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Natural history of amblyopia untreated owing to lack of compliance
1Krieger Children's Eye Center, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA.
Insights
Untreated amblyopia in preschool children often worsens or new cases develop. This highlights the risks associated with delaying treatment for amblyopia and its risk factors in young children.
Area of Science:
- Ophthalmology
- Pediatric eye care
- Vision science
Background:
- Amblyopia, or 'lazy eye', affects visual development in children.
- A need exists for data on untreated amblyopia in preschoolers to inform treatment strategies.
Purpose of the Study:
- To assess the outcomes of amblyopia in preschool children who did not receive treatment.
- To evaluate the natural course of amblyopia and its risk factors in an untreated cohort.
Main Methods:
- A longitudinal study of 18 preschool children (4-6 years) with diagnosed amblyopia who did not comply with treatment.
- Reanalysis of data from three prior studies comparing compliant and non-compliant amblyopia treatment groups.
Main Results:
- No significant improvement in visual acuity was observed in the untreated group; 41% showed deterioration.
- Three children developed new-onset amblyopia.
- Reanalyzed data confirmed significantly poorer outcomes in non-compliant versus compliant amblyopia treatment groups.
Conclusions:
- Preschool children with amblyopia or risk factors face deterioration or new onset if untreated.
- The findings raise ethical concerns regarding prospective studies of amblyopia treatment in this age group without prior intervention.
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.