A randomized trial of atropine versus patching for treatment of moderate amblyopia: follow-up at 15 years of age

Volume 18 Number 4 / August 2014 026 A randomized trial of atropine versus patching for treatment of moderate amblyopia: follow-up at 15 years of age. Michael X. Repka, Raymond T. Kraker, Jonathan M. Holmes, Allison I. Summers, Carmen N. Barnhardt, David R. Tien, Stephen R. Glaser; the Pediatic Eye Disease Investigator Group Introduction: PEDIG conducted a randomized trial comparing patching with atropine eye drops for moderate amblyopia (20/40 to 20/100) in children younger than 7 years of age.1 We report the visual acuity outcome at 15 years of age for those children enrolled in long term follow up. Methods: The main outcome measure was visual acuity measured with the electronic ETDRSÓ test completed in 147 participants. Results: The mean amblyopic-eye acuity at age 15 years was 0.14 logMAR (approximately 20/25) and 60% of amblyopic eyes were 20/ 25 or better. Mean interocular acuity difference (IOD) was 2.1 logMAR lines; 29% of subjects had amblyopic eye 20/32 or worse and an IOD of 2 or more lines. Better visual acuity at age 15 years was achieved by those who were \5 years old at the time of entry into the randomized trial (mean logMAR 5 0.09) compared with those who were 5 to \7 years old (mean logMAR 5 0.18, P \ 0.001). Comparing subgroups based on original treatment, there were no significant differences in amblyopic- and fellow-eye visual acuities at age 15 years (P 5 0.44 and 0.43, resp.). Discussion: At age 15 years most children treated for moderate amblyopia when \7 years old have good visual acuity, although mild residual amblyopia is common. Conclusion: The outcome is similar regardless of initial randomized treatment. The improvement in vision appears to be maintained. References 1. Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2002;120:268-78.

027 Sustained improvement of reading symptoms following botulinum toxin A injection for convergence insufficiency. Jon Peiter Saunte, Jonathan M. Holmes Introduction: Treatment of convergence insufficiency (CI) in adults can be challenging. We evaluated the use of botulinum toxin in this condition. Methods: We studied 8 patients (median age, 36 years; range 1777) with CI, defined as an exodeviation greater at near, not exceeding 10D in the distance measured by prism and alternate cover test, who all had reading symptoms. 5 patients received injection of 5 IU botulinum toxin type A (Botox) in 0.1 ml saline to one lateral rectus muscle, 2 patients 2.5 IU to one lateral rectus muscle, and one received 2.5 IU Botox to both lateral rectus muscles. Results: At 1 month after injection, all patients had an initial esoshift from baseline (mean, 13D, P 5 0.008). At 6 months, when the pharmacological effect of Botox had completely worn off, patients still maintained a small esoshift (mean, 5.6D; P 5 0.3). Reading symptoms improved in 7 of 8 patients at 1 month post injection, and in all patients at 6 months. For the 2 patients who had health-related quality of life assessed with the Adult Strabismus 20 Questionnaire, both showed improved Reading Function scores at 6 months. Interestingly, 3 patients reported improved reading despite returning to the baseline angle at 6 months. In patients with 12-month follow-up, 2 out of 4 still reported improved reading.

Journal of AAPOS

e9 Discussion: In adult CI patients, Botox injection to a lateral rectus muscle improves reading symptoms beyond the duration of the pure pharmacological effect. Conclusion: Botulinum toxin injection may be useful in the management of adult patients with convergence insufficiency.

028 Comparison of the WINROP and CHOP-ROP growth models for the detection of ROP. Irene Shyu, Anupam Kumar, David Morrison Introduction: WINROP and CHOP-ROP are complicated linear regression models that use infant growth as a surrogate of serum IGF-1 levels in an attempt to identify infants at high risk to develop threshold retinopathy of prematurity (ROP). We report the effectiveness of both algorithms in a single patient population. Methods: Retrospective chart review. Two groups of infants were identified. The first group consisted of infants treated for threshold ROP. The WINROP and CHOP-ROP models using birth weight, gestational age and growth were then applied to these data to determine each programs sensitivity in identifying babies treated for threshold ROP. A second group of infants that did not develop threshold disease were additionally identified to determine the false positive alarm rate for each program. Results: A total of 34 treated and 256 untreated infants were identified. CHOP-ROP accurately predicted severe ROP in 33/34 treated infants. WINROP detected 29/34 treated infants. The CHOP-ROP and WINROP models alarmed for 49% and 51% of untreated infants, respectively. Discussion: While each model reduced potential screenings by 50%, neither was 100% sensitive in identifying all treated infants. While low serum IGF-1 levels and poor infant growth may be predictive of ROP for infants born at earlier gestational ages, older infants may develop ROP due to other factors including oxygen saturation that are less growth-dependent. Conclusion: Standard screening methods remain superior for identifying infants at risk for ROP.

029 Stereopsis results at 4.5 years of age in the Infant Aphakia Treatment Study. Ann U. Stout, E. Eugenie Hartmann, Michael J. Lynn, Kimberly G. Yen, Stacey J. Kruger, Scott R. Lambert Introduction: Stereopsis is the ability to perceive depth from image disparity between two eyes. Patients with a unilateral congenital cataract requiring surgery do not generally demonstrate stereopsis despite best efforts at visual rehabilitation. This study looks at whether the type of optical correction used for aphakia influences this outcome. Methods: The Infant Aphakia Treatment Study (IATS) randomized 114 unilateral cataract patients at age 1 to 6 months to either primary intraocular lens (IOL) or contact lens (CL) correction. At 4.5 years of age a traveling examiner performed stereo testing using the Titmus Fly , Frisby Stereo , and Randot Preschool tests on 110 of the patients. Results: Of 110 patients tested, 28 (25%) had a positive response to at least one of the tests. Positive Titmus results were found in 8 (15%) CL patients versus 13 (23%) IOL patients . Frisby stereopsis was present in 6 (11%) CL patients and 7 (13%) IOL patients. Randot stereo was present in 3 (6%) CL patients and 1 (2%) IOL patient. Discussion: Gross stereopsis was found in 25% of patients and did not appear to be related to type of optical correction used. Randot