Asper Lisa, Watt Kathleen, Khuu Sieu
School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.
Clin Exp Optom. 2018 Jul;101(4):431-442. doi: 10.1111/cxo.12657. Epub 2018 Feb 2.
Despite evidence that amblyopia can often be treated by optical treatment alone, many practitioners still do not use an optical-correction-only phase in amblyopia treatment and some investigators omit this important step in their research. This paper aims to systematically review the evidence for the optical treatment of strabismic, refractive and combined-mechanism amblyopia and to quantify the evidence via a meta-analysis.
A search of online databases MEDLINE, EMBASE, PsycInfo, the Cochrane Library, and bibliographies of review papers, along with subsequent personal communication, resulted in 29 papers that met our inclusion criteria, with 20 providing sufficient data for the calculation of effect sizes. A meta-analysis was performed to determine effect sizes and the heterogeneity thereof. Meta-regression was used to evaluate the contribution of the possible moderating factors of age, duration of optical correction, and initial visual acuity to the heterogeneity of the studies. In addition, effect sizes were analysed in subgroups based on amblyopia aetiology, that is refractive or strabismic or combined, and also in the fellow eyes.
No evidence of publication bias in the included studies was found using a Galbraith plot. Optical treatment of amblyopia resulted in a large positive effect size of 1.07 (±0.49, 95 per cent confidence limits) on visual acuity, although the heterogeneity was significant (Q = 597.05, I = 96.65 per cent, p < 0.0001). Meta-regression indicated that effect sizes significantly decreased with age, increased with treatment duration, and that better initial acuity was associated with higher effect sizes.
Effect sizes were always moderate to large, whether participants were younger or older children, or whether the aetiology was refractive or strabismic. Thus, optical treatment of amblyopia should be considered prior to other treatment in those with refractive error. Improved acuity before initiating other treatment would presumably make occlusion or penalisation less onerous and may improve compliance with further treatment.
尽管有证据表明弱视通常仅通过光学治疗即可治愈，但许多从业者在弱视治疗中仍未采用仅光学矫正阶段，一些研究人员在其研究中也省略了这一重要步骤。本文旨在系统回顾斜视性、屈光性和混合机制性弱视光学治疗的证据，并通过荟萃分析对证据进行量化。
检索在线数据库MEDLINE、EMBASE、PsycInfo、Cochrane图书馆以及综述文章的参考文献，并随后进行个人交流，共得到29篇符合纳入标准的论文，其中20篇提供了足够的数据用于计算效应量。进行荟萃分析以确定效应量及其异质性。采用元回归评估年龄、光学矫正持续时间和初始视力等可能的调节因素对研究异质性的贡献。此外，根据弱视病因（即屈光性、斜视性或混合性）以及对侧眼对效应量进行亚组分析。
使用Galbraith图未发现纳入研究存在发表偏倚的证据。弱视的光学治疗对视力产生了较大的正向效应量，为1.07（±0.49，95%置信区间），尽管异质性显著（Q = 597.05，I = 96.65%，p < 0.0001）。元回归表明，效应量随年龄显著降低，随治疗持续时间增加，且初始视力越好，效应量越高。
无论参与者是年幼儿童还是年长儿童，也无论病因是屈光性还是斜视性，效应量始终为中度至高度。因此，对于屈光不正患者，应在其他治疗之前考虑进行弱视的光学治疗。在开始其他治疗之前提高视力可能会使遮盖或压抑疗法的负担减轻，并可能提高对进一步治疗的依从性。
