굴절부등약시에서 약시치료 전 안경착용의 효과

최덕규,최미영,Duk Kyu Choi,Mi Young Choi 대한안과학회 2011 대한안과학회지 Vol.52 No.5

Purpose: To identify the efficacy of spectacle wearing for 4 months before amblyopia treatment in children with anisometropic amblyopia. Methods: The patients with anisometropic amblyopia without strabismus were selected for the present study. The patients were divided into 2 groups; patients who began amblyopia treatment while simultaneously wearing glasses (Group A, 16 patients) and patients who began amblyopia treatment after wearing spectacles for 4 months (Group B, 17 patients). Intermittent atropine penalization or part-time occlusion was provided for amblyopia treatment. Age and best-corrected visual acuity at the start and cessation of treatment, type of amblyopia, treatment method and duration of treatment were analyzed. Results: There were no statistical differences among age, best-corrected visual acuity of the amblyopic and better eyes, type of amblyopia, or treatment method between the 2 groups. In Group B, visual acuity of the amblyopic and better eyes improved after 4 months of spectacle wearing. At the last visit, there were no statistical differences of visual acuity in the amblyopic eye between the 2 groups. In children with resolution of amblyopia, the treatment duration of Group A (15 patients) was 17.3 months, longer than the 4.7 months in Group B (13 patients) (p = 0.003). Conclusions: Wearing spectacles for 4 months prior to amblyopia treatment may be an effective method of shortening the treatment duration. J Korean Ophthalmol Soc 2011;52(5):550-556

Comparison of the Thickness and Volume of the Macula and Fovea in Patients with Anisometropic Amblyopia Prior to and after Occlusion Therapy

윤동희,천보영 대한안과학회 2018 Korean Journal of Ophthalmology Vol.32 No.1

To compare the thickness of superior, temporal, inferior, and nasal macula and foveal thickness andvolume in patients with anisometropic amblyopia prior to and after successful occlusion therapy using opticalcoherence tomography (OCT) measurement. Methods: Data were collected prospectively on 30 patients with unilateral anisometropic amblyopia fromDecember 2006 to August 2007. All patients had anisometropia of 2.0 diopters or more. OCT scans wereobtained for all patients at diagnosis. Occlusion therapy was then prescribed and OCT scans were obtainedagain at the time of successful occlusion therapy (defined as interocular difference of <0.1 log units). TheStratus OCT-3 was used to measure fovea thickness and volume and the thickness of superior, temporal,inferior, and nasal macula (within a diameter of 3 mm). Results: Of 30 patients, 22 (mean age of 5.8 years) had successful resolution of amblyopia. The mean durationof occlusion was 11.24 months and mean best-corrected visual acuity at diagnosis was 0.35 ± 0.12 logarithmof the minimum angle of resolution. The mean thicknesses of the superior, temporal, inferior, and nasalmacula prior to and after occlusion were not significantly different (p > 0.05). However, mean foveal volumeprior to occlusion therapy (0.15 ± 0.02 mm3) decreased after occlusion (0.14 ± 0.01 mm3) with statistical significance(Wilcoxon signed rank test, p = 0.025). Conclusions: There was a meaningful decrease in foveal volume in patients with anisometropic amblyopia aftersuccessful occlusion therapy. Whether this decrease relates to visual improvement of the amblyopic eyeremains to be determined. Key Words: Anisometropic amblyopia, Foveal

Thicknesses of Macular Retinal Layer and Peripapillary Retinal Nerve Fiber Layer in Patients with Hyperopic Anisometropic Amblyopia

( Sang Won Yoon ),( Won Ho Park ),( Seung Hee Baek ),( Sang Mook Kong ) 대한안과학회 2005 Korean Journal of Ophthalmology Vol.19 No.1

This prospective study was performed to measure the macular and the peripapillary retinal nerve fiber layer (RNFL) thicknesses using optical coherence tomography (OCT) in patients with anisometropic amblyopia. Thirty-one patients with hyperopic anisometropic amblyopia were included. The macular retinal thickness and the peripapillary RNFL thickness were measured using OCT. The mean refractive error was +3.71 diopters (D) and +1.00 D, the mean macular retinal thickness was 252.5 μm and 249.7 μm, and the mean RNFL thickness was 115.2 μm and 109.6 μm, in the amblyopic eye and the normal eye, respectively. OCT assessment of RNFL thickness revealed a significantly thicker RNFL in hyperopic anisometropic amblyopia (P=0.019), but no statistically significant difference was found in macular retinal thickness (P>0.05). In conclusion, the amblyopic process may involve the peripapillary RNFL, but not the macula. However, further evaluation is needed.

