Amblyopia

[Ms. Kathy]

Amblyopia begins before birth when a clear image cannot be focused in one eye and the message to the brain from that eye is not developed correctly. According to Dr. Greene.com (http://www.drgreene.com/21_1024.html)
"Anything that interferes with a normal image on the retina during this time can lead to amblyopia – a loss of vision that continues even if no problem remains in the eye."


Amblyopia or lazy eye can occur under several situations. Strabismus (cross eyes or wall eyes) is one most common situation. Strabismus is when one eye seems to look over to the side and eventually isn't used as much or not at all if not treated. This may happen when the vision in one eye is not as clear as the other as in astigmatism, or if one eye is more nearsighted or farsighted than the other. It might occur if there is a cataract blocking vision in one eye, or if there has been an injury.

Dr. Greene says: "Whatever the cause, if the 'lazy' eye relaxes, the vision in that eye gets worse, and a destructive cycle begins. The initial difference between the eyes does not have to be dramatic."

Post questions, discussions, etc. about amblyopis here.

[Judy M]

I had amblyopia when I was a child. The doctor caught it in time. I had to wear a patch over my good eye for a while to make the poorer eye work. Parents be sure to take your child to the doctor if the eyes look a little bit crossed to catch it early.

[Ms. Kathy]

I have a parent of a child who has been told to get this corrected. The child is now ready for surgery. The mom is reluctant to put the little through surgery. Already he is depending on the one eye and the other is seriously casting off to the side. Vision will be lost in this eye. Some people think this is just a condition where one eye looks a little crooked or crossed but it is beyond that. It is easily corrected, especially when caught in time but if ignored the "lazy" eye loses vision from non-use.

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Since posting the above I have found more info at this link:
www.eyefinity.com/consumer/html/consumer_childvision_a2.htm?fromvsp=Y

[Ms. Kathy]

Vision Test Can Help Spot 'Lazy Eye'
07.28.06, 12:00 AM ET

FRIDAY, July 28 (HealthDay News) -- Any back-to-school checklist should include a vision test, since eye problems can seriously impair a child's ability to learn.

So say experts at Prevent Blindness America, who point out that an eye exam or vision screening may be the only way to detect amblyopia (lazy eye), the most common cause of visual impairment in children, according to the U.S. National Eye Institute.

Amblyopia occurs when the brain and an eye don't work together effectively. As the child's brain develops and receives diminished images from the affected eye, the brain begins to suppress the images from the affected eye and favors the unaffected eye. If amblyopia goes untreated, the weaker eye may become useless.

"The most frightening aspect of amblyopia is that your child may have it and not even know it. The child grows up believing that how he or she sees is how everyone else sees," Daniel D. Garrett, senior vice president of Prevent Blindness America, said in a prepared statement.

"We can't emphasize enough how important it is to have your children's vision checked early on. When detected early, treatment of amblyopia can be highly successful," Garrett said.

The organization has declared August as Children's Eye Health and Safety Awareness Month and offers parents and children resources to learn about amblyopia and ways to manage the condition.

More information

To learn more about amblyopia and other children's vision problems, go to Prevent Blindness America.


Source: Forbes.com www.forbes.com/forbeslife/health/feeds/hscout/2006/07/28/hscout533979.html

[Ms. Kathy]

ARVO: Children with 'Lazy Eye' View Themselves Poorly
Source Link:Teaching Brief® - MedPage Today www.medpagetoday.com/tbprint.cfm?tbid=5620&topicid=160

By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
May 10, 2007


MedPage Today Action Points

Explain that amblyopia can be caused by a variety of oculomotor defects, such as strabismus or anisometropia, and requires intervention to prevent permanent loss of vision in the affected eye.


This study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed publication.

Review
FORT LAUDERDALE, Fla. May 10 -- Amblyopia may affect children's self-esteem as well as their visual acuity and fine-motor coordination, according to Australian researchers.

Children with amblyopia have significantly poorer depth perception, impaired stereo vision, and more difficulty with fine motor skills than do age-matched controls, reported Ann Louise Webber, M.S., of the School of Optometry at the Queensland University of Technology in Brisbane, and colleagues.


Problems accomplishing tasks that come naturally to other children wears away at their self-image and self-confidence, said Webber at the Association for Research in Vision and Ophthalmology meeting here.


