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Dr. Vinod Kumar Baranwal, B06219, Dr. Nidhi Kalra, Dr. (Col) Rajendra Prasad Gupta, Dr. Gaurav Kapoor

INTRODUCTION

Amblyopia is a developmental defect of spatial visual processing that occurs in the central visual pathways of the eye.1These defects may be explained by the mechanism of lack of use of an eye because of media opacity or extreme refractive errors that cause a chronically blurred image to form on the fovea of that eye; however, the cause of amblyopia in an eye that has strabismus is not as straightforward and is the result of abnormal binocular interaction.2

Amblyopia is graded in three grades, Mild amblyopia (BCVA>20/40, Moderate amblyopia (BCVA 20/60- 20/80) and Severe amblyopia (BCVA =20/120).

Amblyopia should be suspected in any strabismus child who has a preference for fixation with one eye, but it is important to recognize that many patients who have amblyopia have aligned eyes (monofixation syndrome with amblyopia).Amblyopia should also be suspected as acontributor to decreased visual acuity when the hyperopic refractiveerrors between the two eyes differ by more than about 2.00 D, whenthe myopic refractive errors differ by more than about 4.00 D, and when astigmatic errors differ by more than about 1.25 D.3

Patients who have amblyopia usually have no detectable abnormal structural lesions in the eye. However, patients who have abnormal structural lesions may have a superimposed amblyopia. Many patients who have abnormal structural eye lesions benefit from a trial of amblyopia therapy.4Correction of significant refractive errors is an essential preparation for active amblyopia treatment.

There are different treatment options available, and patching is the gold standard of therapy.Occlusion therapy by a patch over the better-sighted eye remains the mainstay of active treatment of amblyopia, even in patients who have eccentric fixation.2However opinions are varied about how many hours of daily patching should be prescribed for treatment of moderate amblyopia ranging from as little 1or 2 hours to 24 hours per day.2Patients who undergo full-time occlusion are re-evaluated at intervals of a week per year of life. Approximately one-fourth of successfully treated amblyopic children experience a recurrence within 6 Months of treatment cessation.5Prognostic considerations are younger the age better the prognosis, and the type of amblyopia.

Recently a new treatment modality has been developed in the form of occluding the eye intermittently by wearable glasses whose screen is made of liquid crystal glasses (digital patch). (reference) In this treatment modality, the dominant eye is occluded intermittently. This new treatment approach may be  a good alternative to conventional patch therapy and it has several advantages over conventional patch therapy e.g. better compliance ,lower chances of suppression of better eye ,easy to operate and the duration  of occlusion of eye can be adjusted, no social stigma ,no allergic reactions , cosmetically accepted.

Aim of the study

“TO COMPARE THE EFFICACY OF STANDARD PATCHING THERAPY AND DIGITAL SMART GLASSES IN TREATMENT OF AMBLYOPIA” Sentence case would be preferred

MATERIAL AND METHODS

Study was conducted at the Eye Out-Patient Department of a tertiary eye care center from Sep 2016 to Sep 2017.It was a prospective, interventional, safety/efficacy study with primary purpose of treatment. Institutional ethical clearance was (same tense either past or present) taken for conduct of study and informed consent (future tense) was be taken from patients. A detailed ocular examination was done for all cases at enrollment, at 4 weeks, at 8 weeks, at 12 Weeks, 24 weeks and 36 weeks of follow-up.Children included in study were 3-10 years olduntreated, moderate, unilateral anisometropicamblyopes.Two groups were formed in this study for comparative analysis. Subjects were allocated into one of the 2 groups randomly.(how was the randomization done) Total 30 patients were included. GROUP 1:  included 15 eyes of the children 3-10 years of age with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/100 in the amblyopic eye). This group used a 6-hour intermittent occlusion therapy with smart glasses, set at 40-second opaque/ 20 second transparent intervals (occluded 66% of wear time).

GROUP 2 included 15 eyes of the patient with Children 3-8 years of age with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/100 in the amblyopic eye). All subjects woreoptimal refractive correction .This group used a 4-hour continuous patching (occluded 100% of wear time).

For each patient, visual acuity was measured using snellen’s vision chart before and at 1 week, 4 week, 8 week, and 12 week, 24 week and after 36 weeks of treatment.

Results were analyzed by appropriate statistical methods.

Results and conclusion

In both groups improvement was significant, but the difference between groups was not significant. No adverse effects were reported. Intermittent occlusion therapy with liquid crystal glasses is not inferior to adhesive patching and is a promising alternative treatment for Children 3-8 years of age with moderate amblyopia.

This new treatment approach is a good alternative to conventional patch therapy ,it has several advantages over conventional patch therapy e.g. better compliance ,lower chances of suppression of better eye ,easy to operate and the duration  of occlusion of eye can be adjusted, no social stigma ,no allergic reactions , cosmetically accepted. Its efficacy in the form of visual acuity improvement of two snellen’s line is comparable to standard patch therapy after 3 months of therapy.

Limitations of study

Many studies have been conducted to compare efficacy of gold standard patching therapy and other treatment options available. Most studies are done to compare efficacy of gold standard patching therapy and atropine penalization6.

REFERENCES

  1. Eggers HM. Amblyopia. In: Diamond GR, Eggers HM,eds. Strabismus and pediatric ophthalmology, Vol. 5 in Podos SM, Yanoff M, eds. Textbook of ophthalmology. London: Mosby; 1993: 13.1–17.
  2. MyronYanoff& Jay S. Duker, Ophthalmology-Sixth Edition.
  3. Donahue SP. Relationship between anisometropia,patient age and the development of amblyopia. Trans Am Opthalmol Soc. 2005;103:313–36.
  4. Bradford GM, Kutschke PJ, Scott WE. Results of amblyopia therapy in eyes with unilateral structural abnormalities.Ophthalmology. 1992; 99:1616–21
  5. Pediatric Eye Disease Investigator Group. Risk of amblyopia recurrence after cessation of treatment.JPediatrOphthalmol Strabismus. 2004;8:420–8.
  6. The Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs. patching for Treatment of moderate amblyopia in children. Arch Ophthalmol 2002;120:268–78.

Didn’t find any discussion in the paper.

 

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