Abstract
Purpose
To evaluate the outcome achieved by using Bangerter filters in cases of mild and moderate anisometropic amblyopia, and to define the predictive factors for the final visual outcome.
Methods
Prospective study comprising 62 children (age range 3–11 years) with unilateral amblyopia associated with myopic or hyperopic anisometropia. In all cases, the use of Bangerter filters were prescribed for amblyopia treatment due to the unsuccessful outcome with refractive correction. The prescribed filter always induced a visual acuity reduction in the non-amblyopic eye of 2 lines below the BSCVA of the amblyopic eye. A follow-up of 12 months was completed.
Results
A statistically significant improvement in visual acuity was observed at 3 months in both groups, amblyopic and non-amblyopic eyes (p < 0.01). At 6, 9 and 12 months, additional small but statistically significant improvements in visual acuity were detected only in the amblyopic group (p ≤ 0.02). Filter density had to be changed during the follow-up in a total of 22 eyes (35.5%). A significant correlation of the visual acuity with the baseline interocular visual acuity difference was found at 3 months (r = 0.44, p < 0.01), but not at the end of the follow-up (r = 0.12, p = 0.36). Multiple linear regression analysis revealed that the final visual outcome was significantly correlated with the baseline visual acuity, sphere and the difference in visual acuity between eyes (R2: 0.42, p < 0.01).
Conclusions
Bangerter filters are useful for treating mild or moderate amblyopia due to anisometropia, but ocular dominance inversion should be maintained during treatment for obtaining an optimized outcome.
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References
Loudon E, Simons HJ (2005) The history of the treatment of amblyopia. Strabismus 13:93–106
Ciuffreda KJ, Levi D, Selenow A (1991) Amblyopia: basic and clinical aspects. Chapter 1: history, definitions, classifications and prevalence. Butterworth-Heinemann, Boston, pp 1-42
Pediatric Eye Disease Investigator Group (2006) Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology 113:895–903
Pediatric Eye Disease Investigator Group (2005) Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 123:437–447
Stewart CE, Moseley MJ, Fielder AR, Stephens DA, Cooperative MOTAS (2004) Refractive adaptation in amblyopia: quantification of effect and implications for practice. Br J Ophthalmol 88:1552–1556
Alió J, Laria C (2007) Diagnosis and treatment of amblyopia. In: Garg A, Prost ME, Azad R (eds) Surgical and medical management of pediatric ophthalmology. Jaypee Brothers Medical Publishers Ltd, New Delhi, pp 855-874
Menon V, Shailesh G, Sharma P, Saxena R (2008) Clinical trial of patching versus atropine penalization for the treatment of anisometropic amblyopia in older children. J AAPOS 12:493–497
Pediatric Eye Disease Investigator Group (2006) A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. Ophthalmology 113:904–912
Pediatric Eye Disease Investigator Group (2005) A randomized pilot study of near activities versus non-near activities during patching therapy for amblyopia. J AAPOS 9:129–136
Pediatric Eye Disease Investigator Group (2003) A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors. Ophthalmology 110:1632–1638
Pediatric Eye Disease Investigator Group (2002) A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol 120:268–278
Keech RV, Ottar W, Zhang L (2002) The minimum occlusion trial for the treatment of amblyopia. Ophthalmology 109:2261–2264
Moseley MJ, Fielder AR, Irwin M, Jones HS, Auld RJ (1997) Effectiveness of occlusion therapy in ametropic amblyopia: a pilot study. Br J Ophthalmol 81:956–961
Foley-Nolan A, McCann A, O’Keefe M (1997) Atropine penalization vs. occlusion as the primary treatment for amblyopia. Br J Ophthalmol 81:54–57
Repka MX, Kraker RT, Beck RW, Birch E, Cotter SA, Holmes JM, Hertle RW, Hoover DL, Klimek DL, Marsh-Tootle W, Scheiman MM, Suh DW, Weakley DR, Pediatric Eye Disease Investigator Group (2009) Treatment of severe amblyopia with weekend atropine: Results from 2 randomized clinical trials. J AAPOS 13:258–263
Kaye SB, Kaye LC, Noonan C, Tripathi A, Ashwin P, Cota N, Clark D, Butcher J (2002) Combined optical and atropine penalization for the treatment of strabismic and anisometropic amblyopia. J AAPOS 6:289–293
