Spectacle correction versus no spectacles for prevention of strabismus in hyperopic children.
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ABSTRACT:
SUBMITTER: Jones-Jordan L
PROVIDER: S-EPMC7117860 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe aims of the study were to develop guidelines for prescribing spectacles for patients with moderate to severe hyperopic amblyopia and to demonstrate how emmetropization progresses.MethodsChildren with hyperopic amblyopia who had a spherical equivalent of ≥ +4.0 diopters (D) or more were included, while those who had astigmatism of > 2.0 D or anisometropia of > 2.0 D were excluded. The patients were divided into a full correction group and an under-correction group according to the amount of hyperopia correction applied. The under-correction group was further subdivided into a fixed under-correction group and a post-cycloplegic refraction (PCR) under-correction group. The duration of amblyopia treatment and changes in initial hyperopia were compared between the groups.ResultsIn total, 76 eyes of 38 patients were analyzed in this study. The full correction group and under-correction group were subjected to 5.5 months and 5.9 months of amblyopia treatment, respectively (P = 0.570). However, the PCR under-correction group showed more rapid improvement (2.9 months; P = 0.001). In the under-correction group, initial hyperopia was decreased by -0.28 D and -0.49 D at 6 months and 12 months, respectively, after initial cycloplegic refraction. Moreover, the amount of hyperopia under-correction was correlated with the amount of hyperopia reduction (P = 0.010).ConclusionThe under-correction of moderate to severe hyperopic amblyopia has beneficial effects for treating amblyopia and activating emmetropization. PCR under-correction can more rapidly improve visual acuity, while both fixed under-correction and PCR under-correction can induce emmetropization and effectively reduce initial hyperopia.
| S-EPMC5397024 | biostudies-literature
Project description:Importance:Uncorrected refractive errors are the most common cause of visual impairment in children despite correction being highly cost-effective. Objective:To determine whether less expensive ready-made spectacles produce rates of spectacle wear at 3 to 4 months comparable to those of more expensive custom-made spectacles among eligible school-aged children. Design, Setting, and Participants:This noninferiority, double-masked, randomized clinical trial recruited children aged 11 to 15 years from January 12 through July 31, 2015, from government schools in urban and periurban areas surrounding Bangalore, India. Follow-up occurred from August 1 through September 31, 2015. Participants met the following eligibility criteria for ready-made spectacles: failed vision screening at the 6/9 level in each eye; refraction was indicated; acuity improved with correction by 2 or more lines in the better-seeing eye; the corrected acuity with the spherical equivalent was not more than 1 line less than with full correction; anisometropia measured less than 1.0 diopter; and an appropriate frame was available. Interventions:Eligible children were randomized to ready-made or custom-made spectacles. Main Outcomes and Measures:Proportion of children wearing their spectacles at unannounced visits 3 to 4 months after the intervention. Results:Of 23?345 children aged 11 to 15 years who underwent screening, 694 had visual acuity of less than 6/9 in both eyes, and 535 underwent assessment for eligibility. A total of 460 children (227 female [49.3%] and 233 male [50.7%]; mean [SD] age, 13.4 [1.3] years) were eligible for ready-made spectacles (2.0% undergoing screening and 86.0% undergoing assessment) and were randomized to ready-made (n?=?232) or custom-made (n?=?228) spectacles. Follow-up rates at 3 to 4 months were similar (184 [79.3%] in the ready-made group and 178 [78.1%] in the custom-made group). Rates of spectacle wear in the 2 arms were similar among 139 of 184 children (75.5%) in the ready-made arm and 131 of 178 children (73.6%) in the custom-made arm (risk difference, 1.8%; 95% CI, -7.1% to 10.8%). Conclusions and Relevance:Most children were eligible for ready-made spectacles, and the proportion wearing ready-made spectacles was not inferior to the proportion wearing custom-made spectacles at 3 to 4 months. These findings suggest that ready-made spectacles could substantially reduce costs for school-based eye health programs in India without compromising spectacle wear, at least in the short term. Trial Registration:isrctn.com Identifier: ISRCTN14715120.