"Many children with amblyopia have poor depth perception in addition to poor vision in one eye," she said. "We were interested in how these may impact on skills important to children, particularly in their early education. Our finding that children with amblyopia do have poorer fine motor skills and lower perception of social acceptance means that, in addition to treating a child's eye condition, eye care practitioners may be able advise parents of potential functional consequences."


Webber and colleagues conducted a case-control study to evaluate fine motor skills, reading eye movements, and perceived self esteem in children with amblyopia, or "lazy eye," compared with age-matched controls with normal vision.


They looked at 82 children with visual defects, and 37 controls, with a mean age of about 8.2 years.


The children with amblyopia had a range of oculomotor defects: 22 had amblyopia caused by infantile esotropia (one or both eyes cross inward), 28 had acquired strabismus, 15 had anisometropia (eyes with different refractive power), 13 had mixed etiology (both anisometropia and strabismus), and nine had stimulus deprivation amblyopia.


Both the children with amblyopia and controls were assessed for visual acuity with minimum angle of resolution (logMAR), stereopsis (depth perception) by the Randot Preschool stereopsis test, and reading eye movements, as measured by the Developmental Eye Movement test.


The investigators assessed the children's fine motor skills using the Visual-Motor Control and Upper Limb Speed and Dexterity subtests of the Brunicks-Oseretsky Test of Motor Proficiency, and they evaluated how children perceived their self-esteem using the Harter Self Perception Profile for Children.


The authors found, as might be expected, that the children with amblyopia had significantly greater difference in interocular visual acuity and significantly reduced stereoacuity than controls (P<0.05).


In addition, on 10 of 16 sub-tests, children with amblyopia had significantly poorer fine motor skills, and scored significantly lower than controls on overall age-standardized scores for both visual-motor control, and upper limb speed and dexterity. Children with amblyopia did not, however, have any more difficulties with reading eye movements than controls.


When the authors turned to the self-perception tests, they found that children with amblyopia rated their level of social acceptance lower than that of controls. This was the only self-esteem measure that was significantly different between the groups.


The funding source for the study was not reported. The authors had no financial disclosures.


Primary source: Association for Research in Vision and Ophthalmology Annual Meeting
Source reference:
Webber AL et al. "The Effect of Amblyopia on Motor and Psychosocial Skills in Children." Abstract 4888, presented May 9.

--------------------------------------------------------------------------------

[Ms. Kathy]

Fine motor skills, social acceptance lower in children with 'lazy eye'
Source Link:Brighjtsurf.com Scinec news: brightsurf.com/news/headlines/30440/Fine_motor_skills_social_acceptance_lower_in_children_with_lazy_eye.html

May 09, 2007 - Fort Lauderdale, Fla. ? A recent study evaluating the fine motor skills and perceived self esteem of children with amblyopia (or "lazy eye") compared with age-matched children will be presented during the Association for Research in Vision and Ophthalmology (ARVO) 2007 Annual Meeting in Fort Lauderdale, Fla. The presentation will be made on Wednesday, May 9 from 3:00 to 4:45 p.m., in Hall B/C of the Greater Fort Lauderdale/Broward County Convention Center.

The study, led by Ann Louise Webber of the Queensland University of Technology in Australia, utilized Visual-Motor Control and Upper Limb Speed and Dexterity subtests of the Brunicks-Oseretsky Test of Motor Proficiency to measure fine motor skills, and perceived self esteem was assessed using the Harter Self Perception Profile for Children. Results shows that fine motor skills were significantly worse and perception of social acceptance was lower in amblyopic children. Performance on the fine motor skill tasks could not predicted by level of stereoposis or inter-ocular visual acuity difference in the amblyopic group.

"Many children with amblyopia have poor depth perception in addition to poor vision in one eye. We were interested in how these may impact on skills important to children, particularly in their early education," said Webber. "Our finding that children with amblyopia do have poorer fine motor skills and lower perception of social acceptance means that, in addition to treating a child's eye condition, eye care practitioners may be able advise parents of potential functional consequences."

Association for Research in Vision and Ophthalmology

Related Amblyopia News Articles

Fine motor skills, social acceptance lower in children with 'lazy eye' brightsurf.com/news/headlines/30440/Fine_motor_skills_social_acceptance_lower_in_children_with_lazy_eye.html
A recent study evaluating the fine motor skills and perceived self esteem of children with amblyopia (or "lazy eye") compared with age-matched children will be presented during the Association for Research in Vision and Ophthalmology (ARVO) 2007 Annual Meeting in Fort Lauderdale, Fla.

