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A randomized trial of Amblyz liquid crystal occlusion glasses versus traditional patching for treatment of moderate unilateral amblyopia in children
Volume 19 Number 4 / August 2015 Methods: The Extraocular muscle tissue was obtained from more than 100 patients undergoing strabismus surgery with an average age of 21 years. The tissue was mechanically dissociated and stem cells were isolated by adherence selection. Differentiation was analyzed by addition of specific induction factors and gene expression was analyzed by real time PCR. The statistical significance was determined using SPSS soft ware. Results: The cells were adherent in nature and spindle shaped, could be passaged upto several generations and had a doubling time of 34 hours. The cells were positive for cell surface expression of CD13,CD44,CD49b,CD49e,CD73,CD90,CD105, HLA class I and negative for CD34,CD45,CD104,CD146,CD200 and HLA class II. The EOM cells could be differentiated into adipocytes and osteocytes. The cells also expressed embryonic markers such as SSEA4, and transcription factors OCT4, NANOG and SOX2. The cells had a high expression of NESTIN and differentiated readily into neuronal cells identified by the expression of GFAP,MAP2B and TUBBIIIB. Discussion: Our study shows for the first time that multipotent progenitor cells are present in the human extraocular muscle tissues and could be successfully isolated. The presence of multipotential stem cells in the ocular muscle tissue has significant therapeutic implications as they can be differentiated into retinal progenitor cells to treat retinal degeneration. Conclusions: Their superior neuronal differentiation potential and multipotent nature make these cells highly desirable for cell therapy.
023 A randomized trial of Amblyz liquid crystal occlusion glasses versus traditional patching for treatment of moderate unilateral amblyopia in children. Daniel E. Neely, Jingyun Wang, Jay Galli, Jessica Kovarik, James Bowsher, Tina Damarjian, Joshua Schliesser, Heather Smith, Dana L. Donaldson, Kathryn M. Haider, Gavin J. Roberts, Derek T. Sprunger, David A. Plager Introduction: A previous nonrandomized pilot study of liquid crystal occlusion glasses suggested that this new device is an effective treatment option for amblyopia (Spierer et al, IOVS 2010;51:3396-8) However, there has not been prior comparison to a traditional occlusion patch control group. This randomized clinical trial is designed to compare the effectiveness of Amblyz glasses versus adhesive occlusion patching for treating moderate, unilateral amblyopia in children. Methods: Sixteen children ranging from 3 to 8 years of age with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/80 in the amblyopic eye) were enrolled. All subjects had worn optimal refractive correction for at least 12 weeks without improvement and their amblyopia was associated with strabismus, anisometropia, or both. Subjects were randomized into one of two treatment groups: a 4-hour daily AmblyzÔ occlusion glasses group with liquid crystal shutter set at 30-second opaque/transparent intervals, or the 2-hour adhesive patching control group. For each patient, visual acuity was measured with ATS-HOTV methods before and after 12 weeks of treatment. Results: At the conclusion of the first 12 week-treatment interval, visual acuity in the amblyopic eye improved an average of 2.04 lines in the 2-hour adhesive patch group and 2.01 lines in the 4-hour Amblyz glasses group. This difference was not statistically significant. Discussion: The apparent effectiveness of Amblyz glasses warrants further investigation with longer follow-up and larger sample size. Conclusions: Amblyz liquid crystal occlusion glasses appear to be equally effective compared to adhesive occlusion patches when
Journal of AAPOS