원시성 굴절부등약시에서 가림치료후 최종시력과 빛간섭단층촬영의 변수와의 관계

박원호,공상묵,백승희,Won Ho Park,Sang Mook Gong,Seung-Hee Baek,M,S 대한안과학회 2007 대한안과학회지 Vol.48 No.6

Purpose: We measured the macular and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with hyperopic anisometropic amblyopia using optical coherence tomography (OCT) to determine the relationship between final visual acuity after occlusion therapy and these OCT parameters. Methods: This prospective study comprised 41 patients with unilateral hyperopic anisometropic amblyopia treated from April 2004 to August 2005. According to the final visual acuity after occlusion therapy, we divided our patients into two groups and compared the macular and peripapillary RNFL thicknesses between normal and amblyopic eyes. Results: The mean refractive error was +4.3 diopters (D) in amblyopic eyes, and +1.3 D in normal eyes. The mean macular thickness of group A (patients with final visual acuity equal to or better than 20/25) and group B (patients with final visual acuity worse than 20/25) was 256.8±17.7 ?m and 259.3±14.5 ?m in amblyopic eyes, and 253.8±17.3 ?m and 254.6±16.7 ?m in normal eyes respectively. The mean peripapillary RNFL thickness of group A and group B was 118.6±12.9 ?m and 111.5±9.0 ?m in amblyopic eyes, and 112.9±9.2 ?m and 108.3±6.5 ?m in normal eyes respectively. In group A, there was a significant difference in peripapillary RNFL thickness between amblyopic and normal eyes (P=0.0003, 0.04). However, the RNFLestimated integral of both groups after correction of refractive error and axial length showed no significant difference (P=0.34, 0.45). Conclusions: There was no significant relationship between OCT parameters and final visual acuity after occlusion therapy in hyperopic anisometropic amblyopia.

8세 이상의 굴절부등약시 환아에서 종일 가림치료와 부분 가림치료의 효과

김성재,박연정,유지명,Seong Jae Kim,MD,Yeon Jeong Park,MD,Ji Myoung Yoo,MD 대한안과학회 2010 대한안과학회지 Vol.51 No.1

Purpose: To compare the effects of full-time and part-time occlusion therapy in patients who had been diagnosed with anisometropic amblyopia after age eight and have begun treatment. Methods: We included patients eight years old or older who had been diagnosed with anisometropic amblyopia. They were treated with full-time or part-time occlusion therapy and followed up for at least six months. Treatment was considered successful when visual acuity was increased by two lines or more. Results: There were 26 total patients. There were 14 part-time and 12 full-time occlusion therapy patients in the respective groups. Visual acuity for the amblyopic eyes was significantly improved while the non-amblyopic eyes did not show any significant differences after the treatment. The changes in the visual acuity were significantly larger for the full-time treatment group compared to the part-time treatment group. The full-time occlusion group showed a significant difference in visual acuity of the amblyopic eyes after treatment. Lower visual acuity of an amblyopic eye at the first visit led to a greater improvement in visual acuity after the treatment. Conclusions: With good compliance, occlusion therapy for anisometropic amblyopia can be successful even if it is initiated after eight years of age. J Korean Ophthalmol Soc 2010;51(1):70-75

안과병원으로 내원한 굴절부등약시 환자의 굴절이상 분포와 임상양상 분석

조수연(Soo-Yeon Cho),김대희(Dae Hee Kim),김응수(Ungsoo Samuel Kim),백승희(Seung-Hee Baek) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.1