Revealing the machinery underlying the 'plastic' juvenile brain brightsurf.com/news/headlines/29057/Revealing_the_machinery_underlying_the_plastic_juvenile_brain.html
Among the central mysteries of neurobiology is what properties of the young brain enable it to so adeptly wire itself to adapt to experience—a quality known as plasticity.

Leicester breakthrough in eye disease brightsurf.com/news/headlines/28043/Leicester_breakthrough_in_eye_disease.html
Researchers at the University of Leicester have identified for the first time a gene which causes a distressing eye condition. Their discovery, as reported in the journal Nature Genetics, is expected to lead to better treatments for the condition.

Adults with lazy eye can improve brightsurf.com/news/headlines/22276/Adults_with_lazy_eye_can_improve.html
Young adults with amblyopia, or lazy eye, can improve substantially and retain their gains under a new treatment developed by researchers at USC and three Chinese universities.

Sight can recover quickly in amblyopia brightsurf.com/news/headlines/21496/Sight_can_recover_quickly_in_amblyopia.html
New research findings led by Thomas Krahe and Ary S. Ramoa of Virginia Commonwealth University School of Medicine offer two pieces of good news for treating children with amblyopia.

Study Highlights Need For UK Childhood Screening For Amblyopia (pp 597, 621) brightsurf.com/news/headlines/14432/Study_Highlights_Need_For_UK_Childhood_Screening_For_Amblyopia_pp_597_621.html
Authors of a study in this week's issue of THE LANCET highlight how the risk of visual loss in the normal eye for individuals with one lazy eye (amblyopia) is greater than previously thought, strengthening the need for effective screening programmes to detect amblyopia in early childhood. Monocular amblyopia occurs in at least 1% of individuals worldwide, causing decreased visual acuity as a result of abnormal early visual experience. Screening for amblyopia in early childhood is done in many countries to ensure that affected children are detected and treated within the critical period (in early childhood), and also achieve a level of vision in their lazy eye that would be useful should they

More amblyopia News articles: brightsurf.com/search/r-a/Amblyopia/1/Amblyopia_news.html

[Ms. Kathy]

Lazy eye affects fine motor skills
Posted on : 2007-05-10 | Author : Health News Editor
News Category : Health


FORT LAUDERDALE, Fla., May 9 (UPI) In children with lazy eye, fine motor skills were significantly worse and perception of social acceptance was lower, Australian researchers say.

Ann Louise Webber, of the Queensland University of Technology in Australia, used visual-motor control and upper limb speed and dexterity subtests of the Brunicks-Oseretsky Test of Motor Proficiency to measure fine motor skills, and perceived self-esteem was assessed using the Harter Self Perception Profile for Children.

Performance on the fine motor skill tasks could not be predicted by the level of stereoposis or inter-ocular visual acuity difference in the amblyopic group, according to a presentation at the Association for Research in Vision and Ophthalmology annual meeting in Fort Lauderdale, Fla.

"Many children with amblyopia have poor depth perception in addition to poor vision in one eye," Webber said in a statement. "Our finding that children with amblyopia do have poorer fine motor skills and lower perception of social acceptance means that, in addition to treating a child's eye condition, eye care practitioners may be able advise parents of potential functional consequences."

Print Source :Earthtimes.org
www.earthtimes.org/articles/show/61322.html

[Ms. Kathy]

Problems that plague little eyes
Source Link: Health 24 - Child, Health www.health24.com/child/Health/833-853-870,26169.asp
Many parents wait until kindergarten to have their children's vision tested.
They could be taking a big risk.

More to vision than an eye chart
Severe eye diseases can begin in infancy or early childhood. And if they aren't caught early, the chances for successful treatment diminish, says Dr Jack Swanson, past chairman of the American Academy of Pediatrics' Committee on Practice and Ambulatory Medicine.

As many as one in seven children need vision correction to see well, according to the Vision Council of America and the American Optometric Association.

Parents need to realise there's more to vision than seeing the eye chart, says optometrist Joel Zaba, a spokesman for the vision council. Screening will catch some problems, but we recommend a comprehensive examination for children.

Kids can't tell you what's wrong
And infants and young children can't tell you they can't see - or even tell you something is wrong.

A child who has problems from birth won't know how things are supposed to look. So even if they can talk, they have no point of reference from which to know something is wrong, says Dr Robert Cykiert, an associate professor of ophthalmology at New York University School of Medicine.

