.97 PD and decreased to 12.14±12.96 PD at 2 years after occlusion therapy (p<0.01). After occlusion therapy, 9 (41%) cases were indications of surgery for residual deviation but if we had planned surgery before occlusion treatment, 18 (82%) of patients would have had surgery. There was a statistical relationship between increase of visual acuity ratio and decrease of deviation angle (r=-0.479, p=0.024).

          Conclusions

          There was a significant reduction of deviation angle of partially accommodative esotropic patients at 2 years after occlusion therapy. Our results suggest that occlusion therapy has an influence on ocular alignment in partially accommodative esotropic patients with amblyopia.

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          Most cited references10

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          Binocular vision and ocular motility

          GK Noorden, EC Campos (2002)
          Article 0 comments Cited 33 times – based on 0 reviews     Review now
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            Reliability of fixation preference testing in diagnosing amblyopia.

            Christina Yiu, F Walonker, Ann K. Wright … (1986)
            We evaluated the sensitivity and specificity of standard fixation preference testing and the 10-prism diopter (PD) fixation test in 427 patients. Standard fixation preference testing showed good sensitivity and specificity for than 10 PD. Patients with small angle tropias, however, had a high false-positive rate, with 40% of nonamblyopic patients inappropriately responding with strong fixation preference. The 10-PD fixation test reduced this high false-positive rate and showed only 1.5% false-positive results. Unfortunately, this shift to equal fixation preference was also seen in some patients with amblyopia, as five of 19 patients with three or more lines difference alternated fixation with the 10-PD fixation test. Retesting disclosed that, although these children would briefly alternate to the amblyopic eye while viewing a stationary target, they would not hold fixation with the amblyopic eye through smooth pursuit. Our conclusion is that standard fixation preference testing can be used to diagnose moderate to severe amblyopia in patients with tropias greater than 10 PD. Patients with small angle deviations or straight eyes should be examined with the 10-PD fixation test, with the criterion for equal vision being the ability to hold fixation well with either eye through smooth pursuit.
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              Timing of amblyopia therapy relative to strabismus surgery.

              Andrew K C Lam, M X Repka, D Guyton (1993)
              It is taught that amblyopia must be fully reversed before surgery for esotropia is undertaken to achieve the best surgical outcome. In some cases, this means delaying surgery for many months. The alternative of operating early, before the completion of amblyopia therapy, and continuing to treat the amblyopia postoperatively has not been evaluated previously. Forty-seven children younger than 8 years of age were identified with a history of both amblyopia and esotropia. They had no other ocular, medical, or neurologic abnormalities. They had no prior strabismus surgery. Of these 47 patients, 26 had their amblyopia fully treated before surgery, and 21 underwent surgery before completing amblyopia therapy. Five of the latter group did not require amblyopia therapy after surgery even though they were still amblyopic before operation. The motor outcome was assessed by comparing the motor alignment at 6 and 0.33 m using accommodative targets in primary position before surgery, at 6 months after surgery, and at the child's most recent visit. Motor success was defined in this study as a postoperative deviation at distance fixation of 8 prism diopters or less. The sensory result was assessed by comparing the frequency of detectable stereoacuity. The treatment groups did not differ significantly in age, depth of amblyopia, refractive error, or preoperative angle. There was no significant difference detected in motor or sensory outcome whether amblyopia was fully or only partially treated before surgery. Performing corrective surgery in children with esotropia before full resolution of amblyopia is safe and efficient if the amblyopia therapy is continued after surgery. This strategy permits earlier surgery without postponing the operation until full resolution of amblyopia. The finding that five patients did not require amblyopia therapy after surgery suggests that eye re-alignment itself can help reverse amblyopia in some cases.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Ophthalmol
                Journal ID (publisher-id): KJO
                Title: Korean Journal of Ophthalmology : KJO
                Publisher: The Korean Ophthalmological Society
                ISSN (Print): 1011-8942
                Publication date (Print): September 2007
                Publication date (Electronic): 20 September 2007
                Volume: 21
                Issue: 3
                Pages: 159-162
                Affiliations
                Department of Ophthalmology, Kyungpook National University, School of Medicine, Daegu, Korea.
                Author notes
                Reprint requests to Jung Yoon Kwon, MD. PhD. Department of Ophthalmology, Kyungpook National University College of Medicine. 50 Samduk-2ga, Jung-gu, Daegu 700-721, Korea. Tel: 82-53-420-5812, Fax: 82-53-426-6552, jykwon@ 123456mail.knu.ac.kr
                Article
                DOI: 10.3341/kjo.2007.21.3.159
                PMC ID: 2629679
                PubMed ID: 17804922
                SO-VID: 85bb37f8-4989-46aa-8b34-a44027097029
                Copyright © Copyright © 2007 The Korean Ophthalmological Society
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 January 2007
                Date accepted : 21 June 2007
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: amblyopia,partially accommodative esotropia,visual acuity ratio,occlusion therapy,ocular alignment
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: amblyopia, partially accommodative esotropia, visual acuity ratio, occlusion therapy, ocular alignment

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