Pediatric Ophthalmology
Pediatric Eye Disease and Investigator Group (PEDIG) Since 2011 ⏩ and ⏩
Optical correction for unilateral amblyopia (3-7y)- Mean improvement of 3 lines, mostly within 16 weeks. Full resolution in 25-33% (less than 1 line difference between eyes). Follow-up of 6-8 weeks for optical correction improvement.
Optical correction for bilateral amblyopia (3-10y)- mean improvement 4 lines, gradually up to 1y. Lower initial VA = greater improvement.
Patching (3-7) - in moderate amblyopia 2h =6h/d. In severe 6h=full time. Rate of improvement did not differ. Some severe cases respond to 2h/d.
Atropine (3-7) - Atropin vs patching for moderate amblyopia: same final VA but atropine took more time. 50% had complete resolution. Weekend application = q1d. VA Max within 4mo (up to 1year). Weekend atropine effective for severe amblyopia (4+ lines for ages 3-7 and 7-12 improved 1.5 lines, not powered). Atropine second line after patch failure.
Bangerter filters - full time equal to 2h patching with better compliance.
Age (7-12) 53% responded in patching with refractive error correction vs 25% for refraction alone. Ages (13-17) had similar effect.
Residual amblyopia with 2h/d patch responded increase to 6h/d with 1.2-2 lines gains. Residual amblyopia after 6h/d didn't change with additional atropine. Results maintained with 2h/d. Levodopa added to patching had no effect.
Recurrence (3-8) in 25% mostly within 3m (up to 1y). Deterioration faster when no patch taper done. 7-12y obly 7% recurred within 1y.
Effect of patching during near activities = far activities.
Diplopia did not occur.
Atropine for the treatment of childhood myopia (ATOM 1), 2006 ⏩
A Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children
Convergence Insufficiency Treatment Trial Investigator Group (CITT), 2008 ⏩
n=221 (Age 9-17), 12w
Study question: Symptomatic Convergence insufficiency treatments: Home pencil push-ups VS Home computer based therapy with pencil push-ups VS office based therapy with home-work, office-based placebo.Study results: Successful tx 73% of office based tx with home-work, 43% home push ups, 33% for computer based tx, 35% placebo group. Office based training with home-work was significantly better than all other groups in CISS score, NPC, PFV. Criticized for un-equal tx dosage and limited home based exercises.
Dichoptic training enables the adult amblyopic brain to learn (Hess, 2013) ⏩
n=18, 1m
Study question: Change in VA in amblyopic adults trained with dichoptic Tetris game. Crossover after 2w Study Results: Both groups showed significant improvements in VA. Dichoptic was 4 fold better. When the monocular group were crossed over to dichoptic training, there was a pronounced (over a factor of 4) and significant further improvement in visual acuity.
Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years (Infant Aphakia Treatment Study group, IATS), 2014 ⏩
n=114, 5y
Study question: visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. Study Results: similar final VA, 50% were 20/200 or less. IOL group had at least 1 adverse event (lens reproliferation into the visual axis, pupillary membranes, and corectopia). Glaucoma/glaucoma suspect occurred in 35% of the contact lens group vs 28% in the IOL group (not significant). 72% the IOL group have had at least 1 additional intraocular surgery (vs 21%). Excluding cases of iris prolapse groups had similar complication profile. Authors' conclude: Younger than 7mo months of age with a unilateral cataract recommended leaving the eye aphakic and focusing the eye with a contact lens.
Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy, 2014 ⏩
n=6
Study question: adjustable nasal transposition of the split lateral rectus (LR) muscle, for managing strabismus associated with third nerve palsy. Study Resutls: Novel technique: four of 6 patients successfully underwent the procedure, 3 achieved orthotropia.
Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2 (ATOM 2), 2015 ⏩
n-400, 5y
Study Question: Atropine daily for 25m, then observation only for 12m. Re-treated if progression detected. Study Results: During phase 1 greater effect in higher doses, but increased regression during phase 2 (washout). Atropine 0.01% being more effective in reducing myopia progression at 3y. Regression: 24% (0.01%), 59% (0.1%), and 68% in 0.5% group. Risk factors for regression: young age and poor response in 1st year. Overall myopia progression at the end of 5 years being lowest in the 0.01%% group -1.3D vs 1.83D (0.1%) and -1.98D (0.5%).
Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children, 2017 ⏩
n=49, 6m
Study question: Botulinum toxin VS standard incisional strabismus surgery for acute onset comitant esotropia. Study results: Botulinum toxin is at least as effective as surgery in the treatment of acute-onset comitant esotropia at 6 months while reducing the duration of general anesthesia and healthcare costs.
The Effect of Botulinum Toxin Augmentation on Strabismus Surgery for Large-Angle Infantile Esotropia, 2018 ⏩
n=30, 4m
Study question: botulinum toxin-augmented bilateral medial rectus muscle recessions VS traditional bilateral medial rectus muscle recessions
Study results: The mean effect on alignment was significantly greater in the augmented-surgery group at 4 months (5.7 ± 1.3 vs 4.0 ± 1.4 PD/mm) and at 1 year (5.4 ± 1.2 vs 3.7 ± 1.2 PD/mm). There was a partial loss of treatment effect between 4 months and 1 year in both groups, which was similar in magnitude. Botulinum toxin augments the surgical effect of medial rectus muscle recession.
Please note that studies on Retinopathy of prematurity (ROP) are on a separate page on this site.
Abbreviations used on this page:
CISS - Convergence Insufficiency Symptom Survey, score
D - diopters
VA - visual acuity
tx - treatment
IOL - intra-ocular lens
m, mo - month
NPC - near point of convergence
PFV - positive fusional vergence at near
y - year
----------------------------------------
🚧This is not a complete list of relevant articles but rather a work in progress. If you have any suggestions you should contact us using the form below. Thank you for your patients.
Optical correction for unilateral amblyopia (3-7y)- Mean improvement of 3 lines, mostly within 16 weeks. Full resolution in 25-33% (less than 1 line difference between eyes). Follow-up of 6-8 weeks for optical correction improvement.
Optical correction for bilateral amblyopia (3-10y)- mean improvement 4 lines, gradually up to 1y. Lower initial VA = greater improvement.
Patching (3-7) - in moderate amblyopia 2h =6h/d. In severe 6h=full time. Rate of improvement did not differ. Some severe cases respond to 2h/d.
Atropine (3-7) - Atropin vs patching for moderate amblyopia: same final VA but atropine took more time. 50% had complete resolution. Weekend application = q1d. VA Max within 4mo (up to 1year). Weekend atropine effective for severe amblyopia (4+ lines for ages 3-7 and 7-12 improved 1.5 lines, not powered). Atropine second line after patch failure.
Bangerter filters - full time equal to 2h patching with better compliance.
Age (7-12) 53% responded in patching with refractive error correction vs 25% for refraction alone. Ages (13-17) had similar effect.
Residual amblyopia with 2h/d patch responded increase to 6h/d with 1.2-2 lines gains. Residual amblyopia after 6h/d didn't change with additional atropine. Results maintained with 2h/d. Levodopa added to patching had no effect.
Recurrence (3-8) in 25% mostly within 3m (up to 1y). Deterioration faster when no patch taper done. 7-12y obly 7% recurred within 1y.
Effect of patching during near activities = far activities.
Diplopia did not occur.
Atropine for the treatment of childhood myopia (ATOM 1), 2006 ⏩
n=400, 2y
Study question: Topical daily atropine 1% vs placebo for myopia -1 to -6. Study results: Progression of myopia was -1.20+/-0.69 D in the placebo group vs -0.28 in tx group. No serious adverse effects. See ATOM 2.
A Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children
Convergence Insufficiency Treatment Trial Investigator Group (CITT), 2008 ⏩
n=221 (Age 9-17), 12w
Study question: Symptomatic Convergence insufficiency treatments: Home pencil push-ups VS Home computer based therapy with pencil push-ups VS office based therapy with home-work, office-based placebo.Study results: Successful tx 73% of office based tx with home-work, 43% home push ups, 33% for computer based tx, 35% placebo group. Office based training with home-work was significantly better than all other groups in CISS score, NPC, PFV. Criticized for un-equal tx dosage and limited home based exercises.