Common eye diseases in children
Young children can suffer from such serious eye diseases as cataracts or strabismus, an eye muscle disorder in which the eyes aren't aligned properly.

Another disease common to children is amblyopia - also known as lazy eye - in which the brain will not receive images from a poorly functioning eye.

They have one eye working better than the other, then the brain will suppress the vision of the eye that's not working well, Swanson says.

About 2,3 percent of American children have strabismus, and another 3,4 percent suffer from amblyopia. If these conditions aren't caught, they can lead to the loss of vision in the weaker eye, Swanson says.

It's not reversible as much if it's not caught early, he adds. It has to be picked up in the first few years to have an optimal chance for treatment.

Poor school performance
Undetected vision problems can also be the cause of poor performance in school, according to Dr Steven Lieberman, a paediatric optometrist in New York City.

A lot of the school-age children who are having reading problems may be having vision problems, especially in focusing, Lieberman says. Even if they pass the screening test, they may have a problem that has not been detected.

The vision of infants and young children can be tested using an optical system known as photoscreening, in which the child looks into the lens of a camera for a few seconds. The resulting photo captures the amount of light bouncing off the retina and can provide clues to numerous vision problems, including cataracts, strabismus, and nearsightedness and farsightedness.

Tests: The younger, the better
The American Academy of Pediatrics urges parents to have their children's eyes tested from as early as six months of age, with continued screening through their developing years.

Swanson suggests testing children's vision no later than age three.

We usually start trying to screen their vision by then, which does take some effort by screeners, Swanson says. Screening at that age is preferable to waiting until school age, because some of these things can be treated better at the younger age.

The type of specialist considered
Swanson and Lieberman disagree on whether parents should seek out a specialist in paediatric optometry to perform a vision screening on a child.

Swanson says any paediatrician should be able to detect a vision disorder. We feel that if a paediatrician is screening properly in their office, they can screen most children properly, he says.

But Lieberman says many children suffering from eye disorders may slip through the screening because the paediatricians do not have enough training to detect them.

A lot of paediatricians in schools do vision screening, but we don't know how many [problems] are missed, Lieberman says. My feeling is it's better to get an eye examination from someone who specialises in children's vision.

Treatment options
Treatment varies depending on the disease.

Cataracts usually require surgery, Lieberman says. A child suffering from strabismus might be given exercises to strengthen the weakened muscles and thereby realign the eyes.

To treat amblyopia, doctors want to make the child use the weaker eye. A patch may be put over the stronger eye, or eye drops or special glasses used to blur vision in the stronger eye.

The treatment usually lasts until vision is normal. For most children, this takes several weeks. A few children need to use eye patches until they are 8 to 10 years old, Lieberman says. - (HealthDayNews) www.health24.com/child/Health/833-853-870,26169.asp

[Ms. Kathy]

Wednesday, August 15, 2007
Kids eye exams important part of back to school prep

By Marcia Schlegelmilch
Staff Writer
Source Link: York News Times www.yorknewstimes.com/stories/081507/localnews_eyeexam.shtml

YORK -- Looking out for your child's vision is imperative, according to Dr. Nancy Dob. Dob says it's extremely important because studies have shown 80 percent of the learning children do is visual.


Dr. Nancy Dob uses charts like this one to test vision of children who don't yet know the alphabet. "So what we want to do is give them the best opportunity to do well when they go to school so that they can focus, and so the eyes work properly. Then they can learn what they need to learn," explains Dob.
It's been two years since the Nebraska Legislature passed a resolution mandating all kindergartners to have eye exams. Aside from kindergartners, transfer students are also expected to have had an eye exam.

"It's really king of amazing. I've talked with parents that thought it was a law already," Dob states.

When she sees a youngster, one of the main things Dr. Dob is looking for is what is commonly called "lazy eye." Lazy eye, amblyopia occurs when one eye is weaker, or can't see a chart at the 20/20 standard. If left untreated lazy eye can affect depth perception, and even career choices. The optometrist says the condition can keep a person from flying a plane for example, or joining the military.

"Amblyopia is treatable if caught early enough. We treat according to the cause. Glass can be used to help both eyes to work equally hard. Patching forces the weaker eye to do the work. And if muscle weakness is the cause, surgery may be necessary," Dr. Dob says.

Testing for the condition is done by bringing a child in for a routine eye exam. Dob stresses that parents and teachers can't tell if a child has vision problems by looking at them. She says young children think what they are seeing is normal -- because it is for them.

