Visual outcomes after spectacles treatment in children with bilateral high refractive amblyopia

Abstract

Purpose

The aim was to investigate the visual outcomes of treatment with spectacles for bilateral high refractive amblyopia in children three to eight years of age.

Methods

Children with previously untreated bilateral refractive amblyopia were enrolled. Bilateral high refractive amblyopia was defined as visual acuity (VA) being worse than 6/9 in both eyes in the presence of 5.00 D or more of hyperopia, 5.00 D or more of myopia and 2.00 D or more of astigmatism. Full myopic and astigmatic refractive errors were corrected, and the hyperopic refractive errors were corrected within 1.00 D of the full correction. All children received visual assessments at four‐weekly intervals. VA, Worth four‐dot test and Randot preschool stereotest were assessed at baseline and every four weeks for two years.

Results

Twenty‐eight children with previously untreated bilateral high refractive amblyopia were enrolled. The mean VA at baseline was 0.39 ± 0.24 logMAR and it significantly improved to 0.21, 0.14, 0.11, 0.05 and 0.0 logMAR at four, eight, 12, 24 weeks and 18 months, respectively (all p = 0.001). The mean stereoacuity (SA) was 1,143 ± 617 arcsec at baseline and it significantly improved to 701, 532, 429, 211 and 98 arcsec at four, eight, 12, 24 weeks and 18 months, respectively (all p = 0.001). The time interval for VA achieving 6/6 was significantly shorter in the eyes of low spherical equivalent (SE) (−2.00 D < SE < +2.00 D) than in those of high SE (SE > +2.00 D) (3.33 ± 2.75 months versus 8.11 ± 4.56 months, p = 0.0005). All subjects had normal fusion on Worth four‐dot test at baseline and all follow‐up visits.

Conclusion

Refractive correction with good spectacles compliance improves VA and SA in young children with bilateral high refractive amblyopia. Patients with greater amounts of refractive error will achieve resolution of amblyopia with a longer time.

Key words:

• refractive amblyopia
• stereoacuity
• Worth four‐dot test

Acknowledgements

This study was supported by grant CMRPG890421 awarded by the Chang Gung Memorial Hospital, Taiwan. The authors thank Dr Hsin‐Ching Lin and Mr Evan Taylor for help in manuscript preparation.