Dichoptic training enables the adult amblyopic brain to learn (Hess, 2013) ⏩
n=18, 1m
Study question: Change in VA in amblyopic adults trained with dichoptic Tetris game. Crossover after 2w Study Results: Both groups showed significant improvements in VA. Dichoptic was 4 fold better. When the monocular group were crossed over to dichoptic training, there was a pronounced (over a factor of 4) and significant further improvement in visual acuity.
Comparison of contact lens and intraocular lens correction of monocular aphakia during infancy: a randomized clinical trial of HOTV optotype acuity at age 4.5 years and clinical findings at age 5 years (Infant Aphakia Treatment Study group, IATS), 2014 ⏩
n=114, 5y
Study question: visual outcomes of patients optically corrected with contact lenses vs IOLs following unilateral cataract surgery during early infancy. Study Results: similar final VA, 50% were 20/200 or less. IOL group had at least 1 adverse event (lens reproliferation into the visual axis, pupillary membranes, and corectopia). Glaucoma/glaucoma suspect occurred in 35% of the contact lens group vs 28% in the IOL group (not significant). 72% the IOL group have had at least 1 additional intraocular surgery (vs 21%). Excluding cases of iris prolapse groups had similar complication profile. Authors' conclude: Younger than 7mo months of age with a unilateral cataract recommended leaving the eye aphakic and focusing the eye with a contact lens.
Adjustable nasal transposition of split lateral rectus muscle for third nerve palsy, 2014 ⏩
n=6
Study question: adjustable nasal transposition of the split lateral rectus (LR) muscle, for managing strabismus associated with third nerve palsy. Study Resutls: Novel technique: four of 6 patients successfully underwent the procedure, 3 achieved orthotropia.
Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2 (ATOM 2), 2015 ⏩
n-400, 5y
Study Question: Atropine daily for 25m, then observation only for 12m. Re-treated if progression detected. Study Results: During phase 1 greater effect in higher doses, but increased regression during phase 2 (washout). Atropine 0.01% being more effective in reducing myopia progression at 3y. Regression: 24% (0.01%), 59% (0.1%), and 68% in 0.5% group. Risk factors for regression: young age and poor response in 1st year. Overall myopia progression at the end of 5 years being lowest in the 0.01%% group -1.3D vs 1.83D (0.1%) and -1.98D (0.5%).
Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children, 2017 ⏩
n=49, 6m
Study question: Botulinum toxin VS standard incisional strabismus surgery for acute onset comitant esotropia. Study results: Botulinum toxin is at least as effective as surgery in the treatment of acute-onset comitant esotropia at 6 months while reducing the duration of general anesthesia and healthcare costs.
The Effect of Botulinum Toxin Augmentation on Strabismus Surgery for Large-Angle Infantile Esotropia, 2018 ⏩
n=30, 4m
Study question: botulinum toxin-augmented bilateral medial rectus muscle recessions VS traditional bilateral medial rectus muscle recessions
Study results: The mean effect on alignment was significantly greater in the augmented-surgery group at 4 months (5.7 ± 1.3 vs 4.0 ± 1.4 PD/mm) and at 1 year (5.4 ± 1.2 vs 3.7 ± 1.2 PD/mm). There was a partial loss of treatment effect between 4 months and 1 year in both groups, which was similar in magnitude. Botulinum toxin augments the surgical effect of medial rectus muscle recession.
Please note that studies on Retinopathy of prematurity (ROP) are on a separate page on this site.
Abbreviations used on this page:
CISS - Convergence Insufficiency Symptom Survey, score
D - diopters
VA - visual acuity
tx - treatment
IOL - intra-ocular lens
m, mo - month
NPC - near point of convergence
PFV - positive fusional vergence at near
y - year
----------------------------------------
🚧This is not a complete list of relevant articles but rather a work in progress. If you have any suggestions you should contact us using the form below. Thank you for your patients.
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