Lazy eye, or amblyopia often runs in families. So if a mother, father, grandmother or grandfather has a history, it becomes even more important to have the child checked.

"Lazy eye shows up in a variety of ways during an exam. Sometimes as a vision problem, other times as a power imbalance," informs the physician.

Kids of all ages are tested. And they don't even need to know the alphabet. Dr. Dob has pictures (instead of letters) for youngsters to identify. So a verbal response isn't necessary. When children come in for an eye exam they are also tested for color vision deficiency (color blindness), and for their ability to focus from distance to near (from chalkboard to book).

Dob says children shouldn't be frightened, exams are painless. She enjoys working with kids and says she's seen some real corkers; like the little boy who identified all the heart pictures on the eye chart as "Achey-Breaky" hearts.

"It's my opinion children should get their eyes checked yearly during school years to keep on top of eye health. During those years things change so quickly in children's bodies so it is important to keep on top if the situation with their eyes."

As kids fill their backpacks with needed items, parents are asked by eye physicians not to forget that eyes are among the most important school supplies.


Wednesday, Aug. 15, 2007
checkups are key for both kids and adults. www.eyecaresource.com is a good place to learn about eye care

[Ms. Kathy]

Fayetteville kid connects with his baseball dream
Wed, 08/22/2007 - 2:43pmBy: Kevin Wandra
Source Link: The Citizen.com www.thecitizen.com/~citizen0/node/19877

One of the hardest tasks in sports is hitting a baseball.

Just imagine attempting to hit a baseball while legally blind.

Fayetteville’s Myles Weathersby did just that and more.

Weathersby, an 11-year-old, first-year student at Rising Starr Middle School, was born with Amblyopia, or “lazy eye.” In amblyopia, one eye is stronger than another, and it can cause loss of vision and depth perception.

Weathersby was legally blind, but his vision improved over the last three years by using eye patches, a standard treatment for amblyopia. Now, with the help of glasses, his corrected vision is 20/30.

Two years ago, Myles’ mother, Kim Weathersby, was looking at sports she thought her son might want to play. Myles played soccer for a year, but he wasn’t passionate about the sport.
Kim Weathersby, a die-hard Georgia Tech baseball fan, encouraged him to give baseball a try. Myles joined a Fayette County recreational league team for 9- and 10-year-olds at Kiwanis Park in Fayetteville.

“When I first started, I didn’t know anything about baseball,” Myles said. “My mom taught me about the game and got me into it. Once I started playing, I liked it a lot.”

He played the entire year, and, though he made contact once or twice, he didn’t accomplish his goal of getting at least one hit.

Myles wasn’t discouraged, though. He joined the same league the following season. He began the new season determined to get a hit, but he couldn’t connect with the ball.

A few games into the season, Kim Weathersby decided that Myles needed professional help, so she called the Dugout Club, a baseball instructional facility in Tyrone, to set up private lessons for her son. She had heard positive feedback about the Dugout Club from one of her son’s teammates who had taken lessons at the facility.

“I called the Dugout Club, which usually makes good players really good,” Kim Weathersby said. “This was a different type of situation. I just wanted my child to be able to hit the ball. Another child on Myles’ team had gone to the Dugout Club and recommended it. I called Scott Camp [the owner of the Dugout Club] and told him Myles is not your average kid who needs to be better.”

Said Myles: “I didn’t know what to think about going there.”

Camp was somewhat apprehensive about teaching Myles.

“I was a little nervous,” Camp said. “I was afraid we might not be able to help him because his vision was so limited. We just had to get him to track the ball.”

Despite not knowing how everything would play out, Camp accepted the challenge and went to work with Myles.

“We did a lot of one-handed drills and a walk-up drill, something we call a ‘Happy Gilmore’ swing,’” Camp said. “Myles was really tense when he came in here. We had to get him to loose that tension.”

Said Myles: “When I first started going to the Dugout Club, I was hitting off a tee. They wanted to get my swing level. They worked on my stance, and lobbed me the ball to get my timing right.”

Myles’ dedication to developing his swing paid off. Shortly thereafter, Myles accomplished his goal of getting a hit, but he didn’t settle for just one.

The game in which he got his first hit, Myles shocked everyone by going 3-for-3.
“It was really cool,” Myles said. “It was very exciting to hit the ball.”

His mother was ecstatic.

“We’re just so proud of him because he worked so hard,” Kim Weathersby said. “We wanted him to get a hit so he could fit in. Myles was proud of himself. And all the parents were saying, ‘What got into him?’”

