Holmes Jonathan M, Lazar Elizabeth L, Melia B Michele, Astle William F, Dagi Linda R, Donahue Sean P, Frazier Marcela G, Hertle Richard W, Repka Michael X, Quinn Graham E, Weise Katherine K
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
Arch Ophthalmol. 2011 Nov;129(11):1451-7. doi: 10.1001/archophthalmol.2011.179. Epub 2011 Jul 11.
To determine whether age at initiation of treatment for amblyopia influences the response among children 3 to less than 13 years of age with unilateral amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity.
A meta-analysis of individual subject data from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol. Age was categorized (3 to <5 years, 5 to <7 years, and 7 to <13 years) because there was a nonlinear relationship between age and improvement in amblyopic eye visual acuity.
Children from 7 to less than 13 years of age were significantly less responsive to treatment than were younger age groups (children from 3 to <5 years of age or children from 5 to <7 years of age) for moderate and severe amblyopia (P < .04 for all 4 comparisons). There was no difference in treatment response between children 3 to less than 5 years of age and children 5 to less than 7 years of age for moderate amblyopia (P = .67), but there was a suggestion of greater responsiveness in children 3 to less than 5 years of age compared with children 5 to less than 7 years of age for severe amblyopia (P = .09).
Amblyopia is more responsive to treatment among children younger than 7 years of age. Although the average treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to treatment.
确定弱视治疗开始时的年龄是否会影响3至未满13岁、单眼弱视且弱视眼视力为20/40至20/400的儿童的治疗反应。
对4项近期完成的随机弱视治疗试验的个体受试者数据进行荟萃分析，以评估年龄与弱视眼logMAR视力改善之间的关系。分析针对基线弱视眼视力、弱视眼等效球镜屈光不正、弱视类型、既往弱视治疗、研究治疗和方案进行了调整。由于年龄与弱视眼视力改善之间存在非线性关系，因此将年龄分为3至<5岁、5至<7岁和7至<13岁。
对于中度和重度弱视，7至未满13岁的儿童对治疗的反应明显低于较年轻的年龄组（3至<5岁的儿童或5至<7岁的儿童）（所有4项比较的P <.04）。对于中度弱视，3至未满5岁的儿童与5至未满7岁的儿童在治疗反应上没有差异（P =.67），但对于重度弱视，3至未满5岁的儿童与5至未满7岁的儿童相比，有治疗反应更大的趋势（P =.09）。
7岁以下儿童的弱视对治疗反应更好。虽然7至未满13岁儿童的平均治疗反应较小，但一些儿童对治疗有明显反应。