| S-EPMC5847082 | biostudies-literature
Project description:BackgroundNormal visual development occurs when the brain is able to integrate the visual input from each of the two eyes to form a single three-dimensional image. The process of development of complete three-dimensional vision begins at birth and is almost complete by 24 months of age. The development of this binocular vision is hindered by any abnormality that prevents the brain from receiving a clear, similar image from each eye, due to decreased vision (e.g. amblyopia), or due to misalignment of the two eyes (strabismus or squint) in infancy and early childhood. Currently, practice patterns for management of a child with both strabismus and amblyopia are not standardized.ObjectivesTo study the functional and anatomic (ocular alignment) outcomes of strabismus surgery before completion of amblyopia therapy as compared with surgery after completion of amblyopia therapy in children under seven years of age.Search methodsWe searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to July 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 24 July 2014. A manual search for articles from a review of the references of the selected publications and conference abstracts was completed to identify any additional relevant studies.Selection criteriaWe searched for randomized controlled trials (RCTs) that provided data on strabismus surgery in children less than seven years of age, performed after initiation of, but before completion of amblyopia therapy, as compared with strabismus surgery after completion of amblyopia therapy.Data collection and analysisTwo authors independently assessed studies identified from the electronic and manual searches.Main resultsThere were no RCTs that fit our inclusion criteria and so no analysis was possible.Authors' conclusionsAs there are no RCTs currently available and the best existing evidence is only from non-randomized studies, there is a need for prospective RCTs to investigate strabismus surgery in the presence of strabismic amblyopia. The optimal timing of when to perform strabismus surgery in children with amblyopia is unknown.
| S-EPMC4438561 | biostudies-literature
Project description:OBJECT: To record emmetropization, visual acuity, and strabismus outcomes among hyperopic infants followed with partial hyperopic corrections given in accordance with dynamic retinoscopy (DR). METHODS: Infants (3.5-12 months of age) with ≥5 D hyperopia were followed without glasses or partial hyperopic corrections prescribed according to their near dynamic accommodative abilities determined by DR responses at the initial visit and follow-ups. Refraction and binocular accommodative ability assessments were made at 3-month intervals up to the age of 1 and at 6-month intervals afterwards for a mean 35.4±2.1 months; main outcome measures being the development of esotropia, emmetropization rate, and visual acuity level after emmetropization period. RESULTS: Among 211, 146 were normal accommodators initially (Group 1). These infants were followed without treatment and none presented with strabismus. Sixty-five infants were hypo-accommodators (Group 2) and received minimum DR-based corrections. Of the 65 infants 31 (48%) developed strabismus (Group 2B). The remaining 34 constituted Group 2A. Each of the three groups showed an overall reduction of hyperopia by 0.37±0.25 days per year, 0.50±0.28 days per year, and 0.60±0.20 days per year, respectively. Visual acuity assessments among Groups 1 and 2A revealed normal values (0.2-0.0 LogMAR); among Group 2B 19% were within normal range. CONCLUSIONS: Binocular accommodative behavior at the initial visit seems to be one of the indicators for pointing out infants at risk of developing strabismus and amblyopia. Prescription of DR-based corrections to hyperopic orthotropic infants does not impede emmetropization and result in normal visual acuities after emmetropization period.
