Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
권호 표지

Efficacy of Occlusion Therapy in Amblyopia Type, Depth & Timing of Amblyopia

약시의 종류와 정도 및 치료 시작 시기에 따른 가림 치료 효과

Oh, Dong-Eun;Lim, Key-Hwan
오동은;임기환

  • Published : 20031200
⟨ Previous Next ⟩

Abstract

Purpose: To study the effect of occlusion therapy in amblyopia according to the beginning time of occlusion therapy, type and depth of amblyopia. Methods: The total 92 children, who had been treated with occlusion therapy were included in this study. Patients were divided into two groups according to the age when occlusion therapy was started : those with less than 7 years vs 7 years or older. Patients were also divided into three groups according to the type of amblyopia and depth of amblyopia : mild amblyopia with visual acuity 0.6 or more , moderate amblyopia with between 0.2 and 0.5 , and severe amblyopia with 0.1 or less. Results; The children under 7 years old were 58 patients and 7 years or over was 34 patients. In patients less than 7 years, 70.7%o achieved a successful treatment and in patients 7 years or more, 67.6% was in success. There was no significant difference between two groups. Among the moderate and severe amblyopic patients, 72.1% of patients under 7 year-old and of 44.4% of over 7 year-old achieved a successful treatment. According to the type of amblyopia, there was no significant difference between the groups. According to the depth of amblyopia, success rate of occlusion in mild, moderate and severe amblyopia was 80.6%, 67.9%, and 37.5% respectively. Conclusions: The success rate was higher in younger group than. older group in moderate and severe amblyopia. The depth of amblyopia affected the final visual outcome, and occlusion therapy was more effective in less severe amblyopia.

목적 : 단안 약시 환아를 대상으로 약시의 종류, 정도 및 치료시작시기에 따른 가림치료의 효과를 알아보고자 한다. 대상과 방법 : 치료시작시기에 따라 7세 미만과 7세 이상의 연령군으로 나누어 치료 효과를 비교하였다. 약시의 원인에 따라 사시성, 부등시성, 복합성 약시로 나누고, 정도에 따라 치료 시작시의 시력이 0.6이상의 경도 약시 0.2${\sim}$0.5 시력의 중등도 약시 0.1이하의 고도 약시로 나누어 치료 효과를 알아보았다. 결과 : 전체 환아는 92명(7세 미만 58명, 7세 이상 34명)이었고, 치료에 성공한 경우는 7세 미만 70.7%, 7세 이상 67.6%이고, 두 군간에 통계적인 차이는 없었다. 중등도와 고도 약시 환아를 대상으로 했을 때는 7세 미만에서 72.1%, 7세 이상은 44.4%로 7세 미만에서 유의하게 성공률이 높았다. 종류에 따라서 사시성 69.4%, 부등시성 70.6%, 복합성 약시 68.2%로 종류에 따른 성공률에 차이가 없었다. 정도에 따라서 경도 약시 80.6%, 중등도 약시 67.9%, 고도 약시에서는 37.5%에서 성공하였다. 결론 : 약시안 시력이 0.5이하인 경우 7세 미만에서 7세 이상보다 가림 치료의 효과가 컸고, 약시의 정도가 심하지 않을수록 성공률이 높다.