Camp was elated when he received a phone call from Kim Weathersby informing him of Myles’ big day at the plate.

“I was at work when Kim called, and I was just so excited for Myles,” Camp said. “It’s a great feeling for a kid to get a hit, no matter what level it’s on. For Myles, it was like a big leaguer hitting a home run. I was very happy for him.

“He’s a good kid and a smart kid.”

Camp and the rest of the instructors at the Dugout Club were so proud of Myles that they gave him a wooden bat that has his name engraved in it — the bat was donated by Rick Behenna, co-owner of Striker Bat Company and an instructor at the Dugout Club — and a certificate commemorating his first hit.

“Getting the bat and stuff was a really unexpected thing to happen,” Myles said. “It’s the first time I had ever had anything happen like that. It was great.”

Kim Weathersby praised the teaching that her son received from Camp and Jason Tidwell, the two Dugout Club instructors who spent the most time working with Myles.

“Scott Camp and Jason Tidwell worked with Myles the most,” Kim said. “They did a great job of working with the mechanics of Myles’ swing and when he should swing the bat.”

Myles still enjoys playing baseball. He recently finished playing his third season of baseball in Fayette’s recreational league, and he is considering play fall ball this upcoming season.

“I just like to play the game and have fun,” Myles said. “I have met some great friends on my teams.”

[Ms. Kathy]

Children With Amblyopia Need Not Wear Eye Patches All Day: Study
Source Link:http://www.medindia.net/news/Children-With-Amblyopia-Need-Not-Wear-Eye-Patches-All-Day-

A new research has revealed that children with amblyopia, commonly known as Lazy Eye, don’t need to wear their eye patches the entire day, and that wearing it for three to four hours a day for 12 weeks can improve vision.

It was argued that using the eye patch for long hours was excessive. But now, studies have shown that occlusion therapy (patching) can improve vision with its use for 6 hours day for 12 weeks and 12 hours a day.

Despite this, many doctors still suggest large doses of patching, so, researchers at City University in London and McGill University in Montreal funded by Fight for Sight, London, decided to determine the amount of patching required in children with amblyopia to achieve the best outcome.

Researchers conducted a study that involved 97 children aged 3-8 years with a confirmed diagnosis of amblyopia. All these children had a full ophthalmic assessment and were instructed to wear glasses all the time for 18 weeks.

When the phase was completed, 80 children who still met the study’s definition of amblyopia were instructed to wear a patch for either six or 12 hours a day.

To monitor the amount of occlusion each child actually received, two electrodes were attached to the under surface of each patch and visual function was recorded every two weeks.

The outcome was that no major difference was found in visual acuity between the two groups. However, the mean dose rates (hours a day with a patch) actually achieved were also not significantly different (4.2 in the six hour group and 6.2 in the 12 hour group).

Both groups who received patching for 3-6 hours a day and 6-12 hours a day showed similar improvement, but significantly worse for children who received less than three hours a day.

This suggested that children under 4 years of age required significantly less occlusion which means less than 3 hours to correct their vision.

This analysis concluded that dose should be taken for three to four hours a day for the best outcome and doctors too should prescribe the same.

And also said that dose should be given according to age such as dose in children of 4 years carrying amblyopia could be reduced.

Therefore, eye patching can cause considerable distress for both the child and family and doctors should try to minimise the amounts necessary for the best expected outcome.

Source-ANI
SRM

[Ms. Kathy]

Issue highlight

Comparing the effectiveness of vision screenings as part of the school entrance physical examination to comprehensive vision examinations in children ages 3 to 6: An exploratory study

Joel N. Zaba O.D., M.A.a, , , William Reynolds O.D.b, Rochelle Mozlin O.D., M.P.H.c, Julia Costich J.D., Ph.D.d, Svetla Slavova M.S.d and Glen T. Steele O.D.e
aPrivate Practice, Virginia Beach, Virginia
bPrivate Practice, Richmond, Kentucky
cState University of New York, State College of Optometry, New York, New York
dUniversity of Kentucky, Lexington, Kentucky
eSouthern College of Optometry, Memphis, Tennessee

Available online 28 September 2007.
Source Link:ScienceDirect - Optometry - Journal of the American Optometric Association www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7W62-4PSBWTK-D&_user=10&_coverDate=10%2F31%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=29964e09ead9002fb1b9e8a4a9fa99b0
Abstract

Purpose

The purpose of this exploratory study was to investigate the effectiveness of vision screenings performed during school entrance physical examinations compared with comprehensive vision examinations in the state of Kentucky, which mandates comprehensive eye examinations for children, ages 3 to 6, who are entering the public school system.