e15 treating 3-8 year old children with moderate unilateral amblyopia. This new device is a promising alternative treatment for amblyopia. 024 Detection of strabismus by the spot vision screener. Mae Millicent W. Peterseim, Jennifer D. Davidson, Rupal H. Trivedi, Edward W. Cheeseman, M. Edward Wilson, Carrie E. Papa Introduction: AAPOS guidelines for amblyopia risk factors (ARF) to be detected by automated vision screeners include manifest strabismus of 8D in primary position. The Spot vision screener is a new automated screener designed for use in schools and pediatric offices. The Spot refers children for strabismus based upon the devices measurement of "gaze." We sought to determine the efficacy of the Spot in detecting ARF strabismus when compared to pediatric ophthalmologist examination. Methods: In this prospective study, new and return patients seen in the pediatric ophthalmology clinic underwent screening with the Spot vision screener, version 1.1.51, prior to a complete examination by a pediatric ophthalmologist. A Redcap database was created including Spot referral status and results of the examination. Patients who were referred by the Spot for "gaze" were included as test positives. Patients found to have constant strabismus of 8D or greater in primary position by the physician were considered to have ARF positive strabismus. Results: 444 patients, average age 72 months (11-221 months) were included. 92/444 (21%) children met ARF for strabismus criteria by the pediatric ophthalmologist examination. The sensitivity of the Spot to detect ARF strabismus risk factors is 77.17% and the specificity 93.73%. PPV is 76.34% and NPV is 94.0% in our population. Discussion: The Spot demonstrates good sensitivity and excellent specificity for detecting AAPOS Amblyopia Risk Factor strabismus. Conclusions: The new Spot vision screener is useful in detecting strabismus in children. 025 Anterior segment optical coherence tomography of the horizontal and vertical extraocular muscles with measurement of the insertion to limbus distance. Matthew S. Pihlblad, Feyza Erenler, Aman Sharma, Ajay M. Manchandia, James D. Reynolds Introduction: To assess the possibility of determining the insertion distance from the limbus of horizontal and vertical extraocular muscles (EOM) with the Heidelberg Spectralis anterior segment optical coherence tomography (AS-OCT). Methods: The right eyes of 46 subjects underwent AS-OCT. The horizontal and vertical EOM insertion distances from the limbus were measured in a masked fashion by two pediatric ophthalmologists. The interclass and intraclass correlation coefficients were used for statistical analysis. Results: 42 lateral, 43 medial, 35 inferior, and 40 superior rectus muscles of right eyes of 46 subjects were included. Insertion to limbus measurements: medial rectus – mean 5.7 0.8 mm, range, 4.3 7.8 mm; lateral rectus – mean 6.8 0.7 mm, range, 4.8 - 8.4 mm; inferior rectus – mean 6.0 0.6 mm, range, 4.8 - 7.0 mm; superior rectus – mean 6.8 0.6 mm, range, 5.5 - 8.1 mm. The intra- and inter-examiner correlation coefficients for medial, lateral, inferior, and superior rectus muscles insertion distances to limbus measurements all exceeded 0.75 (excellent correlation). Discussion: The present study is the first to show that the Heidelberg AS-OCT is capable of imaging all four of the rectus muscle insertions, as well as the first AS-OCT to image the superior and inferior rectus insertions.
023 A randomized trial of Amblyz liquid crystal occlusion glasses versus traditional patching for treatment of moderate unilateral amblyopia in children. Daniel E. Neely, Jingyun Wang, Jay Galli, Jessica Kovarik, James Bowsher, Tina Damarjian, Joshua Schliesser, Heather Smith, Dana L. Donaldson, Kathryn M. Haider, Gavin J. Roberts, Derek T. Sprunger, David A. Plager Introduction: A previous nonrandomized pilot study of liquid crystal occlusion glasses suggested that this new device is an effective treatment option for amblyopia (Spierer et al, IOVS 2010;51:3396-8) However, there has not been prior comparison to a traditional occlusion patch control group. This randomized clinical trial is designed to compare the effectiveness of Amblyz glasses versus adhesive occlusion patching for treating moderate, unilateral amblyopia in children. Methods: Sixteen children ranging from 3 to 8 years of age with previously untreated, moderate, unilateral amblyopia (visual acuity of 20/40 to 20/80 in the amblyopic eye) were enrolled. All subjects had worn optimal refractive correction for at least 12 weeks without improvement and their amblyopia was associated with strabismus, anisometropia, or both. Subjects were randomized into one of two treatment groups: a 4-hour daily AmblyzÔ occlusion glasses group with liquid crystal shutter set at 30-second opaque/transparent intervals, or the 2-hour adhesive patching control group. For each patient, visual acuity was measured with ATS-HOTV methods before and after 12 weeks of treatment. Results: At the conclusion of the first 12 week-treatment interval, visual acuity in the amblyopic eye improved an average of 2.04 lines in the 2-hour adhesive patch group and 2.01 lines in the 4-hour Amblyz glasses group. This difference was not statistically significant. Discussion: The apparent effectiveness of Amblyz glasses warrants further investigation with longer follow-up and larger sample size. Conclusions: Amblyz liquid crystal occlusion glasses appear to be equally effective compared to adhesive occlusion patches when
Journal of AAPOS
e15 treating 3-8 year old children with moderate unilateral amblyopia. This new device is a promising alternative treatment for amblyopia. 024 Detection of strabismus by the spot vision screener. Mae Millicent W. Peterseim, Jennifer D. Davidson, Rupal H. Trivedi, Edward W. Cheeseman, M. Edward Wilson, Carrie E. Papa Introduction: AAPOS guidelines for amblyopia risk factors (ARF) to be detected by automated vision screeners include manifest strabismus of 8D in primary position. The Spot vision screener is a new automated screener designed for use in schools and pediatric offices. The Spot refers children for strabismus based upon the devices measurement of "gaze." We sought to determine the efficacy of the Spot in detecting ARF strabismus when compared to pediatric ophthalmologist examination. Methods: In this prospective study, new and return patients seen in the pediatric ophthalmology clinic underwent screening with the Spot vision screener, version 1.1.51, prior to a complete examination by a pediatric ophthalmologist. A Redcap database was created including Spot referral status and results of the examination. Patients who were referred by the Spot for "gaze" were included as test positives. Patients found to have constant strabismus of 8D or greater in primary position by the physician were considered to have ARF positive strabismus. Results: 444 patients, average age 72 months (11-221 months) were included. 92/444 (21%) children met ARF for strabismus criteria by the pediatric ophthalmologist examination. The sensitivity of the Spot to detect ARF strabismus risk factors is 77.17% and the specificity 93.73%. PPV is 76.34% and NPV is 94.0% in our population. Discussion: The Spot demonstrates good sensitivity and excellent specificity for detecting AAPOS Amblyopia Risk Factor strabismus. Conclusions: The new Spot vision screener is useful in detecting strabismus in children. 025 Anterior segment optical coherence tomography of the horizontal and vertical extraocular muscles with measurement of the insertion to limbus distance. Matthew S. Pihlblad, Feyza Erenler, Aman Sharma, Ajay M. Manchandia, James D. Reynolds Introduction: To assess the possibility of determining the insertion distance from the limbus of horizontal and vertical extraocular muscles (EOM) with the Heidelberg Spectralis anterior segment optical coherence tomography (AS-OCT). Methods: The right eyes of 46 subjects underwent AS-OCT. The horizontal and vertical EOM insertion distances from the limbus were measured in a masked fashion by two pediatric ophthalmologists. The interclass and intraclass correlation coefficients were used for statistical analysis. Results: 42 lateral, 43 medial, 35 inferior, and 40 superior rectus muscles of right eyes of 46 subjects were included. Insertion to limbus measurements: medial rectus – mean 5.7 0.8 mm, range, 4.3 7.8 mm; lateral rectus – mean 6.8 0.7 mm, range, 4.8 - 8.4 mm; inferior rectus – mean 6.0 0.6 mm, range, 4.8 - 7.0 mm; superior rectus – mean 6.8 0.6 mm, range, 5.5 - 8.1 mm. The intra- and inter-examiner correlation coefficients for medial, lateral, inferior, and superior rectus muscles insertion distances to limbus measurements all exceeded 0.75 (excellent correlation). Discussion: The present study is the first to show that the Heidelberg AS-OCT is capable of imaging all four of the rectus muscle insertions, as well as the first AS-OCT to image the superior and inferior rectus insertions.