Simons K, Stein L, Sener EC, Vitale S, Guyton DL (1997) Full-time atropine, intermittent atropine, optical penalization, binocular outcome in treatment of strabismic amblyopia. Ophthalmology 104:2143–2145
France TD, France LW (1999) Optical penalization can improve vision after occlusion treatment. J AAPOS 3:341–343
McIntyre A, Fells P (1996) Bangerter foils: A new approach to the management of pathological intractable diplopia. Br Orthopt J 53:43–47
Bangerter A (1960) Die Okklusion in der Pleoptik und Orthoptik. Klin Monatsbl Augenheilkd 136:305–331
Bangerter A (1946) Behandlung der Amblyopie. Ophthalmologica 111:220
Pediatric Eye Disease Investigator Group (2003) Impact of patching and atropine treatment on the child and family in the Amblyopia Treatment Study. Arch Ophthalmol 121:1625–1632
Fielder AR, Irwin M, Auld R, Cocker KD, Jones HS, Moseley MJ (1995) Compliance in amblyopia therapy: objective monitoring of occlusion. Br J Ophthalmol 79:585–589
Campos EC, Chiesi C, Rozzi N (1991) Intossicazione da atropina in corso di terapia antiambliopica. G It Ortotte Tec Strum Oft 8:185–188
Lowe RF (1965) Atropine treatment for amblyopia ex anopsia. Br Orthopt J 22:35–42
Abraham SV (1954) Intraepithelial cysts of the iris. Am J Ophthalmol 37:327–331
Pediatric Eye Disease Investigator Group Writing Committee, Rutstein RP, Quinn GE, Lazar EL, Beck RW, Bonsall DJ, Cotter SA, Crouch ER, Holmes JM, Hoover DL, Leske DA, Lorenzana IJ, Repka MX, Suh DW (2010) A randomized trial comparing Bangerter filters and patching for the treatment of moderate amblyopia in children. Ophthalmology 117(5):998–1004
Agervi P, Kugelberg U, Kugelberg M, Simonsson G, Fornander M, Zetterström C (2009) Treatment of anisometropic amblyopia with spectacles or in combination with translucent Bangerter filters. Ophthalmology 116:1475–1480
Holladay JT (1997) Proper method for calculating average visual acuity. J Refract Surg 13:388–391
North RV, Kelly ME (1991) Atropine occlusion in the treatment of strabismic amblyopia and its effect on the non-amblyopic eye. Ophthalmic Physiol Opt 11:113–117
Agervi P, Kugelberg U, Kugelberg M, Simonsson G, Fornander M, Zetterström C (2010) Randomized evaluation of spectacles plus alternate-day occlusion to treat amblyopia. Ophthalmology 117:381–387
Dorey SE, Adams GG, Lee JP, Sloper JJ (2001) Intensive occlusion therapy for amblyopia. Br J Ophthalmol 85:310–313
Moseley MJ, Fielder AR, Irwin M, Jones HS, Auld RJ (1997) Effectiveness of occlusion therapy in ametropic amblyopia: a pilot study. Br J Ophthalmol 81:956–961
Odell NV, Leske DA, Hatt SR, Adams WE, Holmes JM (2008) The effect of Bangerter filters on optotype acuity, Vernier acuity, and contrast sensitivity. J AAPOS 12:555–559
Arikan G, Yaman A, Berk AT (2005) Efficacy of occlusion treatment in amblyopia and clinical risk factors affecting the results of treatment. Strabismus 13:63–69
Hussein MA, Coats DK, Muthialu A, Cohen E, Paysse EA (2004) Risk factors for treatment failure of anisometropic amblyopia. J AAPOS 8:429–434
Mazow ML, Chuang A, Vital MC, Prager T (2000) 1999 Costenbander Lecture. Outcome study in amblyopia: treatment and practice pattern variations. J AAPOS 4:1–9
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This study has been supported in part by a grant from the Spanish Ministry of Health, Instituto Carlos III, Red Temática de Investigación Cooperativa en Salud “Patología ocular del envejecimiento, calidad visual y calidad de vida”, Subproyecto de Calidad Visual (RD07/0062)
The authors have no financial interest in any of the issues contained in this article and have no proprietary or commercial interest in the development of marketing of materials used in this study or discussed in this article.
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Laria, C., Piñero, D.P. & Alió, J.L. Characterization of Bangerter filter effect in mild and moderate anisometropic amblyopia: predictive factors for the visual outcome. Graefes Arch Clin Exp Ophthalmol 249, 759–766 (2011). https://doi.org/10.1007/s00417-010-1564-x
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DOI: https://doi.org/10.1007/s00417-010-1564-x