Risk Factors for Amblyopia in the Vision in Preschoolers Study

Pascual, Maisie; Huang, Jiayan; Maguire, Maureen G.; Kulp, Marjean Taylor; Quinn, Graham E.; Ciner, Elise; Cyert, Lynn; Orel‐Bixler, Deborah; Moore, Bruce; Ying, Gui‐Shuang

doi:10.1016/j.ophtha.2013.08.040

Cited by 124 publications

(107 citation statements)

References 21 publications

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“…36–38 One common thread throughout these studies is the dramatic increase in risk for bilateral amblyopia at a threshold of +4 to +5D of hyperopic refractive error. 33–35 This same level of uncorrected hyperopia (+4D) has been shown to be associated with increased accommodative lags and more variable accommodative responses in infants and preschool children. 39, 40 Thirdly, a large-scale study of emmetropization in infants found that the probability of emmetropization drops to 50% with hyperopic refractive error of +5D at 3 months of age.…”

Section: Discussionmentioning

confidence: 97%

Subjective versus Objective Accommodative Amplitude

Anderson¹,

Stuebing²

2014

Optometry and Vision Science

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Purpose This study compared subjective and objective accommodative amplitudes to characterize changes from preschool to presbyopia. Methods Monocular accommodative amplitude was measured with three techniques in random order (subjective push-up, objective minus lens stimulated, and objective proximal stimulated) on 236 subjects 3–64 years using a 1.5mm letter. Subjective push-up amplitudes were the dioptric distance at which the target first blurred along a near-point rod. Objective minus lens stimulated amplitudes were the greatest accommodative response obtained by Grand Seiko autorefraction as subjects viewed the stimulus at 33cm through increasing minus lens powers. Objective proximal stimulated amplitudes were the greatest accommodative response obtained by Grand Seiko autorefraction as subjects viewed the stimulus at increasing proximity from 40cm up to 3.33cm. Results In comparison with subjective push-up amplitudes, objective amplitudes were lower at all ages, with the most dramatic difference occurring in the 3–5 year group (subjective push-up = 16.00 ± 4.98D versus objective proximal stimulated = 7.94 ± 2.37D and objective lens stimulated = 6.20 ± 1.99D). Objective proximal and lens stimulated amplitudes were largest in the 6–10 year group (8.81 ± 1.24D and 8.05 ± 1.82D, respectively) and gradually decreased until the fourth decade of life when a rapid decline to presbyopia occurred. There was a significant linear relationship between objective techniques (y = 0.74 + 0.96x, R2 = 0.85, p<0.001) with greater amplitudes measured for the proximal stimulated technique (mean difference = 0.55D). Conclusions Objective measurements of accommodation demonstrate that accommodative amplitude is substantially less than that measured by the subjective push-up technique, particularly in young children. These findings have important clinical implications for the management of uncorrected hyperopia.

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Section: Discussionmentioning

confidence: 97%

Subjective versus Objective Accommodative Amplitude

Anderson¹,

Stuebing²

2014

Optometry and Vision Science

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“…In humans, amblyopia is comparatively rare in exotropia and the onset of ocular misalignment occurs at a later age than in esotropia (Chia et al 2007;Mohney 2007;Pascual et al 2014). Children usually enjoy normal visual function through infancy but then develop an intermittent exotropia that eventually decompensates into a constant exotropia in some individuals (Buck et al 2012;Choi and Kim 2013;Mohney and Huffaker 2003;Nusz et al 2006).…”

Section: Discussionmentioning

confidence: 99%

Contrasting effects of strabismic amblyopia on metabolic activity in superficial and deep layers of striate cortex