| S-EPMC4194332 | biostudies-other
Project description:Background and aimGlobally, 12.8 million children have vision impairment due to uncorrected refractive error (URE). In Mongolia, one in five children needs but do not have access to spectacles. This pilot cost-benefit analysis aims to estimate the net benefits of a children's spectacles reimbursement scheme in Mongolia.MethodsA willingness-to-pay (WTP) survey using the contingent valuation method was administered to rural and urban Mongolia respondents. The survey assessed WTP in additional annual taxes for any child with refractive error to be provided government-subsidised spectacles. Net benefits were then calculated based on mean WTP (i.e. benefit) and cost of spectacles.ResultsThe survey recruited 50 respondents (mean age 40.2 ± 9.86 years; 78.0% women; 100% response rate) from rural and urban Mongolia. Mean WTP was US$24.00 ± 5.15 (95% CI US$22.55 to 25.35). The average cost of a pair of spectacles in Mongolia is US$15.00. Subtracting the average cost of spectacles from mean WTP yielded a mean positive net benefit of US$9.00.ConclusionA spectacle reimbursement scheme is potentially a cost-effective intervention to address childhood vision impairment due to URE in Mongolia. These preliminary findings support the proposal of the inclusion of children's spectacles into existing Social Health Insurance. A much larger random sample could be employed in future research to increase the precision and generalisability of findings.
| S-EPMC9377584 | biostudies-literature
Project description:PurposeTo compare the surgical outcomes of slanted versus augmented recession in patients with horizontal strabismus.MethodsIn this randomized clinical trial, a total of 100 esotropic (ET) and exotropic (XT) patients with a high AC/A ratio which was defined as a difference of ≥ 10 prism diopters (pd) between the distance and near deviations were included if the patients had a distance deviation ≥ 15 pd. Patients were randomly assigned into the slanted (n = 26 in ET and n = 24 in XT group) and augmented recession groups (n = 25 in ET and n = 25 in XT group). In the slanted group, recession was performed on the superior and inferior poles of the muscle based on the distance and near deviations, respectively, while in the augmented recession group, the muscles were recessed 1.00 or 1.50 mm more than the standard amount according to the distance and near difference between 10 and 20 pd or > 20 pd, respectively.ResultsThe mean age was 9.8 ± 9.6 years and 63% were female. There was a significant postoperative reduction of difference in convergence excess in ET cases compared to patients who underwent the augmented recession procedure (12.65 ± 6.16 vs 8.64 ± 6.1 pd, P = 0.014). Among our XT groups, there was no significant difference in postoperative reduction in the XT angle in the slanted group compared with the augmented group (P > 0.05).ConclusionSlanted recession is recommended in convergence excess ET patients. In XT patients, either slanted or augmented recession may be chosen according to the priority and experience of the surgeon.
| S-EPMC6825697 | biostudies-literature
Project description:PurposeTo report the characteristics of patients with restrictive diplopia following pterygium excision and a successful treatment approach for the strabismus.DesignRetrospective interventional case series.MethodsThis study was set in a single academic institution and included 15 patients with restrictive diplopia after pterygium excision. Patients with any other reason for strabismus were excluded. Patients were evaluated for deficits with special attention to diplopic measures. The intervention was a combined procedure by a strabismologist and oculoplastic surgeon to correct the diplopia. The primary outcome measurements were subjective and objective improvement of diplopia.ResultsFifteen patients (mean age = 49 years) who developed diplopia after pterygium excision were included. Mean time to diplopia was 6 months. All patients had limited abduction in the previously operated eye causing esotropia in the abductive field (mean deviation = 18 prism diopters). After intervention, all patients were no longer diplopic in primary gaze. In the abductive field, 11 (73%) patients had residual small angle esotropia (mean = 7 prism diopters) in ipsilateral extreme end-gaze only. Only 2 patients required additional surgical intervention for scar tissue removal. No patients underwent medial rectus recession.ConclusionsRestrictive diplopia is a potential complication after pterygium excision, particularly for patients with a history of recurrent pterygia requiring multiple excisions and previous amniotic membrane graft placement with fibrin glue. However, diplopia after pterygium excision in primary position is surgically correctable with scar tissue removal and ocular surface reconstruction, without needing medial rectus recession. Given the high volume of pterygium excision, awareness of postoperative restrictive strabismus and the potential for correction is critical.
