Randomised clinical trial of lensectomy versus lens aspiration and primary capsulotomy for children with bilateral cataract in south India.
AIMS: The primary objective was to determine which surgical technique gave the best long term visual outcome for infants and young children with bilateral symmetrical cataract in south India. Secondary objectives were to assess complications and the need for further surgical intervention. METHODS: A randomised controlled clinical trial was undertaken. 65 children under 10 years old with bilateral cataract had one eye treated by lensectomy and the other by aspiration with primary capsulotomy. RESULTS: 56 children (86%) with a mean age at surgery of 53 months were reviewed 3 years after surgery. The overall binocular acuity was 6/18 or better in 57.1% and 6/60 or better in 94.6%. There was no difference in visual acuity between the matched pairs of eyes undergoing aspiration or lensectomy at the third year of follow up (p=0.57). Aspiration eyes were more likely to require a secondary procedure to restore vision than lensectomy eyes (66.1% v 1.8%). CONCLUSION: Aspiration with primary capsulotomy gives an acceptable visual outcome in this part of India providing that there is good follow up to manage capsule opacification. If secondary intervention is not possible owing to poor compliance with follow up, then lensectomy is likely to give better long term visual rehabilitation providing there is good maintenance and technical support for the lensectomy equipment. (+info)
Natural history of amblyopia untreated owing to lack of compliance.
AIMS: A prospective study of the efficacy of amblyopia treatment in preschool children has recently been called for, requiring an untreated control group. The present study assessed data from patients with amblyopia untreated owing to lack of compliance, or with amblyopia risk factors, to determine outcome. METHODS: Longitudinal data were obtained from 18 4-6 year old patients who had initially been screened for amblyopia, strabismus, and/or bilateral refractive error, failed to comply with prescribed treatment, and in whom amblyopia was detected at a rescreening approximately a year later. The data from three previous studies comparing outcome of patients compliant and non-compliant with amblyopia treatment were also reanalysed. RESULTS: One child of the 18, who wore glasses sporadically, showed some improvement in visual acuity in the amblyopic eye. Otherwise, no child showed an improvement, and seven of the 17 (41%) for whom visual acuities were available at both screenings showed a deterioration of visual acuity in the amblyopic eye, including three who apparently developed amblyopia for the first time. A child with an ametropic risk factor for amblyopia whose visual acuity was not obtained at the first screening and who was largely non-compliant presented with amblyopia at the second screening. The reanalysed data from the three previous studies demonstrated a significantly poorer visual acuity outcome in the amblyopic eye in the non-compliant patient groups than in the compliant groups in each study. CONCLUSION: Preschool children with amblyopia or its risk factors are at risk of having the current amblyopia deteriorate, or of developing amblyopia, if not treated. These results raise questions about the ethical acceptability of a prospective study of amblyopia treatment at these ages. (+info)
Preschool vision screening: negative predictive value for amblyopia.
BACKGROUND/AIMS: Single optotype tests of visual acuity are widely used for preschool vision screening in order to optimise cooperation with testing. These tests may, however, underestimate the visual acuity deficit in amblyopia because they lack visual crowding. This study assessed the resultant negative predictive value (NPV) for amblyopia. METHODS: Cohort study of 936 children in the Cambridge Health District selected by date of birth. The presence of amblyopia among children who had passed preschool vision screening was determined using Snellen line acuity as the reference test. Preschool vision screening was conducted at 3.5 years of age by community orthoptists. The screening assessment comprised Sheridan-Gardiner single optotype test of visual acuity (referral criterion 6/9 or worse in either eye), cover test, ocular movements, 20(Delta) prism test, and TNO stereotest. RESULTS: The overall NPV of preschool vision screening for amblyopia was 100% (95% CI 99.4% to 100%). Most children with amblyopia were detected by the Sheridan-Gardiner single optotype test of visual acuity, but the other screening tests were necessary to prevent any false negatives. In isolation, the Sheridan-Gardiner single optotype test of visual acuity has a NPV for amblyopia of only 99.6% (95% CI 98.7% to 99.9%). CONCLUSION: Preschool vision screening using a single optotype test of visual acuity does achieve a high NPV for amblyopia, but only under certain conditions. These comprise a low threshold for referral (6/9 or worse in either eye) and the inclusion of a cover test and tests of binocular function in the screening assessment. (+info)
A deficit in strabismic amblyopia for global shape detection.
Using a task which relied upon the detection of sinusoidal deformations from circularity, we show that strabismic amblyopes exhibit deficits which are not critically dependent on either the scale of deformation or the spatial frequency characteristics of the stimulus (circular D4) itself. We show that this loss is not due to the restricted passband of the amblyopic eye. Furthermore, in a pedestal distortion experiment, we show that the suprathreshold form of this loss is consistent with an elevated level of 'intrinsic noise' rather than a loss in 'sampling efficiency'. (+info)
Orientation-based texture segmentation in strabismic amblyopia.
