Travel Grant + Inspiration = Travel Grantspiration!

Optometry students + residents–earn $500 to attend the 2018 Annual Meeting by writing something just like this!

Last year, Dr. Danielle Campbell (Pacific University ’17) received a Travel Grant for the 2017 Annual Meeting with her article summary on bilateral amblyopia. We’ve shared it with you here, combined with new practice-relevant insights, as inspiration for this year’s applicants!

Amblyopia is defined as a visual developmental disorder that arises after selective disruption of visual input early in life.  The diagnosis of amblyopia typically focuses on the presence of a selective disruptor in young children (the amblyogenic factors of strabismus and/or a significant refractive error) which results in a visual disorder.  Amblyopia can be unilateral, where the dominant eye suppresses the amblyopic eye.  Think of big brother bullying little brother until little brother is hiding in the corner! It can also be bilateral.  The selective disruptor  of high refractive error is present in both eyes and the result is reduced visual function of both eyes. We can still talk about siblings, but now we have twins.  Twins are often born a little premature, and they need time to catch up! Such is the case when both eyes are moderately amblyopic.  Visual acuity and other visual function are reduced in BOTH eyes and they BOTH need time to catch up.

Treatment of bilateral refractive amblyopia in young children begins with the prescription of spectacles and time. The brain needs time to learn to see clearly. The twin eyes will get stronger together, just from wearing glasses.

A recent study looked at the visual outcomes of spectacles only in the treatment of  bilateral refractive amblyopia in young children. The visual outcomes that were measured included visual acuity (VA), the presence of fusion vs. suppression, and stereopsis. Twenty-eight previously untreated bilateral amblyopes between the ages of three and eight who wore their glasses full time were enrolled in the study.

The results of this study showed that given enough time, visual acuity improved with wearing of spectacle correction. At 12 months, 93% (26/28 participants) demonstrated improvements in VA; and at 18 months, all participants demonstrated improvements in VA. Similar improvements were seen in stereopsis.  All participants had fusion at baseline testing and all subsequent appointments, suggesting that suppression is not often present in children with bilateral refractive amblyopia.

This study found a greater improvement in visual acuity and stereoacuity than in some previous studies. This may be due to a younger average age of participants (4.6 years) and that only those reported as wearing their correction full time were included in the study. Only 28 children participated in the study; a larger cohort  is needed to have statistically significant findings.

In conclusion, good compliance with wearing spectacle correction improves visual acuity and stereopsis in young children with bilateral amblyopia. The time period of resolution of amblyopia is directly correlated to the amount of refractive error, with those with higher refractive errors requiring more time for visual functions to maximize. Although many of the children had 20/20 visual acuity after 18 months of spectacle wear, not all of them did, and many still had reduced stereo acuity.

For young patients with bilateral refractive amblyopia, at the very least, spectacles are an essential part of the treatment, as long as you give their brains a chance to learn to see clearly, and monitor their progress at regular intervals. For many of these children, vision therapy may be required to improve and enhance all visual skills because 20/20 vision is really just the beginning.

Lin PW, Chang HW, Lai IC, Teng MC. Visual outcomes after spectacles treatment in children with bilateral high refractive amblyopia. Clin Exp Optom 2016; 99:550-554.