Purpose: To investigate clinical characteristics and visual prognosis of anisometropic amblyopia patients in a secondary referral eye hospital in Seoul, South Korea. Methods: Medical records of 561 patients with anisometropic amblyopia between 3 and 12 years of age were retrospectively reviewed and 450 patients who followed up ≥ 2 times were included for comprehensive analysis. Amblyopia was defined as best corrected visual acuity difference of ≥ 0.2 logarithm of the minimum angle of resolution (logMAR) between the sound and amblyopic eyes. Anisometropia was defined by ≥ 1 diopter (D) difference in spherical equivalents (SE), or ≥ 1.5 D difference of cylindrical error in any meridian between the eyes. Baseline clinical characteristics, best corrected visual acuity and cycloplegic refraction of both eyes at the first visit were collected. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥ 1 D), emmetropia (-1 < SE < +1) and myopia groups (SE ≤ -1 D). Treatment success was defined as achieving interocular logMAR visual acuity difference < 0.2. Treatment success rates and time to reach treatment success were compared among the SE groups. Results: Median age of patients was 5.0 years. Median follow-up period was 25.8 months. The proportions of hyperopia, emmetropia and myopia groups were 68.9%, 14.4%, and 16.7%, respectively. Emmetropia group showed anisometropia mostly due to cylindrical error difference between the eyes, rather than SE difference. Treatment success rates were the highest in emmetropia group (95.4%), followed by hyperopia group (85.8%) and then myopia group (77.3%, p = 0.010). Among the patients who fulfilled the success criteria, median time to reach treatment success was the shortest in emmetropia group (3.0 months) followed by hyperopia group (3.6 months) and then myopia group (4.0 months, p < 0.001). Conclusions: Hyperopia was the most common refractive error of the amblyopic eyes in anisometropic amblyopia patients who presented to an eye hospital in Seoul. Treatment success rate was the best in emmetropia group, followed by hyperopia group, and then by myopia group. Time to reach treatment success was the shortest in emmetropia group.

원시성약시와 굴절부등, 남시와의 관계 연구

박현주 한국안광학회 2007 한국안광학회지 Vol.12 No.3

The purpose of this study was to investigate sole effect of therapy of spectacles correction on the refractive amblyopia. Spectacles were prescribed to give the same effect as the occlusion therapy undercorrecting in the case of hyperopia, and effectiveness of the therapy was compared with occlusion therapy without additional prescription. The results can be summarized as follows: 1. The higher anisometropic power was the lower initial visual acuity was. 2. Anisometropic power did not influence final visual acuity. 3. The latter beginning time of therapy was the higher astigmatism was. 4. Therapy of spectacles correction on the hyperopic amblyopia was quite effective. 이 연구는 굴절성 약시에서 가림 치료를 대신할 수 있는 방법들 중 안경 교정에 의한 약시치료효과와, 부등굴절 력과 난시와의 관계를 연구하였다. 안경교정치료는 기존의 가림 치료 효과를 주도록 정상안에 대해 저교정을 하여 차폐 효과를 주는 것으로 원시성약시를 교정하는 추가적 처방 없이 안경 착용만으로 치료하였다. 안경교정에 의한 약시치료 결과 원시성약시에서 부등도수와의 관계 연구에서 다음과 같은 결과를 얻었다. 1. 양안의 부등굴절력이 클 수록 치료 전 약시안의 교정시력이 낮았다. 2. 부등굴절력이 치료 후 교정시력에 영향을 주지 않았다. 3. 치료시작 나이가 늦을수록 난시굴절력이 높게 나타났다. 4. 차폐 없이 안경교정으로 약시치료의 효과를 얻을 수 있었다.

약시치료로 시력이 호전된 한 눈 굴절부등약시 환아의 입체시 평가

이상욱(Sang Wook Lee),정은혜(Eun Hye Jung) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 약시치료 후 시력이 회복된 한 눈 굴절부등약시 환아의 입체시검사 결과를 정상 소아와 비교하고 입체시검사 결과에 영향을 주는 요인에 대해 분석해보고자 하였다. 대상과 방법: 한 눈 굴절부등약시로 진단받고 안경 및 가림치료로 시력이 회복된 후 입체시가 시행된 약시 환아(약시군) 37명과 정상 소아 34명의 의무기록을 후향적으로 조사하였다. 약시군과 정상군의 임상 특성을 살펴보고, 각 군 간의 입체시(워트4등검사, 랑II검사, 티트무스검사, 티엔오검사)검사 결과를 비교 분석하였다. 또한 약시군의 입체시검사 결과에 영향을 주는 인자들을 분석하였다. 결과: 입체시 시행 시 나이, 성별, 평균 구면렌즈대응치, 정상안 logMAR 시력은 두 군 사이에 유의한 차이가 없었으나, 약시군의 최종약시안 logMAR 시력(0.04 ± 0.04)은 정상군(0.01 ± 0.02)에 비해 유의하게 나빴다(p=0.001). 약시군에서 정상 입체시를 보인 환자는 정상군에 비해 랑II검사, 티트무스검사, 티엔오검사 모두에서 유의하게 적었다. 랑II검사에서는 고도약시인 경우, 티트무스검사의 경우 최종 약시안의 시력이 나쁠수록 유의하게 입체시 저하를 보였다. 결론: 약시 환아는 안경착용 및 가림치료로 시력이 회복되었더라도 정상 소아에 비해 입체시가 낮았다. 약시 환아에서 치료 전 약시 정도와 치료 후 약시안의 시력은 입체시검사 결과에 영향을 주는 인자로, 좋은 입체시 획득을 위해서 고도약시의 환아 치료 시 더 주의를 기울이고 약시안의 최종 시력을 조금 더 좋게 회복하는 것이 도움이 될 것이다. Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity. Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group. Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test. Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.

