Khan Taskin
Assistant Professor, Department of Ophthalmology, Hamdard Institute of Medical Sciences and Research , Jamia Hamdard, New Delhi, India .
J Clin Diagn Res. 2015 Aug;9(8):NC01-4. doi: 10.7860/JCDR/2015/13277.6288. Epub 2015 Aug 1.
Amblyopia, a common cause of low vision, is rarely treated in adults. Improvement in vision has been seen beyond the critical period at times. Hence, this study was taken up to study the effect of minimal occlusion therapy (2-4 hours/day) in anisometropic amblyopic patients in the age group of 12-30 years.
The study is a prospective, randomized case series of anisometropic amblyopia patients aged 12-30 years who reported in the outpatient department of Hakeem Abdul Hameed Centenary Hospital, New Delhi, from December 2011 to November 2013. Thorough ocular examination and cycloplegic refraction was done to rule out other ocular disease. Anisometropic Amblyopia was diagnosed only after four weeks of spectacle wear. The selected patients were then advised occlusion therapy of 2-4 hours per day of better eye with stress on near visual task. Videogames, computers, mobile phone gaming and colouring in especially designed patterns were used as vision training aids. The outcome measure selected was best corrected visual acuity (BCVA) achieved that remained stable for three consecutive months of occlusion.
Sixty one patients of anisometropic amblyopia were included in the study (32 males and 29 females) aged 12-30 years (mean age 17 years). Mean BCVA at the start of treatment was 20/125 (0.8 log MAR units) and 20/32 (0.2 log MAR units) at the end of the treatment. Thirty three patients (54%) out of 61 had BCVA of 20/20, while 58 patients (95%) had ≥ 20/40 BCVA, 01(1.6%) had 20/50 and 02 (3.27%) had 20/80 BCVA at the end of therapy. The results were statistically significant (p- value <0.0001) with a 95% confidence interval.
This study clearly proves that there is no critical period for the treatment in older (12-30 years) anisometropic amblyope. Even 2-4 hours per day of occlusion of better eye with vision training thorough near visual task of amblyopic eye is effective. However, counseling and patient compliance is important for successful outcome of therapy.
弱视是导致视力低下的常见原因，在成人中很少得到治疗。有时在关键期之后视力也会有所改善。因此，本研究旨在探讨最小遮盖疗法（每天2 - 4小时）对12至30岁屈光参差性弱视患者的疗效。
本研究是一项前瞻性、随机病例系列研究，研究对象为2011年12月至2013年11月期间在新德里哈基姆·阿卜杜勒·哈米德百年医院门诊部就诊的12至30岁屈光参差性弱视患者。进行了全面的眼部检查和睫状肌麻痹验光，以排除其他眼部疾病。仅在佩戴眼镜四周后才诊断为屈光参差性弱视。然后建议所选患者每天遮盖优势眼2 - 4小时，并强调进行近视力任务。电子游戏、电脑、手机游戏以及按照特别设计的图案进行填色被用作视力训练辅助工具。所选的结局指标是达到的最佳矫正视力（BCVA），且在连续三个月的遮盖治疗期间保持稳定。
本研究纳入了61例12至30岁（平均年龄17岁）的屈光参差性弱视患者（32例男性和29例女性）。治疗开始时的平均BCVA为20/125（0.8 log MAR单位），治疗结束时为20/32（0.2 log MAR单位）。61例患者中有33例（54%）的BCVA达到20/20，而在治疗结束时，58例（95%）患者的BCVA≥20/40，1例（1.6%）患者的BCVA为20/50，2例（3.27%）患者的BCVA为20/80。结果具有统计学意义（p值<0.0001），置信区间为95%。
本研究清楚地证明，年龄较大（12至30岁）的屈光参差性弱视患者不存在治疗关键期。即使每天仅遮盖优势眼2 - 4小时，并通过弱视眼的近视力任务进行视力训练也是有效的。然而，咨询和患者的依从性对于治疗的成功结果很重要。
