Factors predicting recurrence in successfully treated cases of anisometropic amblyopia
Rohit Saxena1, Shraddha Puranik, Digvijay Singh
1Squint and Neuro-Ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Context:
Recurrence after successful treatment of amblyopia is known and understanding the risk factors could help effective management.
Aim:
To measure incidence of recurrence in successfully treated cases of anisometropic amblyopia and evaluate factors predicting it.
Settings And Design:
Cohort Study at a tertiary level institution.
Materials And Methods:
Successfully treated anisometropic amblyopes aged 4-12 years were followed up for 1 year after stopping therapy. Best corrected visual acuity (BCVA), refractive error, stereoacuity and contrast sensitivity were evaluated at baseline and follow-up.
Statistical Analysis:
Intergroup analysis with appropriate tests: Chi-square test, Fisher's exact test, Wilcoxon rank sum test and paired t-test.
Results:
One hundred and two patients with mean age at diagnosis 7.06 μ 1.81 years were followed-up for a mean duration of 1.0 μ 0.2 years. The mean pre-treatment BCVA (LogMAR score) at diagnosis was 0.73 μ 0.36 units which improved to 0.20 μ 0.00 with treatment and after 1 year of stopping treatment was 0.22 μ 0.07. Thirteen (12.74%) patients showed amblyopia recurrence during follow-up. Risk of recurrence was higher with older age of onset of treatment (6.64 μ 1.77 years without recurrence v/s 8.53 μ 1.39 years with recurrence, P = 0.0014). Greater extent of improvement of VA (P = 0.048) and final VA at stopping occlusion (P = 0.03) were associated with higher recurrence. Binocularity status or stereoacuity changes were not associated with risk of recurrence.
Conclusions:
Significant numbers of children suffer recurrence of amblyopia after stopping therapy. Older age, better BCVA after stopping therapy and greater magnitude of improvement in BCVA are important risk factors for recurrence. Careful follow-up is essential for early detection and management of recurrence.
