Amblyopia is a visual development deficit caused by abnormal visual experience in early life, mainly manifesting as defected visual acuity and binocular visual impairment, which is considered to reflect abnormal development of the brain rather than organic lesions of the eye. Previous studies have reported abnormal spontaneous brain activity in patients with amblyopia. However, the location of abnormal spontaneous activity in patients with amblyopia and the association between abnormal brain function activity and clinical deficits remain unclear. The purpose of this study is to analyze spontaneous brain functional activity abnormalities in patients with amblyopia and their associations with clinical defects using resting-state functional magnetic resonance imaging (fMRI) data. In this study, 31 patients with amblyopia and 31 healthy controls were enrolled for resting-state fMRI scanning. The results showed that spontaneous activity in the right angular gyrus, left posterior cerebellum, and left cingulate gyrus were significantly lower in patients with amblyopia than in controls, and spontaneous activity in the right middle temporal gyrus was significantly higher in patients with amblyopia. In addition, the spontaneous activity of the left cerebellum in patients with amblyopia was negatively associated with the best-corrected visual acuity of the amblyopic eye, and the spontaneous activity of the right middle temporal gyrus was positively associated with the stereoacuity. This study found that adult patients with amblyopia showed abnormal spontaneous activity in the angular gyrus, cerebellum, middle temporal gyrus, and cingulate gyrus. Furthermore, the functional abnormalities in the cerebellum and middle temporal gyrus may be associated with visual acuity defects and stereopsis deficiency in patients with amblyopia. These findings help explain the neural mechanism of amblyopia, thus promoting the improvement of the treatment strategy for amblyopia.
Adult ; Amblyopia/pathology* ; Brain ; Brain Mapping ; Humans ; Magnetic Resonance Imaging/methods* ; Visual Acuity

BACKGROUNDAmblyopia is a common ophthalmological condition and the wavefront aberrometer is a relatively new diagnostic tool used globally to measure optical characteristics of human eyes as well as to study refractive errors in amblyopic eyes. We studied the wavefront aberration of the amblyopic children's eyes and analyzed the mechanism of the wavefront aberration in the formation of the amblyopia, try to investigate the new evidence of the treatment of the amblyopia, especially in the refractory amblyopia.

METHODSThe WaveScan Wavefront System (VISX, USA) aberrometer was used to investigate four groups of children under dark accommodation and cilliary muscle paralysis. There were 45 cases in the metropic group, 87 in the amblyopic group, 92 in the corrected-amblyopic group and 38 in the refractory amblyopic group. One-way analysis of variance (ANOVA), t-test and multivariate linear regression were used to analyze all the data.

RESULTSThird order to 6th order aberrations showed a decreasing trend whereas in the higher order aberrations the main ones were 3rd order coma (Z(3)(-1)-Z(3)(1)), trefoil (Z(3)(-3)-Z(3)(3)) and 4th order aberration (Z(4)(0)); and 3rd order coma represented the highest percentage of all three main aberrations. Within 3rd order coma, vertical coma (Z(3)(-1)) accounted for a greater percentage than horizontal coma (Z(3)(1)). Significant differences of vertical coma were found among all clinical groups of children: vertical coma in the amblyopic group (0.17 +/- 0.15) was significantly higher than in the metropic group (0.11 +/- 0.13, P < 0.05). In addition, the vertical coma in the refractory amblyopic group (0.19 +/- 0.15) was higher compared with the metropic group (P < 0.05), the 5th order aberration (0.11 +/- 0.08) was also significantly higher than in the metropic group (0.07 +/- 0.04, P < 0.05). No significant difference was found in vertical coma and 5th order aberration between the corrected-amblyopic group (0.13 +/- 0.11) and metropic group (0.07 +/- 0.04) (P > 0.05).

CONCLUSIONSAlthough lower order aberrations such as defocus (myopia and hyperopia) and astigmatism are major factors determining the quality of the retinal image, higher order aberrations also need to be considered in amblyopic eyes as their effects are significant.

Aberrometry ; Amblyopia ; pathology ; physiopathology ; Child ; Child, Preschool ; Female ; Humans ; Male ; Refraction, Ocular ; physiology ; Refractive Errors ; diagnosis ; pathology