Methods and subjects

In this exploratory study, 1,386 children had forms submitted from 36 optometrists and 1 ophthalmologist reporting on their vision and eye problems. Vision and eye problems were defined as the presence of strabismus, amblyopia, or a refractive error requiring an optical correction, as determined by the optometrists or ophthalmologist using cycloplegic refraction. Among these 1,386 children, there were 300 diagnosed with vision problems.

Results

Sixty-six children were diagnosed with a vision problem who had not previously been to an eye doctor and had received a vision screening at their school entrance physical examination. In 56 of these 66 children, the vision problem was not detected by the vision screening, according to the parents.

Conclusion

The exploratory study suggests that comprehensive vision examinations may identify some vision problems that were not found in children’s preschool physical examinations that included vision screenings. A larger randomized study is needed to determine the most appropriate method of timely diagnosis of vision problems in children that can be corrected with early intervention in order to ensure the vision health and well-being of children entering the public school system.

Keywords: Vision screening; Comprehensive vision examination; School entrance physical examination; Vision problems



Corresponding author: Joel N. Zaba, O.D., M.A., 281 Independence Blvd., Suite 105, Virginia Beach, Virginia 23462.

Optometry - Journal of the American Optometric Association
Volume 78, Issue 10, October 2007, Pages 514-522

[Ms. Kathy]

Lazy eye helped by patch 3 hours a day


Published: 14, 2007 at 7:16 PM
LONDON, 14 (UPI) -- Children with amblyopia, known as lazy eye, need only wear an eye patch for three to four hours a day to improve vision, a British and Canadian study found.

Researchers at City University in London and McGill University in Montreal studied 97 children ages 3 to 8 with confirmed diagnoses of amblyopia. All children had a full ophthalmic assessment and were instructed to wear glasses full-time for 18 weeks.

On completion of this phase, 80 children who still met the study’s definition of amblyopia were then told to wear a patch for either six or 12 hours a day for 12 weeks. Two electrodes were attached under surface of each patch to monitor the amount of occlusion each child actually received, and visual function was recorded every two weeks.

The study, published in the British Medical Journal Online First, found no significant difference in visual acuity between the two groups. However, the mean dose rates, hours a day with a patch, actually achieved were also not significantly different -- 4.2 in the six hour group and 6.2 in the 12 hour group.

Visual improvement was similar for those children who received three to six hours a day or six to 12 hours a day, but significantly worse for children who received less than three hours a day. Patching beyond 12 weeks did not confer additional benefit.

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Source Link: United Press International - NewsTrack - Health - www.upi.com/NewsTrack/Health/2007/09/14/lazy_eye_helped_by_patch_3_hours_a_day/2967/

[Ms. Kathy]

Early Glasses Do the Trick for Bilateral Amblyopia
Visit us online at www.MedPageToday.com
Source Link: MedPage Today www.medpagetoday.com/Surgery/Ophthalmology/tb/6845


By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
October 02, 2007


MedPage Today Action Points

Explain to patients that in the vast majority of cases amblyopia is easily treated, but if left uncorrected can result in permanent visual disability or blindness.

Review
TAMPA, Fla., Oct. 2 -- Early prescription of glasses for children with bilateral refractive amblyopia may prevent a lifetime of visual disability, a team of pediatric ophthalmologists has found.

Young children with bilateral amblyopia given glasses early had a mean improvement in binocular visual acuity of four Snellen lines, and three-fourths saw 20/25 or better at one year, reported David K. Wallace, M.D., M.P.H., of Duke, and colleagues, in the Pediatric Eye Disease Investigators Group based here, in the October issue of the American Journal of Ophthalmology.


"This study shows that glasses are a powerful treatment for bilateral amblyopia in children," said Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute, which funded the study. "When we detect and treat this problem early in life, most children are able to achieve normal vision."


Bilateral refractive amblyopia can result when children have large degrees of uncorrected hypermetropia, astigmatism or both, the authors noted. It occurs in only four of 830 children in one study, compared with a two to three per 100 estimated prevalence for standard "lazy eye" amblyopia, but the condition can cause significant visual disability if not treated during childhood.


