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Updated: May 22, 2026
The Measurement and Treatment of Suppression in Amblyopia
Published on: December 14, 2012
Effect of ocular alignment on emmetropization in children <10 years with amblyopia
Marjean T Kulp1, Nicole C Foster, Jonathan M Holmes
1The Ohio State University, College of Optometry, Columbus, Ohio, USA. pedig@jaeb.org
Insights
Children
Area of Science:
- Ophthalmology
- Pediatric eye care
- Refractive error development
Background:
- Amblyopia treatment in young children often involves atropine or patching.
- Understanding long-term refractive error changes is crucial for pediatric eye health.
- Ocular alignment plays a role in visual development and refractive outcomes.
Purpose of the Study:
- To investigate the association between changes in refractive error and ocular alignment in children previously treated for amblyopia.
- To analyze refractive error progression in relation to baseline ocular alignment categories.
Main Methods:
- Prospective cohort study of 105 children (3 to <7 years) from a prior amblyopia treatment trial.
- Cycloplegic refraction and ocular alignment assessed at baseline and age 10.
- Multivariate regression analyzed refractive error change against alignment, adjusting for covariates.
Main Results:
- Amblyopic eyes showed a significant decrease in hyperopia (spherical equivalent: -0.65 D).
- Greater refractive error reduction in the amblyopic eye was linked to better ocular alignment (orthotropic).
- No significant association found between alignment and refractive error change in the fellow eye.
Conclusions:
- Children treated for amblyopia experience a shift towards less hyperopia in the amblyopic eye by age 10.
- This refractive change is associated with better ocular alignment, suggesting improved visual fusion promotes emmetropization.
- Findings support the link between binocular vision and refractive development in children.
Purpose:
To determine whether change in refractive error is associated with ocular alignment in 105 children 3 to <7 years of age who previously participated in a randomized trial comparing atropine and patching for moderate amblyopia.
Design:
Prospective cohort study.
Methods:
One hundred five children 3 to <7 years of age previously participated in a randomized trial comparing atropine with patching for moderate amblyopia. Cycloplegic refraction was measured at baseline and 10 years of age. Ocular alignment at baseline was categorized as orthotropic, microtropic (1-8 Δ horizontal tropia), or heterotropic (>8 Δ horizontal tropia). Multivariate regression models evaluated whether change in spherical equivalent refractive error was associated with alignment category, after adjusting for age, baseline spherical equivalent refractive error, and type of amblyopia treatment.
Results:
Between enrollment and the age 10-year examination, there was a decrease in spherical equivalent refractive error from hyperopia to less hyperopia (amblyopic eye: -0.65 diopter, 95% CI -0.85, -0.46; fellow eye: -0.39 diopter, 95% CI -0.58, -0.20). A greater decrease in amblyopic eye refractive error was associated with better ocular alignment category (P = .004), with the greatest decrease occurring in orthotropic patients. There was no relationship between ocular alignment category and change in fellow-eye refractive error.
Conclusions:
Among children treated for anisometropic, strabismic, or combined mechanism amblyopia, there is a decrease in amblyopic eye spherical equivalent refractive error to less hyperopia after controlling for baseline refractive error. This negative shift toward emmetropia is associated with ocular alignment, which supports the suggestion that better motor and sensory fusion promote emmetropization.
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