Adams

Economides

Horton

2015

Journal of Neurophysiology

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To probe the mechanism of visual suppression, we have raised macaques with strabismus by disinserting the medial rectus muscle in each eye at 1 mo of age. Typically, this operation produces a comitant, alternating exotropia with normal acuity in each eye. Here we describe an unusual occurrence: the development of severe amblyopia in one eye of a monkey after induction of exotropia. Shortly after surgery, the animal demonstrated a strong fixation preference for the left eye, with apparent suppression of the right eye. Later, behavioral testing showed inability to track or to saccade to targets with the right eye. With the left eye occluded, the animal demonstrated no visually guided behavior. Optokinetic nystagmus was absent in the right eye. Metabolic activity in striate cortex was assessed by processing the tissue for cytochrome oxidase (CO). Amblyopia caused loss of CO in one eye's rows of patches, presumably those serving the blind eye. Layers 4A and 4B showed columns of reduced CO, in register with pale rows of patches in layer 2/3. Layers 4C, 5, and 6 also showed columns of CO activity, but remarkably, comparison with more superficial layers showed a reversal in contrast. In other words, pale CO staining in layers 2/3, 4A, and 4B was aligned with dark CO staining in layers 4C, 5, and 6. No experimental intervention or deprivation paradigm has been reported previously to produce opposite effects on metabolic activity in layers 2/3, 4A, and 4B vs. layers 4C, 5, and 6 within a given eye's columns.

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“…11 Pascual et al recently reported that bilateral hyperopia was associated with increased odds of bilateral amblyopia in preschool children enrolled in the VIP study (odds ratio of 9.4 for bilateral hyperopia ≥ +4 D, reference level 0.00 to < +1 D, p<0.0001). 12 A recent population based study showed an increased prevalence of strabismus and amblyopia in 6- and 12-year-old children with moderate hyperopia. 13 Longitudinal studies have also supported an association between hyperopia and strabismus and/or amblyopia.…”

mentioning

confidence: 98%

Associations between Hyperopia and Other Vision and Refractive Error Characteristics

Kulp¹,

Ying²,

Huang³

et al. 2014

Optometry and Vision Science

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Purpose To investigate the association of hyperopia >+3.25D with amblyopia, strabismus, anisometropia, astigmatism, and reduced stereoacuity in preschoolers. Methods 3- to 5-year old Head Start preschoolers (n=4040) underwent vision examination including monocular visual acuity (VA), cover testing, and cycloplegic refraction during the Vision In Preschoolers (VIP) study. VA was tested with habitual correction, and was retested with full cycloplegic correction when VA was reduced below age norms in the presence of significant refractive error. Stereoacuity testing (Stereo Smile II) was performed on 2898 children during study years 2 and 3. Hyperopia was classified into 3 levels of severity (based upon most positive meridian on cycloplegic refraction): Group 1:≥+5.00D, Group 2:>+3.25D to <+5.00D with interocular difference (IOD) in spherical equivalent (SE) ≥0.50D, and Group 3:>+3.25D to <+5.00D with IOD in SE<0.50D. “Without” hyperopia was defined as refractive error of +3.25 D or less in the most positive meridian in both eyes. Standard definitions were applied for amblyopia, strabismus, anisometropia, and astigmatism. Results Relative to children without hyperopia, children with hyperopia >+3.25D (N=472, Groups 1, 2, 3) had a higher proportion of amblyopia (34.5% vs. 2.8%, p<0.0001) and strabismus (17.0% vs. 2.2%, p<0.0001). More severe levels of hyperopia were associated with higher proportions of amblyopia (51.5% in Group 1 vs 13.2% in Group 3) and strabismus (32.9% in Group 1 vs 8.4% in Group 3; trend p<0.0001 for both). Presence of hyperopia >+3.25D also was associated with a higher proportion of anisometropia (26.9% vs. 5.1%, p<0.0001) and astigmatism (29.4% vs. 10.3%, p<0.0001). Median stereoacuity of non-strabismic, non-amblyopic children with hyperopia (N=206) (120″) was worse than that of children without hyperopia (60″) (p<0.0001) and more severe levels of hyperopia were associated with worse stereoacuity (480″ for Group 1, 120″ for Groups 2 and 3, p<0.0001). Conclusions The presence and magnitude of hyperopia among preschoolers was associated with higher proportions of amblyopia, strabismus, anisometropia, astigmatism and with worse stereoacuity even among non-strabismic, non-amblyopic children.

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Risk Factors for Amblyopia in the Vision in Preschoolers Study

Cited by 124 publications

References 21 publications

Subjective versus Objective Accommodative Amplitude

Subjective versus Objective Accommodative Amplitude

Contrasting effects of strabismic amblyopia on metabolic activity in superficial and deep layers of striate cortex

Associations between Hyperopia and Other Vision and Refractive Error Characteristics

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