Optical treatment of amblyopia in older children and adults is essential prior to enrolment in a clinical trial

Gao, Tina; Anstice, Nicola; Babu, Raiju J.; Black, Joanna; Bobier, William R.; Dai, Shuan; Guo, Cindy X.; Hess, Robert F.; Jenkins, Michelle; Jiang, Yannan; Kearns, Lisa S.; Kowal, Lionel; Lam, Carly Siu Yin; Pang, Peter C. K.; Parag, Varsha; South, Jayshree; Staffieri, Sandra E; Wadham, Angela; Walker, Natalie; Thompson, Benjamin

doi:10.1111/opo.12437

Cited by 40 publications

(50 citation statements)

References 57 publications

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“…The composite BF score has been successfully used in recent amblyopia treatment trials for analysis of treatment effects . The scale is ordinal, rather than continuous, therefore, outcomes are analysed with non‐parametric statistics.…”

Section: Discussionmentioning

confidence: 99%

“…The composite BF score has been successfully used in recent amblyopia treatment trials for analysis of treatment effects. 8,9 The scale is ordinal, rather than continuous, therefore, outcomes are analysed with non-parametric statistics. We have shown that the composite score highly correlates with both a measure of inter-ocular suppression and with a threshold measure of stereoacuity that tests coarse levels of binocular disparity detection beyond the range of common clinical tests.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to reporting visual acuity change, recent amblyopia treatment studies, including randomised clinical trials, have sought to quantify changes in the level of suppression or stereoacuity . This requires recording binocular function in individuals with a broad range of measureable stereoacuity through to those with complete suppression and no measurable stereopsis.…”

Section: Introductionmentioning

confidence: 99%

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From suppression to stereoacuity: a composite binocular function score for clinical research

Webber

Wood

Thompson

et al. 2019

Ophthalmic Physiologic Optic

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Purpose: This study aimed to validate a binocular function score that is based on common clinical measures of visual function, providing a more complete analysis of binocular outcomes, against laboratory-based dichoptic tests of threshold stereoacuity and depth of suppression. Methods: Scores on a composite binocular function (BF) score derived from clinical stereoacuity measures (Randot Preschool Stereoacuity Test and Randot Butterfly) and the Worth 4 Dot test were determined in adults (n = 20; age 24.8 ± 7.2 years) and children (N = 77; age 8.3 ± 1.7 years) with abnormal binocular vision from strabismus or amblyopia. Adults had threshold stereoacuity measured with a novel, computerised dichoptic psychophysical test of stereopsis. Depth of suppression (dichoptic eye chart inter-ocular contrast balance test) was determined in both adults and children. Results: Clinical Randot stereoacuity was measurable in 50% of adult and 61% of child participants. Threshold stereoacuity was measurable in 65% of the adult participants. The presence of suppression or simultaneous perception (flat fusion or diplopia) was measurable in all participants, enabling assignment of a BF score to all participants in both groups. In adults, the BF score was highly correlated with the psychophysical threshold stereoacuity measure (ρ = 0.71; p < 0.001). In both adults and children, there was also a high correlation between the BF score and inter-ocular contrast balance (adult ρ = 0.90; child ρ = 0.86; p < 0.001). Conclusions: The composite BF score is a convenient and valid scale of binocularity that can be used to extend the stereoacuity measure in cohorts where nil stereoacuity is common and thus could be considered as an outcome measure in clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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From suppression to stereoacuity: a composite binocular function score for clinical research

Webber

Wood

Thompson

et al. 2019

Ophthalmic Physiologic Optic

Self Cite

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“…There are reports that for adults with amblyopia, refractive adaptation has limited and insignificant effects on visual acuity and stereoacuity. 36,37 Therefore, we assume that the refractive adaptation effects from 20 to 28 hours of new lens wearing would have very small effects on acuity and stereoacuity improvements in these six observers, and the overall effects would be minimal when all 11 observers' results are considered together.…”

Section: Discussionmentioning

confidence: 99%

Dichoptic De-Masking Learning in Adults With Amblyopia and Its Mechanisms

Liu

Zhang

2019

Invest. Ophthalmol. Vis. Sci.

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Citation: Liu X-Y, Zhang J-Y. Dichoptic de-masking learning in adults with amblyopia and its mechanisms. Invest Ophthalmol Vis Sci. 2019;60:2968-2977. https://doi.org/10.1167 PURPOSE. Recently, we reported that dichoptic de-masking training can further boost stereoacuity, but not visual acuity, in adults with amblyopia after extensive monocular perceptual training. Here, we investigated whether this dichoptic training targets on interocular suppression directly, or improves vision through high-level brain mechanisms.METHODS. Eleven adults with amblyopia first used amblyopic eyes (AEs) to perform contrast (n ¼ 6) or orientation (n ¼ 5) discrimination training, while resisting dichoptic noise masking from fellow eyes (FEs). Learning was indicated by increased maximal tolerable noise contrast (TNC) for AE contrast/orientation discrimination. After dichoptic training, six observers continued to use AEs to perform monocular training for nine sessions. RESULTS.(1) Training of dichoptic de-masking doubled maximal TNC, but learning did not transfer much to the same task at an orthogonal orientation or a different task, showing orientation/task specificities. (2) Following a training-plus-exposure (TPE) protocol, AEs then received exposure of the orthogonal orientation by performing the other orientation/contrast discrimination task at the orthogonal orientation. After this TPE training, dichoptic learning with the original discrimination task transferred to the orthogonal orientation. (3) Dichoptic training improved AE's acuity (1.2 lines), stereoacuity (60.2%), and contrast sensitivity (mainly at higher spatial frequencies). (4) Additional monocular training did not produce further acuity and stereoacuity gains.CONCLUSIONS. The initial orientation/task specificities exclude the possibility that dichoptic training reduces physiological interocular suppression. The later transfer of learning to an orthogonal orientation with TPE training suggests improvement in high-level brain processing. Dichoptic training may strengthen top-down attention to AEs to counter the impacts of attentional bias to FEs and/or physiological interocular suppression and improve stereoacuity.

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“…As a result, a minimum period of around 14 weeks has been advanced . The effect also decreases with age, although improvements can still be generated in older children and adults . Starting acuity appears to be reasonably predictive of the improvement, but in contrast to occlusion therapy, milder amblyopia is associated with larger gains .…”

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confidence: 99%