PURPOSE: This study was designed to assess and compare the thicknesses of the fovea and the retinal nerve fiber layer in normal children and children with amblyopia. METHODS: Optical Coherence Tomography (OCT) was performed on 26 children (52 eyes total) with unilateral amblyopia that was due to anisometropia or strabismus. OCT was also performed on 42 normal children (84 eyes), for a total of 136 eyes. Retinal thickness measurements were taken from the fovea, and the retinal nerve fiber layer thickness measurements were taken from the superior, inferior, nasal and temporal quadrants in the peripapillary region. RESULTS: The average age of the normal children was 8.5 years, and the average age of the children with amblyopia was 8.0 years. The average thickness of the fovea was 157.4 micrometer in normal eyes and was 158.8 micrometer in amblyopic eyes. The difference between the two groups was not statistically significant (p=0.551). The thicknesses of the superior, inferior, nasal and temporal quadrants of the retinal nerve fiber layer between the normal children and the children with amblyopia were also not statistically significant (p=0.751, 0.228, 0.696 and 0.228, respectively). However, for the children with anisometropic amblyopia and the children with strabismic amblyopia, the average thicknesses of the fovea were 146.5 micrometer and 173.1 micrometer, respectively, and the retinal nerve fiber layer thicknesses were measured to be 112.9 micrometer and 92.8 micrometer, respectively, and these were statistically significant differences (p=0.046, 0.034, respectively). CONCLUSIONS: Normal thicknesses of the fovea and the retinal nerve fiber layers were established, and there were no differences in the fovea and the retinal nerve fiber layer thickness found between normal children and children with amblyopia.
Tomography, Optical Coherence ; Severity of Illness Index ; Retrospective Studies ; Retinal Ganglion Cells/*pathology ; Nerve Fibers/*pathology ; Male ; Humans ; Fovea Centralis/*pathology ; Female ; Child, Preschool ; Child ; Amblyopia/*pathology ; Adolescent

Adolescent ; Amblyopia ; genetics ; Child, Preschool ; Female ; Finger Joint ; pathology ; Hearing Loss, Conductive ; congenital ; genetics ; Humans ; Male ; Pedigree ; Young Adult

This prospective study was performed to measure the macular and the peripapillary retinal nerve fiber layer (RNFL) thicknesses using optical coherence tomography (OCT) in patients with anisometropic amblyopia. Thirty-one patients with hyperopic anisometropic amblyopia were included. The macular retinal thickness and the peripapillary RNFL thickness were measured using OCT. The mean refractive error was +3.71 diopters (D) and +1.00 D, the mean macular retinal thickness was 252.5 micrometer and 249.7 micrometer, and the mean RNFL thickness was 115.2 micrometer and 109.6 micrometer, in the amblyopic eye and the normal eye, respectively. OCT assessment of RNFL thickness revealed a significantly thicker RNFL in hyperopic anisometropic amblyopia (P=0.019), but no statistically significant difference was found in macular retinal thickness (P> 0.05). In conclusion, the amblyopic process may involve the peripapillary RNFL, but not the macula. However, further evaluation is needed.
Amblyopia/complications/*pathology ; Anisometropia/complications/*pathology ; Child ; Child, Preschool ; Female ; Humans ; Macula Lutea/*pathology ; Male ; Nerve Fibers/*pathology ; Optic Disk/*pathology ; Prospective Studies ; Retinal Ganglion Cells/*pathology ; Tomography, Optical Coherence/methods

Strabismus is a pathologic condition in which the eyes do not properly align with each other forming different images on the corresponding retinal points. Early diagnosis and appropriate management of strabismus in the sensitive period of visual maturation is critical for the development of normal binocular vision in children. Therefore, it is important to perform ophthalmologic examinations including cycloplegic refraction and ocular alignment as early as possible to detect risk factors for amblyopia and strabismus. Strabismus could also be a sign of intraocular pathology, brain diseases or myasthenia gravis which may require urgent treatment. Strabismus can be treated by surgical and non-surgical methods. The first step in the management of strabismus is to correct amblyogenic refractive errors and prescribe glasses if necessary. Bifocal lenses, prism glasses, occlusion therapy, and botulinum toxin injection could also be considered. Surgery is usually performed if non-surgical treatments are unsuccessful. Making an accurate diagnosis and setting practical goals and limitations of treatment is the key to success in the treatment of strabismus.
Amblyopia ; Botulinum Toxins ; Brain Diseases ; Child ; Diagnosis ; Early Diagnosis ; Eyeglasses ; Glass ; Humans ; Myasthenia Gravis ; Pathology ; Refractive Errors ; Retinaldehyde ; Risk Factors ; Strabismus ; Vision, Binocular