Texture segmentation of 'target' Gabors from an array of 'background' Gabors was measured in terms of the difference in orientation between the two regions, as well as the difference in orientation within each region. Segmentation was shown to occur on the basis of local orientation differences at the boundary between the target and background regions (Nothdurft, H.C. (1992). Feature analysis and the role of similarity in preattentive vision. Perception and Psychophysics, 52, 355-375.). We obtained similar results for both the amblyopic and non-amblyopic eye of three strabismic amblyopes, and showed also that the effects of texture undersampling and positional jitter were similar for the two eyes. This pattern of results is consistent with intact mechanisms of texture perception in amblyopic cortex, and suggests also that any amblyopic deficits in first-order cortical units (undersampling and/or positional uncertainty) do not limit higher-order texture segmentation processes. Therefore, first- and second-order processes involved in perceptual grouping of oriented elements (that appear to be abnormal in amblyopic cortex; Kovacs, I., Polat, U., Norcia, A.M. (1996). Breakdown of binding mechanisms in amblyopia. Association for Research in Vision and Ophthalmology Abstracts; Mussap, A.J., Levi, D.M. (1995). Amblyopic deficits in perception of second-order orientation. Investigative Ophthalmology and Visual Science (Supplement), 36, S634; Mussap, A.J., Levi, D.M. (1998). Amblyopic deficits in perceptual grouping. Vision Research, submitted) do not contribute to texture perception based on orientation contrast. (+info)
Position jitter and undersampling in pattern perception.
The present paper addresses whether topographical jitter or undersampling might limit pattern perception in foveal, peripheral and strabismic amblyopic vision. In the first experiment, we measured contrast thresholds for detecting and identifying the orientation (up, down, left, right) of E-like patterns comprised of Gabor samples. We found that detection and identification thresholds were both degraded in peripheral and amblyopic vision; however, the orientation identification/detection threshold ratio was approximately the same in foveal, peripheral and amblyopic vision. This result is somewhat surprising, because we anticipated that a high degree of uncalibrated topographical jitter in peripheral and amblyopic vision would have affected orientation identification to a greater extent than detection. In the second experiment, we investigated the tolerance of human and model observers to perturbation of the positions of the samples defining the pattern when its contrast was suprathreshold, by measuring a 'jitter threshold' (the amount of jitter required to reduce performance from near perfect to 62.5% correct). The results and modeling of our jitter experiments suggest that pattern identification is highly robust to positional jitter. The positional tolerance of foveal, peripheral and amblyopic vision is equal to about half the separation of the features and the close similarity between the three visual systems argues against extreme topographical jitter. The effects of jitter on human performance are consistent with the predictions of a 'template' model. In the third experiment we determined what fraction of the 17 Gabor samples are needed to reliably identify the orientation of the E-patterns by measuring a 'sample threshold' (the proportion of samples required for 62.5% correct performance). In foveal vision, human observers are highly efficient requiring only about half the samples for reliable pattern identification. Relative to an ideal observer model, humans perform this task with 85% efficiency. In contrast, in both peripheral vision and strabismic amblyopia more samples are required. The increased number of features required in peripheral vision and strabismic amblyopia suggests that in these visual systems, the stimulus is underrepresented at the stage of feature integration. (+info)
Abnormal depth perception from motion parallax in amblyopic observers.
Many similarities exist between the perception of depth from binocular stereopsis and that from motion parallax. Moreover, Rogers (1984, cited in, Howard, I. P., & Rogers, B. J. (1995). Binocular vision and stereopsis. Oxford Claridon, New York.) suggests a relationship between an observer's ability to use disparity information and motion parallax information in a depth perception task. To more closely investigate this relationship, depth perception was studied in normal observers and amblyopic observers with poor stereo vision. As expected, amblyopic observers performed much worse than normal observers on depth discriminations requiring use of binocular disparity. However, amblyopic observers also performed much worse than normal observers on depth discriminations based on motion parallax. This result provides supporting evidence for a psychoanatomical link between the perception of depth from motion and the perception of depth from binocular disparity. (+info)
Assessment of cortical dysfunction in human strabismic amblyopia using magnetoencephalography (MEG).
The aim of this study was to use the technique of magnetoencephalography (MEG) to determine the effects of strabismic amblyopia on the processing of spatial information within the occipital cortex of humans. We recorded evoked magnetic responses to the onset of a chromatic (red/green) sinusoidal grating of periodicity 0.5-4.0 c deg-1 using a 19-channel SQUID-based neuromagnetometer. Evoked responses were recorded monocularly on six amblyopes and six normally-sighted controls, the stimuli being positioned near the fovea in the lower right visual field of each observer. For comparison, the spatial contrast sensitivity function (CSF) for the detection of chromatic gratings was measured for one amblyope and one control using a two alternate forced-choice psychophysical procedure. We chose red/green sinusoids as our stimuli because they evoke strong magnetic responses from the occipital cortex in adult humans (Fylan, Holliday, Singh, Anderson & Harding. (1997). Neuroimage, 6, 47-57). Magnetic field strength was plotted as a function of stimulus spatial frequency for each eye of each subject. Interocular differences were only evident within the amblyopic group: for stimuli of 1-2 c deg-1, the evoked responses had significantly longer latencies and reduced amplitudes through the amblyopic eye (P < 0.05). Importantly, the extent of the deficit was uncorrelated with either Snellen acuity or contrast sensitivity. Localization of the evoked responses was performed using a single equivalent current dipole model. Source localizations, for both normal and amblyopic subjects, were consistent with neural activity at the occipital pole near the V1/V2 border. We conclude that MEG is sensitive to the deficit in cortical processing associated with human amblyopia, and can be used to make quantitative neurophysiological measurements. The nature of the cortical deficit is discussed. (+info)