| S-EPMC6548686 | biostudies-literature
Project description:Hyperopia is a common refractive error, apparent in 25% of Europeans. Treatments include spectacles, contact lenses, laser interventions and surgery including implantable contact lenses and lens extraction. Laser treatment offers an expedient and reliable means of correcting ametropia. LASIK is well-established however SMILE (small-incision lenticule extraction) or lenticule implantation (derived from myopic laser-correction) are newer options. In this study we compared the outcomes of hyperopic LASIK, SMILE and lenticule re-implantation in a primate model at +2D/+4D treatment. While re-implantation showed the greatest regression, broadly comparable refractive results were seen at 3-months with SMILE and LASIK (<1.4D of intended), but a greater tendency to regression in +2D lenticule reimplantation. Central corneal thickness showed greater variation at +2D treatment, but central thickening during lenticule reimplantation at +4D treatment was seen (-17± 27?m LASIK, -45 ± 18?m SMILE and 28 ± 17?m Re-implantation; p <0.01) with expected paracentral thinning following SMILE. Although in vivo confocal microscopy appeared to show higher reflectivity in all +4D treatment groups, there were minimal and inconsistent changes in inflammatory responses between modalities. SMILE and lenticule re-implantation may represent a safe and viable method for treating hyperopia, but further optimization for lower hyperopic treatments is warranted.
| S-EPMC5874005 | biostudies-literature
Project description:PurposeThis study identifies and characterizes the nasotemporal hemifield difference of interocular suppression in subjects who have been successfully treated for strabismus.MethodsInterocular suppression in the nasal and temporal hemifields were measured using two methods, namely, binocular phase combination and dichoptic motion coherence, both entailed suprathreshold stimuli. We tested 29 clinical subjects, who had strabismus (19 with exotropia and 10 with esotropia) but regained good ocular alignment (within 10 prism diopters) after surgical or refractive correction, and 10 control subjects.ResultsBoth the hemifield binocular phase combination and the hemifield dichoptic motion coherence tests revealed similar nasotemporal asymmetry of interocular suppression. Subjects with previous exotropia showed deeper suppression in the nasal hemifield, and those with previous esotropia showed deeper suppression in the temporal hemifield. This finding was consistent with the hemifield suppression theory. Furthermore, there was deeper suppression but less imbalance of nasotemporal asymmetry in the hemifield dichoptic motion coherence test. Finally, clinical stereopsis and the nasotemporal asymmetry of suppression (P < 0.05 in both tests) were negatively correlated in subjects with previous exotropia and measurable stereopsis.ConclusionsHemifield asymmetry of interocular suppression in corrected strabismus can be measured by using static and dynamic suprathreshold stimuli. Thus, the evaluation of binocular vision in strabismus should focus on both the magnitude and the pattern of interocular suppression.
| S-EPMC7425725 | biostudies-literature
Project description:The objective of this study is to examine the role of proprioception in postural balance in children with strabismus before and after realignment of their visual axes by eye surgery. Postural recordings were made with the TechnoConcept® force platform in 23 children. Several conditions were studied, whether the subjects had both eyes open, or either the dominant or the non-dominant eye open, without and with foam pads of 4 mm underfoot. Recordings were performed before and after strabismus surgery. The surface area, the length and the mean speed of the center of pressure (CoP) were analyzed. Before strabismus surgery, all children showed better stability with both eyes open with respect to the condition with the non-dominant eye open; furthermore postural stability improved in the presence of foam pads. After surgery, the surface area of CoP decreased significantly, especially in the non-dominant eye viewing condition. We suggest that strabismic children use mainly proprioceptive information in order to control their posture, but also visual inputs, which are important for obtaining a good postural stability. The alignment of the visual axes after surgery provides enhanced postural stability, suggesting, again the major role of visual inputs in the control of posture. Proprioceptive plasticity after strabismus surgery may allow better visual rehabilitation.
| S-EPMC5012200 | biostudies-literature