PURPOSE: To investigate the relationship between higher-order aberrations (HOAs) and amblyopia treatment in children with hyperopic anisometropic amblyopia. METHODS: The medical records of hyperopic amblyopia patients with both spherical anisometropia of 1.00 diopter (D) or more and astigmatic anisometropia of less than 1.00 D were reviewed retrospectively. Based on the results of the amblyopia treatment, patients were divided into two groups: treatment successes and failures. Using the degree of spherical anisometropia, subjects were categorized into mild, moderate, or severe groups. Ocular, corneal, and internal HOAs were measured using a KR-1W aberrometer at the initial visit, and at 3-month, 6-month, and 12-month follow-ups. RESULTS: The results of the 45 (21 males and 24 females) hyperopic anisometropic amblyopia patients who completed the 12-month follow-up examinations were analyzed. The mean patient age at the initial visit was 70.3 months. In total, 28 patients (62.2%) had successful amblyopia treatments and 17 patients (37.8%) failed treatment after 12 months. Among the patient population, 24 (53.3%) had mild hyperopic anisometropia and 21 (46.7%) had moderate hyperopic anisometropia. When comparing the two groups (i.e., the success and failure groups), ocular spherical aberrations and internal spherical aberrations in the amblyopic eyes were significantly higher in the failure group at every follow-up point. There were no significant differences in any of the HOAs between mild and moderate cases of hyperopic anisometropia at any follow-up. When the amblyopic and fellow eyes were compared between the groups there were no significant differences in any of the HOAs. CONCLUSIONS: HOAs, particularly ocular spherical aberrations and internal spherical aberrations, should be considered as reasons for failed amblyopia treatment.
Aged ; Amblyopia/complications/physiopathology/*therapy ; Anisometropia/complications/physiopathology/*therapy ; Cornea/*pathology/physiopathology ; *Eyeglasses ; Female ; Follow-Up Studies ; Humans ; Hyperopia/complications/physiopathology/*therapy ; Male ; Middle Aged ; Refraction, Ocular/*physiology ; Retrospective Studies ; Treatment Outcome ; *Visual Acuity

PURPOSE: To investigate the relationship between higher-order aberrations (HOAs) and amblyopia treatment in children with hyperopic anisometropic amblyopia. METHODS: The medical records of hyperopic amblyopia patients with both spherical anisometropia of 1.00 diopter (D) or more and astigmatic anisometropia of less than 1.00 D were reviewed retrospectively. Based on the results of the amblyopia treatment, patients were divided into two groups: treatment successes and failures. Using the degree of spherical anisometropia, subjects were categorized into mild, moderate, or severe groups. Ocular, corneal, and internal HOAs were measured using a KR-1W aberrometer at the initial visit, and at 3-month, 6-month, and 12-month follow-ups. RESULTS: The results of the 45 (21 males and 24 females) hyperopic anisometropic amblyopia patients who completed the 12-month follow-up examinations were analyzed. The mean patient age at the initial visit was 70.3 months. In total, 28 patients (62.2%) had successful amblyopia treatments and 17 patients (37.8%) failed treatment after 12 months. Among the patient population, 24 (53.3%) had mild hyperopic anisometropia and 21 (46.7%) had moderate hyperopic anisometropia. When comparing the two groups (i.e., the success and failure groups), ocular spherical aberrations and internal spherical aberrations in the amblyopic eyes were significantly higher in the failure group at every follow-up point. There were no significant differences in any of the HOAs between mild and moderate cases of hyperopic anisometropia at any follow-up. When the amblyopic and fellow eyes were compared between the groups there were no significant differences in any of the HOAs. CONCLUSIONS: HOAs, particularly ocular spherical aberrations and internal spherical aberrations, should be considered as reasons for failed amblyopia treatment.
Aged ; Amblyopia/complications/physiopathology/*therapy ; Anisometropia/complications/physiopathology/*therapy ; Cornea/*pathology/physiopathology ; *Eyeglasses ; Female ; Follow-Up Studies ; Humans ; Hyperopia/complications/physiopathology/*therapy ; Male ; Middle Aged ; Refraction, Ocular/*physiology ; Retrospective Studies ; Treatment Outcome ; *Visual Acuity

PURPOSE: To identify the long term clinical course of amblyopia and strabismus that developed secondary to a monocular corneal opacity following suspected epidemic keratoconjunctivitis (EKC) in infancy. METHODS: This was a retrospective study analyzing the medical records of seven patients, treated in our clinic, who were followed for more than five years. RESULTS: Four patients in our clinic underwent a corneal ulcer treatment following suspected EKC. Each developed a monocular corneal opacity. Three patients with a chief complaint of corneal opacity were transferred to our clinic from other clinics. These patients had documented histories of treatment for EKC in infancy. All patients were treated with early occlusion therapy, but amblyopia persisted in four patients. Furthermore, all patients had strabismus and showed a significant reduction of stereoscopic vision. CONCLUSIONS: Although infants with EKC are not always cooperative, slit lamp examination should be performed as early as possible, and appropriate medical treatment should be performed, thus reducing the development of corneal opacity. Careful follow up should be regularly performed, and the occurrence of amblyopia or strabismus should be verified at an early stage using visual acuity or ocular alignment examination. Ophthalmologic treatments, including active occlusion therapy, should also be pursued.
Adenoviridae Infections/*complications/diagnosis/epidemiology ; Amblyopia/*etiology/pathology/physiopathology ; Child ; Child, Preschool ; Corneal Opacity/*complications/pathology ; Disease Progression ; *Epidemics ; Eye Infections, Viral/*complications/diagnosis/epidemiology ; Female ; Follow-Up Studies ; Humans ; Infant ; Keratoconjunctivitis/*complications/diagnosis/epidemiology ; Male ; Prognosis ; Refraction, Ocular ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Strabismus/*etiology/pathology/physiopathology ; Vision, Binocular ; Visual Acuity