"The presumed mechanism of bilateral refractive amblyopia is pattern vision deprivation," the authors wrote. "Abnormal binocular interaction with suppression also may contribute in those cases with concomitant strabismus."


The authors conducted a prospective study in 27 community- and university-based sites, with the goal of determining the time course and the amount of binocular visual acuity improvement with standard therapy.


They enrolled 113 children, mean age 5.1 + 1.3 years, all of whom had untreated bilateral refractive amblyopia. The authors defined the conditions as 20/40 to 20/400 best-corrected binocular visual acuity in the presence of 4.00 diopters (D) or more of hypermetropia by spherical equivalent, 2.00 D or more of astigmatism, or both in each eye.


The children were prescribed glasses that fully corrected for anisometropia, astigmatism, and myopia, or, in the case of hypermetropia, fully corrected or undercorrected symmetrically by no more than 1.50 D in both eyes. There were no untreated controls.


The authors measured best-corrected binocular and monocular visual acuities at baseline and at five, 13, 26, and 52 weeks. The main outcome measure was binocular acuity at one year.


They found "mean binocular visual acuity improved from 0.50 logarithm of the minimum angle of resolution (logMAR) units (20/63) at baseline to 0.11 logMAR units (20/25) at one year." This translated into a mean improvement of 3.9 lines (95% confidence interval 3.5 to 4.2) on the Snellen chart.


The degree of improvement was significantly greater among those children with worse baseline acuity. For 84 children with baseline binocular acuity of 20/40 to 20/80, the mean improvement at one year was 3.4 Snellen lines (95% CI, 3.2 to 3.7). For 16 children with baseline binocular acuity of 20/100 to 20/320, the mean improvement at one year was 6.3 lines (95% CI, 5.1 to 7.5, P<0.001).


Only 12% of the children required additional treatment for amblyopia, with either patching of the stronger eye or visual blocking with atropine.


The cumulative probability that the children would have binocular visual acuity of 20/25 or better was 21% at five weeks, 46% at 13 weeks, 59% at 26 weeks, and 74% at 52 weeks.


"Although there was no untreated control group, the observed improvement substantially exceeded any expected learning or age effect," the authors wrote. "Visual acuity improvement was accompanied by a corresponding improvement in stereopsis, with 60% of children improving by at least two levels on the Randot Preschool Stereoacuity Test."


The study was supported by a grant from the National Eye Institute. The authors reported that they have no conflicts of interest.


Primary source: American Journal of Ophthalmology
Source reference:
Wallace DK et al. "Treatment of Bilateral Refractive Amblyopia in Children Three to Less Than 10 Years of Age." Am J Ophthalmol 2007; 144: 487-496.

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[Ms. Kathy]

Early treatment of children with bilateral amblyopia essential, according to multisite study

October 02, 2007 - When a child is farsighted or has astigmatism or has both conditions in both eyes, bilateral amblyopia may develop. In contrast to single-eye amblyopia or "lazy eye," where one eye presents an unclear image to the brain, bilateral amblyopia affects both eyes and is less common. In an article published in the October issue of the American Journal of Ophthalmology, researchers report that this condition can be successfully treated with corrective lenses, particularly when diagnosed and treated early. Left untreated, bilateral amblyopia may result in permanent visual disability.

The Pediatric Eye Disease Investigator Group (PEDIG) conducted a study of 113 children between 3 and 9 years-old with bilateral refractive amblyopia, who were treated with glasses and followed prospectively at 27 community- and university-based sites. After one year, visual acuity measured with both eyes open had improved an average of about 4 lines on the traditional Snellen eye chart. Average visual acuity improved from 20/63 to 20/25, and most children (74%) reached 20/25 or better. Those children who started with visual acuity of 20/100 or worse showed the greatest improvement, averaging 6.3 lines after one year.

"This study shows that glasses are a powerful treatment for bilateral amblyopia in children. When we detect and treat this problem early in life, most children are able to achieve normal vision," said Paul A. Sieving, M.D., Ph.D., Director of the National Eye Institute, one of the Federal government's National Institutes of Health and the agency that sponsored the study.

"Most ophthalmologists or optometrists will see no more than a few cases of bilateral amblyopia each year, which is not enough to be able to do a large study on this condition. The structure of the Pediatric Eye Disease Investigator Group allows us to enroll children at multiple sites to do large studies of important but relatively uncommon conditions like bilateral amblyopia," said David Wallace, M.D., lead author for the study.

Elsevier Health Sciences

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