This document summarizes several studies conducted by the Pediatric Eye Disease Investigator Group from 2002 to 2018 on treatments for amblyopia. The studies compared treatments such as atropine drops, patching, Bangerter filters, and computer games to standard patching. The studies involved children from ages 3 to 17 years old with mild to severe amblyopia. The studies found that many treatments, including atropine drops, shorter periods of patching, and optical correction alone, can improve amblyopia, though residual vision deficits often remain. A later study found that increasing patching time may further improve vision over shorter periods in some cases.
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
It describes about the procedure of Hess charting. it serves as a great tool to understand the concepts involved. Suitable for optometry course. This is not a routine procedure but an important procedure which is used in diagnosis.
THE MOST SIMPLE BUT COMPACT WAYS OF HANDLING A 3-YEAR-OLD PATIENT. YOU SHOULD NOT MISS THIS!
CLINICAL CASE PRESENTATION FOR A 3-YEAR-OLD PATIENT WITH THE COMPLAINT OF DIFFICULTY TO RECOGNISE FAR OBJECTS.
Stay tuned for another presentation.
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
THE MOST SIMPLE BUT COMPACT WAYS OF HANDLING A 3-YEAR-OLD PATIENT. YOU SHOULD NOT MISS THIS!
CLINICAL CASE PRESENTATION FOR A 3-YEAR-OLD PATIENT WITH THE COMPLAINT OF DIFFICULTY TO RECOGNISE FAR OBJECTS.
Stay tuned for another presentation.
Gives a very brief review of how to evaluate a case of squint in day to day clinical practice. How to diagnose a basic abnormality of the movement of eye.
Passive Therapy in Management of Amblyopia (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤
Passive Therapy in Management of Amblyopia
. Passive Therapy
The patient experiences a change in visual stimulation without any conscious effort
- Proper refractive correction
- Occlusion
- Penalization
Should Astigmatism be Corrected until the Age of Three? Results of a Six-year...inventionjournals
The state of refraction in young children is important to be examined in order to prevent different eye diseases (amblyopia, strabismus, hordeolosis, blepharitis etc.). Part of these diseases may interfere with the normal development of a child, as well as they may affect the process of socialization. AIM: The aim of this study is to determine and follow-up aspheric refraction dynamics in children up to age three. Patients and Methods: The study covers 324 children (648 eyes) from Sofia city and Sofia district (Bulgaria), aged between 6 and 12 months at their first visit and refraction examination. 159 of them are girls (318 eyes) and 165- boys (330 eyes). The children are followed up in time. They are grouped in four age groups and divided by gender. The methods used are: photorefractometry with PlusoptiX S04; cycloplegia, retinoscopy and optical correction if needed; statistics. Results: Astigmatism changes with age (towards reducing); Diopters of astigmatism are most decreased in age between 12 and 18 months; There is no statistically significant difference in aspheric refraction between genders. Conclusion: PlusoptiX S04 photorefractometer is operational for children aged at least 5 months. This is a quite accurate method for determining the aspheric refraction in children without cycloplegia. It allows us to state that astigmatism reduces considerably with age
Preferred Patterns in Myopia Control (Philippines) was presented at the online conference dedicated to Myopia: Challenges and New Treatment Methods, June 9, 2023, organized by the Ministry of Education and Science, Republic of Poland, Okulistyka 21, etc.
Strategies for better toric IOL outcomes (Apr 2018)Han Chieh Yu
Residual astigmatism after cataract surgery makes negative impact on patients’ visual acuity and contrast sensitivity. Posterior corneal astigmatism contributes to total corneal astigmatism, acting as a vector, must be considered in the toric IOL calculation. The decision to advise toric IOL to patients should depend on the estimated post-operative total astigmatism, instead of the power of anterior corneal astigmatism. Getting consistent keratometry values from one of the many instruments is essential for IOL calculation. Toric calculator should also consider the variable ratios between the toricity of the IOL and corneal plane. Intra-operative tips to avoid IOL misalignment and reorientation to correct it are discussed. A small case series utilizing prior methods, with good post-operative refractive cylinder results, will be presented.
Irregular Astigmatism after DSAEK in case of Congenital Hereditary Endothelial Distrophy with Intrastromal Vacuolization - L. Avoni, L. Cappuccini, M. Busin
Current Trend in Management of Amblyopia (Amblyopia Therapy)/ Amblyopia Treat...Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
Dear viewers, to download this presentation visit___ https://healthkura.com/lazy-eye-amblyopia/
Current Trend in Management of Amblyopia. Latest as well as old methods of amblyopia management which include active and passive therapies. Amblyopia Therapy/ Amblyopia Treatment
What would be the perfect amblyopia therapy?