가림치료에 반응하지 않는 난치성 약시에서 도파민 약물치료의 효과

김승현,신형호,고성범,조윤애,Seung Hyun Kim,Hyoung Ho Shin,Seong Bum Koh,Yoonae A,Cho 대한안과학회 2006 대한안과학회지 Vol.47 No.3

Purpose: This study was undertaken to evaluate the effect of L-dopa in amblyopic children for whom occlusion treatment failed. Methods: We studied nine amblyopic children (11 eyes) for whom part-time occlusion (4~8 hours/day) treatment for a minimum period of 6 months had failed. The types of amblyopia included: anisometropic (1 patient, 1 eye), stimulus deprivation (4 patients, 6 eyes) and mixed (anisometropic and strabismic: 2 patients, 2 eyes; anisometropic and organic: 2 patients, 2 eyes). Best corrected visual acuity before treatment was between 0.05 and 0.5. They received, with full informed consent of the parent, levodopa (2~4 mg/kg) for 8 weeks combined with part-time occlusion. Results: The children were between 4 and 11 years old (mean 5.8±2.05). Of the subjects, 45.5% (4 patients, 5 eyes) had improved visual acuity after 8 weeks of treatment. In one patient with anisometropic, two patients with mixed (anisometropic and strabismic), and one patient with stimulus deprivation (ametropic) amblyopia, visual acuity improved by one to five lines. Conclusions: In anisometropic, strabismic amblyopes and mild deprivational amblyopes for whom occlusion treatment failed, L-dopa improved visual acuity. L-dopa may be an additional option for treatment of amblyopic patients with a guarded visual prognosis.

Part-Time Occlusion Therapy for Anisometropic Amblyopia Detected in Children Eight Years of Age and Older

( Young Rok Lee ),( Ju Youn Lee ) 대한안과학회 2006 Korean Journal of Ophthalmology Vol.20 No.3

Purpose: To determine the outcome of part-time occlusion therapy in children with anisometropic amblyopia detected after they were 8 years of age. Methods: We analyzed 29 eyes with anisometropic amblyopia in children 8 years of age and older. The mean age was 8.79±0.98 (range 8~12) years old. The subjects whose best-corrected visual acuity (BCVA) did not improve by two lines or better within 2 weeks of wearing glasses full-time were prescribed occlusion therapy for 6 hours a day outside of school hours, along with the instruction to wear glasses full-time. Subjects who complied with occlusion for more than 3 hours a day were considered to comply well. Results: The major component of the anisometropia was hyperopia in 51.7% of the subjects, and hyperopia plus astigmatism was found in 24.1%. The mean pretreatment BCVA score was 0.51±0.23 (LogMAR). Compliance was 89.66%. The mean posttreatment BCVA was 0.03±0.01 (LogMAR), and the success rate, based on a posttreatment BCVA of 0.1 (LogMAR) and better, was 96.43%. It took an average of 4.79±3.35 months to reach the desired posttreatment BCVA. The mean posttreatment stereopsis was 79.78±37.61 seconds of arc. The recurrence rate was 8%. The visual improvement was related to the degree of compliance (p=0.000). The time taken to reach the posttreatment BCVA was shorter in subjects with a better pretreatment BCVA (p=0.019), but it did not relate to the compliance (p=0.366). Conclusions: The most common component of anisometropia detected after 8 years of age was hyperopia. The part-time occlusion therapy, which had been carried out after school hours, was successful in most cases.