Hamm Lisa M, Chen Zidong, Li Jinrong, Dai Shuan, Black Joanna, Yuan Junpeng, Yu Minbin, Thompson Benjamin
School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.
State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Clin Exp Optom. 2018 Jul;101(4):541-552. doi: 10.1111/cxo.12630. Epub 2017 Nov 28.
Children with deprivation amblyopia due to childhood cataract have been excluded from much of the emerging research into amblyopia treatment. An investigation was conducted to determine whether contrast-balanced binocular treatment - a strategy currently being explored for children with anisometropic and strabismic amblyopia - may be effective in children with deprivation amblyopia.
An unmasked, case-series design intended to assess proof of principle was employed. Eighteen children with deprivation amblyopia due to childhood cataracts (early bilateral n = 7, early unilateral n = 7, developmental n = 4), as well as 10 children with anisometropic (n = 8) or mixed anisometropic and strabismic amblyopia (n = 2) were prescribed one hour a day of treatment over a six-week period. Supervised treatment was available. Visual acuity, contrast sensitivity, global motion perception and interocular suppression were measured pre- and post-treatment.
Visual acuity improvements occurred in the anisometropic/strabismic group (0.15 ± 0.05 logMAR, p = 0.014), but contrast sensitivity did not change. As a group, children with deprivation amblyopia had a smaller but statistically significant improvement in weaker eye visual acuity (0.09 ± 0.03 logMAR, p = 0.004), as well a significant improvement in weaker eye contrast sensitivity (p = 0.004). Subgroup analysis suggested that the children with early bilateral deprivation had the largest improvements, while children with early unilateral cataract did not improve. Interestingly, binocular contrast sensitivity also improved in children with early bilateral deprivation. Global motion perception improved for both subgroups with early visual deprivation, as well as children with anisometropic or mixed anisometropic/strabismic amblyopia. Interocular suppression improved for all subgroups except children with early unilateral deprivation.
These data suggest that supervised contrast-balanced binocular treatment should be further investigated as a treatment option for children with deprivation amblyopia. However, for children with more severe deprivation amblyopia due to early unilateral cataracts, supplementary or alternative options should also be explored.
因儿童白内障导致的剥夺性弱视儿童被排除在许多关于弱视治疗的新兴研究之外。开展了一项调查，以确定对比度平衡双眼治疗（一种目前正在为屈光参差性和斜视性弱视儿童探索的策略）对剥夺性弱视儿童是否有效。
采用旨在评估原理证明的非盲法病例系列设计。18名因儿童白内障导致剥夺性弱视的儿童（早期双侧性n = 7，早期单侧性n = 7，发育性n = 4），以及10名屈光参差性（n = 8）或屈光参差性与斜视性混合弱视（n = 2）的儿童，在六周内每天接受一小时的治疗。提供监督治疗。在治疗前后测量视力、对比敏感度、整体运动感知和双眼抑制。
屈光参差性/斜视性组视力有所改善（0.15±0.05 logMAR，p = 0.014），但对比敏感度未改变。作为一个整体，剥夺性弱视儿童较弱眼的视力有较小但具有统计学意义的改善（0.09±0.03 logMAR，p = 0.004），较弱眼的对比敏感度也有显著改善（p = 0.004）。亚组分析表明，早期双侧剥夺的儿童改善最大，而早期单侧白内障的儿童没有改善。有趣的是，早期双侧剥夺的儿童双眼对比敏感度也有所改善。早期视力剥夺的两个亚组以及屈光参差性或屈光参差性与斜视性混合弱视的儿童的整体运动感知均有所改善。除早期单侧剥夺的儿童外，所有亚组的双眼抑制均有所改善。
这些数据表明，应进一步研究监督下的对比度平衡双眼治疗作为剥夺性弱视儿童的一种治疗选择。然而，对于因早期单侧白内障导致的更严重剥夺性弱视儿童，也应探索补充或替代方案。