Effective
Good compliance
Acceptable to pts. and parent
Quick
Safe
Easy to administer
Cost effective
Well maintained
..............
Summary
Amblyopia occurs due to abnormal visual experience early in life
Proper optical correction alone is necessary for short period of time (6-8 weeks)
before initiation of other therapy
Part time occlusion of better eye is mainstay of treatment since 18th century to till
now
For severe and moderate amblyopia, 6 hrs and 2 hrs of patching is advised
respectively
Atropine is also used in children with poor compliance
Trial of patching can be given in patients as old as 17 yrs
Perceptual learning and pharmacological manipulation have shown areas of
amblyopia treatment beyond the critical period of visual development
Binocular stimulation, software based treatments and other methods do not have
promising result to replace the patching therapy till date
Most of the active therapy methods have good results when used together with
patching therapy
Ocular hypotony following reenclavation of a partially dislocated (disenclavated) retropupillary iris-clipped intraocular lens in a child with Marfan Syndrome was presented and won best paper in the Pediatric Ophthalmology and Genetics Category at the 6th Asean Ophthalmology Congress in conjunction with the Philippine Academy of Ophthalmology Annual Convention, October 2023, SMX Convention Center, Pasay City, Philippines.
Reenclavation of a partially disenclavated retropupillary iris-clipped intraocular lens in a child with Marfan Syndrome. Slide deck was the basis of an e-poster presented at the 6th Asean Ophthalmology Congress in conjunction with the Philippine Academy of Ophthalmology Annual Convention held at the SMX Convention Center, Pasay City, MetroManila, Philippines October 2023.
A meta-analysis on the use of atropine for myopia control was presented at the online joint meeting of the Israel Society of Ophthalmology and the Manila Doctors Hospital Department of Ophthalmology, January 2022
Social Media and the Ophthalmologist was presented at the Makati Medical Center, Department of Ophthalmology Post Graduate Course: More than Meets the Eye: Ethics and Professionalism in Ophthalmology, August 2023, Makati Medical Center, Makati Metro Manila, Philippines
Creating a social media policy for the Philippine Academy of Ophthalmology was presented at the Asia-Pacifice Bioethics Network (APBEN) Congress 2023 Manila, held at the Henry Sy Auditorium, St. Luke's Global City, Taguig, MetroManila, Philippines, June 2023
Strabismus surgeries for cranial nerve palsies. Presented at the 27th Postgraduate Course of the St Luke's International Eye Institute: "Naughty or Neyes: Comparing Old and New Techniques", Henry Sy Auditorium, St Luke's Global City, Taguig, Metro Manila, December 2, 2023
Presented at the 6th Asean Ophthalmology Congress in conjunction with the Philippine Academy of Ophthalmology Annual Convention, SMX Convention Center, Pasay City, Philippines, October 2023
Actual e-poster presented at the 6th Asean Ophthalmology Congress in conjunction with the Philippine Academy of Ophthalmology Annual Convention, SMX Convention Center, Pasay City, MetroManila, Philippines, October 2023
A lay forum lecture about digital eye strain, dry eye disease in children, myopia and stopping myopia, other refractive errors, common causes of eye consults, some eye myths, the truth about blue light filter in glasses, and a little bit about presbyopia and cataract for parents of Xavier School Nuvali, July 31, 2022
Lecture to be given to St Jude Catholic Schools Alumni Association 28 Aug 2021, talking about Kids Eye Health this pandemic, specifically discussing digital eye strain, myopia, and myths about kids' eye health
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
1. Amblyopia
Treatment Studies
Pediatric Eye Disease Investigator Group
2002-2018
(Based on Publications as of September 2018)
Alvina Pauline D. Santiago, MD
September 2018
#PEDIG (c) APSantiago 2018
3. Amblyopia Definition
Gunter K von Noorden
• Unilateral or bilateral decrease in
VA
• caused by pattern vision
deprivation (lack of adequate
vision stimulation) or abnormal
binocular interaction
• no cause can be detected by
physical examination
• reversible by therapeutic
measures
http://www.ascrs.org
vonNoorden GK. Amblyopia. A Multidisciplinary Approach.
