Results of occlusion therapy in anisomyopic amblyopia with myelinated nerve fibers

The combination of anisomyopia and myelinated nerve fibers in the highly myopic eye is often correlated with severe and therapy-resistant amblyopia. There are very few reports on successful amblyopia therapy in patients with this constellation of symptoms. We report on six patients aged 6, 7, 9 (two cases), and 28 years (two cases) who presented with anisomyopia, myelinated nerve fibers, and severe amblyopia in the highly myopic eye. The four younger patients took part in a therapeutic trial with contact lens correction and occlusion. The six patients suffered from varying degrees of anisomyopia, which ranged between -3.5 and -18.5 D. Four patients underwent strict occlusion therapy. The best visual improvement was from 1/25 to 0.2 (factor of 5) and the best final visual acuity was 0.4. Two patients had microstrabismus, three displayed exotropia, and one patient showed no strabismus. The combination of unilateral high-grade myopia and myelinated nerve fibers represents a special conjunction that is usually correlated with severe amblyopia. The amblyopia is practically resistant to therapy, even under strict treatment regimen with contact lenses and forced occlusion. The goal must be to diagnose this constellation in the first 2 years of life. As case reports show in the literature, consistent therapy at this age can lead to good visual acuity.