TY  - JOUR
A1  - Mehmed, Berna
A1  - Fronius, Maria
A1  - Pohl, Tabea
A1  - Ackermann, Hanns
A1  - Schramm, Charlotte
A1  - Spieth, Konstanze Bettina
A1  - Hofmann, Christian
A1  - Kohnen, Thomas
A1  - Wenner, Yaroslava
T1  - Electronically monitored occlusion therapy in amblyopia with eccentric fixation
T2  - Graefe's archive for clinical and experimental ophthalmology
N2  - Purpose: Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods: In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results: The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion: Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.
KW  - Amblyopia
KW  - Eccentric fixation
KW  - Occlusion treatment
KW  - Dose response
KW  - Efficiency
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/64059
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-640593
SN  - 1435-702X
N1  - Funding was provided by Research Award of the association “Augenstern e.V.” (a non-profit association supporting research in paediatric ophthalmology) from Frankfurt, Germany.
N1  - Early View: Online Version before inclusion in an issue.
N1  - Version of Record: http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:hebis:30:3-627996
VL  - 2021
PB  - Springer
CY  - Berlin ; Heidelberg
ER  -