Proctor Lecture. IOVS; 1985; 26: 1704-16
#PEDIG
(c) APSantiago 2018
4. Definition of Terms: PEDIG
•Amblyopia
• Mild: 20/25 to < 20/40
• Moderate: 20/40 to 20/100 ATS-1, -8, -9
20/40 to 20/80 ATS-2B, -4, 10
• Severe: 20/100 to 20/400 ATS-2A
#PEDIG (c) APSantiago 2018
5. Amblyopia Treatment Study-1 (ATS-01)
Atropine vs part-time patch, moderate amblyopia
I. Arch Ophthalmol 2002: 120(3) 268-278
II. Arch Ophthalmol 2002: 120 (3) 281-287
III. Arch Ophthalmol 2003: 121 (11): 1625-32
IV. Arch Ophthalmol 2005: 123 (2): 149-157
V. J AAPOS 2005: 9 (6): 542-545
VI. Arch Ophthalmol 2008: 1039-1044
VII. JAMA Ophthalmol. 2014 July ; 132(7): 799–805
VIII. Arch Ophthalmol 2002: 120(3) 268-278
#PEDIG (c) APSantiago 2018
6. Amblyopia Treatment Study-1 (ATS-01)
Atropine vs part-time patch, moderate amblyopia
3-7 years
>/= 3 lines 79%P, 74%A
Atropine better acceptability
Strabismic=anisometropic amblyopia
2 yr follow-up, after 6 months treatment,
both 2 lines behind
Same rates of deterioration &
improvement
New strabismus resolved with cessation
of treatment (18%P, 16%A)
#PEDIG (c) APSantiago 2018
7. 10 & 15 years follow-up
• improvement maintained
• residual amblyopia common
http://www.ibeta.com
Arch Ophthalmol 2008: 1039-1044;
JAMA Ophthalmol. 2014 July ; 132(7): 799–805
Amblyopia Treatment Study-1 (ATS-01)
Atropine vs part-time patch, moderate amblyopia
http://logopond.com/
#PEDIG (c) APSantiago 2018
8. Amblyopia Treatment Study-2 (ATS-2)
(6h vs full; 2h vs 6h)
• I. Ophthalmology 2003: 110(11) 2075-2087
• II. Arch Ophthalmol 2003: 121 (5) 603-611
• III. J AAPOS 2004: 8(5): 420-428
https://upload.wikimedia.org
https://www.hosteurope.de https://blog.logos.com
#PEDIG (c) APSantiago 2018
9. Amblyopia Treatment Study-2A (ATS-2A)
Patch 6 hrs vs full time, severe amblyopia
• Full time: all waking hrs minus 1 hour off
• Severe amblyopia: 20/100-20/400
• Age 3-7 years
• After 4 months
• 4.8 lines in 6 hrs group; vs 4.7 in full time
http://oceansignal.com
http://oceansignal.com
Ophthalmology 2003: 110(11) 2075-2087
#PEDIG (c) APSantiago 2018
10. Amblyopia Treatment Study-2B (ATS-2B)
Patch 2 hrs (minimal time) vs 6 hrs (part time) for Moderate amblyopia
• moderate: 20/40-20/80
• ages 3-7 years
• At 4 months: 2.4 lines in both groups with 1 hr of
near visual activity
https://www.hosteurope.de
https://upload.wikimedia.org
http://oceansignal.com
Arch Ophthalmol 2003: 121 (5) 603-611
#PEDIG
(c) APSantiago 2018
11. Amblyopia Treatment Study-2C (ATS-2C)
Recurrence after cessation of patching / Atropine
• younger than age 8
• 3 months of amblyopia treatment
• Recurrence same
• 24% of patched patients;
• 21% of atropinized
• 1/4 experience recurrence within
1st year of cessation
• RCT for weaning vs. no-weaning
J AAPOS 2004: 8(5): 420-428
#PEDIG (c) APSantiago 2018
13. Amblyopia Treatment Study-3 (ATS-3)
7 to < 18: spectacles vs atropine/patch
• ages 7-17 years
• 20/40-20/400
• Given optimal optical
correction then randomized
• Tx: glasses, patch plus near
activity, atropine
• No Tx: glasses alone
http://cdn4.teen.com
Arch Ophthalmol 2005: 123: 437-477 (Control)
Am J Ophthalmol 2004: 137: 581-583 (10-18yrs)
Arch Ophthalmol 2007: 125: 655-659
#PEDIG (c) APSantiago 2018
14. Amblyopia Treatment Study-3 (ATS-3)
7 to < 18: spectacles vs atropine/patch
• Responders: improved > 10 letters / 2 lines
• Improves with glasses alone in 25%
• Most patients left with residual VA deficit
• Ages 7-12: tx improved amblyopia even if previously
treated
• Ages 13-17: tx improved if no previous tx for
amblyopia
• Unknown: if treatment results robust http://cdn4.teen.com
Arch Ophthalmol 2005: 123: 437-477 (Control)
Am J Ophthalmol 2004: 137: 581-583 (10-18yrs)
Arch Ophthalmol 2007: 125: 655-659
#PEDIG (c) APSantiago 2018
15. Amblyopia Treatment Study-4 (ATS-4)
Atropine weekend vs daily; moderate amblyopia
• 20/40-20/80
• ages 3-7 years
• Similar results with
weekend atropine vs daily
atropine
• 2.3 lines in both groups
https://thejobshop.files.wordpress.com
Ophthalmology 2004: 111: 2076-2085
#PEDIG (c) APSantiago 2018
16. Amblyopia Treatment Study-5 (ATS-5)
3 to < 7y, spectacles alone
• amblyopia improved with glasses by
> 2 lines in 77%
• amblyopia resolved in 27% with
glasses alone
• 3 line improvement average
• Lessen the burden of amblyopia
therapy
Ophthalmology 2006: 113 (6) 895-903.
#PEDIG (c) APSantiago 2018
17. Amblyopia Treatment Study-5 (ATS-5)
spectacles first then patch 2 hrs vs spectacles, 20/40-20/400
o Strabismic &anisometropic amblyopia
o 2 hrs (1 hr near activity) + specs vs. specs alone
• At 5 wks: 1.1 lines improvement for treated; 0.5 lines for
specs alone
• Any visit average: 2.2 lines treated; 1.1 lines specs
• After glasses, 2 hrs patching (with 1 hr near activity)
improves moderate to severe amblyopia
https://t2.ftcdn.net
✚
http://cdn4.teen.com
#PEDIG (c) APSantiago 2018
http://cdn4.teen.com
18. Amblyopia Treatment Study-6 (ATS-6)
3 to <7, patch 2 hrs with near vs far activities after spectacles
• Pilot: 4 wks: suggestion of
greater improvement in
amblyopic eye with near
activities prescribed
• 2.6 lines near; 1.6 lines far (p=0.07)
http://www.adventuresetup.com
http://glacialblog.com
J AAPOS 2005: 9: 129-136
#PEDIG (c) APSantiago 2018
19. Amblyopia Treatment Study-6 (ATS-6)
3 to <7, patch 2 hrs with near vs far activities after spectacles
(VA 20/40 to 20/400)
• At 8 wks: improvement in
amblyopic eye
• Distance activity: 2.6 lines
• Near activity: 2.5 lines 2.6 lines
near; 1.6 lines far (p=0.07)
• Similar for both groups, even at 2,
5, 17 wks.
http://s7.photobucket.com
Ophthalmology 2008; 115: 2071-78
#PEDIG (c) APSantiago 2018
20. Amblyopia Treatment Study-6 (ATS-6)
3 to <7, patch 2 hrs with near vs far activities after spectacles
(VA 20/40 to 20/400)
• 3.6 lines improvement in severe amblyopic
group
• Adding near activities did not improve VA
outcome in anisometropic, strabismic,
combined amblyopia with 2 hrs of daily
patching
• Severe amblyopia can respond even to 2 hrs of
daily patching
http://www.getbettergradesnow.com
Ophthalmology 2008; 115: 2071-78
#PEDIG (c) APSantiago 2018
21. Amblyopia Treatment Study-7 (ATS-7)
Bilateral refractive amblyopia 20/40-20/400; specs x 1 yr
(Response to treatment of previously untreated presumed
bilateral refractive amblyopia)
• less than 10 years old
• Hypermetropia > 4.0D;
• astigmatism > 2.0D
• Eyeglasses alone improves
binocular VA to 20/25 or better
within 1 year
http://cdn4.teen.com
Am J Ophthalmol 2007: 144: 487-496
#PEDIG (c) APSantiago 2018
22. • Age 7-12; moderate amblyopia
20/40-20/100
• similar degrees of improvement
• About 1 in 5 achieved VA of 20/25 or
better in the amblyopic eye.
• Atropine and patching achieved
similar results among older children
with unilateral amblyopia
Amblyopia Treatment Study-9 (ATS-9)
(7 to <13, ATS-1: weekend atropine vs. patch 2hours
http://dissurat.net
https://t2.ftcdn.net
Arch Ophthalmol. 2008;126(12):1634-1642
#PEDIG (c) APSantiago 2018
23. Amblyopia Treatment Study-10 (ATS-10)
Bangerter filters vs. patching
• moderate amblyopia 20/40-20/80; 3-<10y.
• At 24 wks, 1.9 lines improvement with Bangerter,
vs.2.3 lines in patching group
• Average difference in vision improvement between
Bangerter filters and patching was less than half a
line
• ower burden of treatment on the child and family,
Bangerter filter treatment is a reasonable option
to consider for initial treatment of moderate
amblyopia.
Ophthalmology 2010;117:998-1004. |
#PEDIG (c) APSantiago 2018 23
24. ATS 13: An Observational Study of Optical
Correction for Strabismic & Combined
Strabismic Anisometropic Amblyopia in
Children 3 to < 7 years old
• VA after 18 weeks improved mean of 2.6 lines
• 75% > 2 lines, 54% > 3 lines
• Resolution of amblyopia in 32%
• Greater in Strabismic Amblyopia alone
(3.2 vs 2.3 lines)
• VA improved regardless of whether alignment
better
• Optical treatment alone results in clinically meaningful
improvement;
• may consider as primary sole initial treatment
Ophthalmology 2012; 119: 150-158. Epub 2011 Sep 29.
#PEDIG (c) APSantiago 2018
25. ATS 15: Increasing patching for amblyopia study
from 2 to 6 hours
(3 to <8, 20/50 to 20/400)
• When amblyopic eye VA stops improving with 2 hours of
daily patching, increasing the daily patching dosage to 6
hours results in more improvement in VA after 10 weeks
compared with continuing 2 hours daily.
Pediatric Eye Disease Investigator Group. A randomized trial of increasing patching for amblyopia.
Ophthalmology 2013 Nov;120(11):2270-7. Epub 2013 Jun 4
#PEDIG (c) APSantiago 2018
26. Amblyopia Treatment Study-17 (ATS-
17)
Levodopa for Residual Amblyopia
• 7-12y, 20/50 to 20/400 with patching
• 139 children 7-12 years old
• Strabismic &/or anisometropic amblyopia
• Pilot showed improvement at 4 weeks
• But study at 18 weeks: placebo = levodopa
Ophthalmology. 2015 May;122(5):874-819
Repka MX, Kraker RT, Beck RW, et. al., Pediatric Eye Disease Investigator Group. Pilot study of levodopa dose as treatment for
residual amblyopia in children aged 8 years to younger than 18 years. Arch Ophthalmol 2010;128(9):1215-7.
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28. Amblyopia Treatment Study-18 (ATS-18)
Binocular Computer Studies for Amblyopia
Ended May 2016
• To compare the effectiveness of 1 hour/day of binocular
game play 7 days per week (minimum of 4 days per week)
with 2 hours/day of patching 7 days per week, in children 5
to <13 years of age (younger cohort), as a non-inferiority
study.
• To compare the effectiveness of 1 hour/day of binocular
game play 7 days per week (minimum of 4 days per week)
with 2 hours/day of patching 7 days per week, in children
13 to <17 years of age (older cohort), as a superiority study.
#PEDIG (c) APSantiago 2018
29. Amblyopia Treatment Study-18 (ATS-18)
Binocular iPAD game vs patching (5-12)
• Non inferiority RCT
• 16 wk trial
• iPAD improved 1.05 lines vs patching 1.35 lines
• primary noninferiority analysis was indeterminate
• a post hoc analysis suggested that VA improvement with iPad not as
good as with 2 hours of prescribed daily patching.
Holmes et al … PEDIG. Effect of a binocular iPad game versus part-time
patching in children aged 5 to 12 with amblyopia: a randomized clinical
trial. JAMA Ophthalmol 2016;134(12)
#PEDIG (c) APSantiago 2018
30. Amblyopia Treatment Study-18 (ATS-18)
Binocular iPAD game vs patching (13 to <17)
• Amblyopia 20/40 to 20/200
• 16 wks of iPAD 1 h game or patching 2h/day
• 3.5 letters in iPAD group vs. 6.5 letters in patching group
• Even in the iPAD group, only 13% of patients completed >75% of
prescribed treatment
• PATCHING still better, iPAD possibly worse
• Compliance vs lack of treatment effect?
Manh VM, Holmes JM, Lazar EL, et al and Pediatric Eye Disease Investigator Group. A
Randomized Trial Of A Binocular iPad Game Versus Part-Time Patching In Children 13
To 16 Years Of Age With Amblyopia. Am J Ophthalmol 2018;186:104-15.
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32. Non PEDIG RCTs
https://www.aao.org
• 3-8 y, 20/40 to 20/100
• Glasses x 12 wks, no improvement
• Occluded 50% x 4h vs Patching 2h
• Not inferior to patching
• Alternative for treatment
#PEDIG (c) APSantiago 2018
33. Amblyopia Treatment Study-19 (ATS-19)
Excimer Laser Surgery for Anisometropic Amblyopia
• Upcoming
• To compare the efficacy and safety of surgical
treatment (PRK) versus non-surgical treatment
of anisometropic amblyopia in children who
have failed conventional treatment due to non-
compliance or non-response.
#PEDIG (c) APSantiago 2018
34. Amblyopia Treatment Study-20 (ATS-20)
Binocular Dig Rush Game for Amblyopia
• Recruiting
• 1 hour/day of binocular game play 5 days per
week plus spectacle correction vs. spectacle
correction only
• for treatment of amblyopia
• children 4 to <13 years of age.
#PEDIG (c) APSantiago 2018
https://www.ophth.wisc.edu/blog/2018/02/12/binocular-dig-
rush-game-treatment-amblyopia/
35. Recap: Lessons learned from PEDIG
1. Atropine = patching
• 3-7 years old, 20-40 to 20/100
• Anisometropic and strabismic amblyopia
• Long-term follow-up 10y and 15y same
• New strabismus can develop in either by 2
years 16-18%,
• Resolved at cessation of therapy
• Residual amblyopia common
• 7-12y, 20/40 to 20/100
• 1 in 5 achieved > 20/25
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36. Recap: Lessons learned from PEDIG
2. 6 hours = full time
• 3-7 years old
• Severe amblyopia 20/100-20/400
3. 2 = 6 hours
• 3-7 years old
• Moderate amblyopia 20/40 to 20/80
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37. Recap: Lessons learned from PEDIG
4. Amblyopia improves with glasses alone.
• 20/40 to 20/400, 7-17y (25%)
• 3 to <7, 20/40 to 20/400
• Resolved in 27%
• Improved in 77%
• Better improvement in strabismic than
combined strabismic and amblyopic
amblyopia
• Less than 10y, 20/40 to 20/400
• Bilateral refractive amblyopia VA > 20/25 in
a year
AP Santiago MD 2017
#PEDIG (c) APSantiago 2018
38. Recap: Lessons learned from PEDIG
5. Atropine and/or patching can be added
after glasses.
• Moderate to severe amblyopia 20/40 to
20/400, 7 to <18
6. Add patching after glasses given time to
work.
• Moderate to severe amblyopia: 20/40 to 20/400
• 3 to <7y, 2h patch (1 hr near)
• 7-12 even if previously treated
• 13 to <18 if no previous treatment
#PEDIG (c) APSantiago 2018
39. Recap: Lessons learned from PEDIG
7. Daily = weekly atropine
• 3-7 years
• Moderate amblyopia: 20/40 to 20/80
8. Near = Far
• 3-7 years
• moderate to severe amblyopia: 20/40 to
20/400
AP Santiago MD 2017
#PEDIG (c) APSantiago 2018
40. Lessons learned from PEDIG Studies
9. Severe amblyopia can improve even with 2 h of
patching
• 3-7 years, 20/40 to 20/400
10.Bangerter filter a reasonable option.
• 3 to <10, 20/40 to 20/80
• Not better than patching
• More acceptable
11.Patching 2h/d better than binocular iPAD
• 5-<13, 13 to <17
• 20/40 to 20/200
#PEDIG (c) APSantiago 2018
41. Lessons learned from PEDIG Studies
12. Intensive final push with atropine and patch not
effective.
13.Levodopa same as placebo.
• 8-17y, already on patching
14.6h >2h: Increasing 2 to 6 hours can improve
amblyopia
• 3 to <8m 20/50 to 20/400
• if plateau with 2 hours reached
15.Plano lenses don’t work.
16.Standardizing vision therapy unsuccessful.
#PEDIG (c) APSantiago 2018
42. What the future holds
• Laser refractive correction as a viable option for
anisometropic amblyopia
• Others options
• Virtual reality games
• Smart glasses
• Dichoptic movie viewing
AP Santiago MD 2017
#PEDIG (c) APSantiago 2018
43. Virtual Reality Games for Amblyopia
❖ 0:33 The Oculus Rift
❖ 0.38 – 1:29 How it Works
https://www.youtube.com/watch?v=KumScsJ0xNQ
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