Keywords

References

  1. Friedman Z, Neumann E, Hyams SW, et al. Opthalmic screening of 38,000 children, age 1 to $2\frac{1}{2}$years, in child welfare clinics. J Pediatr Ophthalmol Strabismus 1980;17:261.
  2. Vereecken EP, Brabant P. Prognosis for vision in amblyopia after loss of the good eye. Arch Ophthalmol 1984;102:220.
  3. von Noorden GK. Amblyopia: a multidisciplinary approach Invest Ophthalmol Vis Sci 1985;26:1704-16.
  4. Daw NW. Critical periods and amblyopia. Arch Ophthalmol 1998;116:502-5. https://doi.org/10.1001/archopht.116.4.502
  5. von Noorden GK. New clinical aspects of stimulus deprivation amblyopia. Am J Ophthalmol 1981;92:416-21. https://doi.org/10.1016/0002-9394(81)90534-1
  6. Keech RV, Kutschke PJ. Upper age limit for the development of amblyopia. J Pediatr Ophthalmol Strabismus 1995;32:89-93.
  7. Vaegun, Taylor D. Critical period for deprivation amblyopia in children. Traus Opthalmol Soc UK 1979;99:432-9.
  8. Hardman Lea SJ, Loades J, Rubinstein MP. The sensitive period for anisometropic amblyopia. Eye 1989;3:783-90. https://doi.org/10.1038/eye.1989.122
  9. Epelbaum M, Milleret C, Buisseret P, Dufier JL. The sensitive period for strabismic amblyopia in humans. Ophthalmology 1993;100:323-7. https://doi.org/10.1016/S0161-6420(13)32170-8
  10. Flynn JT, Cassady JC. Current trends in amblyopia therapy. Am Acad Ophthalmol 1978;85:434-8. https://doi.org/10.1016/S0002-9394(14)77755-4
  11. 박성철, 이경희, 김주년. 약시 치료에서의 시력개선에 대한 임상적 고찰. 한안지 1991;32:802-8.
  12. Flynn JT, Schiffinan J, Feuer W, Corona A. The therapy of amblyopia: an analysis of the results of amblyopia therapy utilizing the pooled data of published studies. Trans Am Ophthalmol Soc 1998;96:431-53.
  13. Beardshell R, Clarke S, Hill M. Outcome of occlusion treatment for amblyopia. J Pediatr Ophthalmol Strabismus 1999;36:19-24.
  14. Lithander J, Sjostrand J. Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment. Br J Ophthalmol 1991;75:111-6. https://doi.org/10.1136/bjo.75.2.111
  15. Fulton AB, Mayer DL. Esotropic children with amblyopia effects of patching on acuity. Graefe's Arch Clin Exp Ophthalmol 1988;226:309-12. https://doi.org/10.1007/BF02172956
  16. Mintz-Hittner HA, Fernandez KM. Successful amblyopia therapy initiated after age 7 years. Arch Ophthalmol 2000;118:1535-41. https://doi.org/10.1001/archopht.118.11.1535
  17. 분철신, 진용한. 순수 부등시성 약시의 치료시작 나이에 따른 결과비교. 한안지 1998;39:185-92.
  18. Oliver M, Neumann R, Chaimovitch Y, et al. Compliance and results of treatment for amblyopia in children more than 8 year old. Am J Ophthalmol 1986;102:340-5. https://doi.org/10.1016/0002-9394(86)90008-5
  19. Clearly M. Efficacy of occulsion for strabismic amblyopia:can an optimal duration be identified? Br J Ophthalmol 2000;84:572-8.
  20. Woodruff G, Hiscox F, Thompson JR, Smith LK. Factors affecting the outcome of children treated for amblyopia. Eye 1994;8:627-31. https://doi.org/10.1038/eye.1994.157
  21. Levartovsky S, Oliver M, Gottesman N, Shirnshoni M. Long term effect of hypermetropic anisometropia on the visual acuity of treated amblyopic eyes. Br J Ophthalmol 1998;82:55-8. https://doi.org/10.1136/bjo.82.1.55
  22. 최철영, 장혜란. 약시 가림치료시 순응도에 영향을 미치는 요소. 한안지 2000;41:2633-7.
  23. LaRoche GR, FRCSC. Amblyopia: detection, prevention, and rehabilitation. Curr Opin Ophthalmol 2001;12:363-7. https://doi.org/10.1097/00055735-200110000-00007
  24. 김영택,장혜란. 소아 단안약시의 추적 관찰. 한안지 1998;39:2803-9.
  25. Levartovsky S, Oliver M, Gottesman N, Shimshoni M. Factors affecting long term results of successfully treated amblyopia: initial visual acuity and type of amblyopia. Br J Ophthalmol 1995;79:225-8. https://doi.org/10.1136/bjo.79.3.225
  26. Nucci P, Alfarano R, Piantanida A, et al. Compliance in antiamblyopia occulsion therapy. Acta Ophthalmol 1992;70:128-31. https://doi.org/10.1111/j.1755-3768.1992.tb02104.x
  27. The 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. https://doi.org/10.1001/archopht.120.3.268
  28. Hubel DH, Wiesel TN. Binocu1ar interaction in striate cortex of kittens reared with artificial squint. J Neurophysiol 1965;28:1041-59. https://doi.org/10.1152/jn.1965.28.6.1041
  29. Hubel DH, Wiesel TN. The period of susceptibility to the physiological effects of unilateral eye closure in kittens. J Physiol 1970;206:419-36. https://doi.org/10.1113/jphysiol.1970.sp009022
  30. Fahle M. Naso-temporal asymmetry of binocular inhibition. Invest Ophthalmol vis sci 1987;28:1016-7.
  31. 남훈, 노영배. 사시성 약시에서 차폐법에 의한 시력 개선의 분석. 한안지 1991;32:476-81.
  32. Paakkala AM. Surgical treatment of strabismus; A retrospective investigation of results of surgical treatment of horizontal strabimus. Acta Ophthalmologica, supplementurn 1982;156:1-107.
  33. Ching FC, Parks MM, Friendly DS. Practical management of amblyopia. J Pediatr Ophthalmol Strabismus. 1986;23:12-6.
  34. Scott WE, Dickey CF. Stability of visual acuity in amblyopic patients after visual maturity. Graefe Arch Clin Exp Ophthalmol 1988;226:154-7. https://doi.org/10.1007/BF02173306
  35. Leiba H, Shimshoni M, Oliver M, et al. Long-term follow-up of occlusion therapy in amblyopia. Opthalmology 2001;108:1552-5. https://doi.org/10.1016/S0161-6420(01)00697-2
  36. Ohlsson J, Baumann M, Sjostrand J, Abrahamsson M. Long term visual outcome in amblyopia treatment. Br J Ophthalmol 2002;86:1148-51. https://doi.org/10.1136/bjo.86.10.1148
  37. Levartovsky S, Gottesman N, Shimshoni M, Oliver M. Factors affecting long-term results of successfully treated amblyopia: age at beginning of treatment and age at cessation of monitoring. J Pediatr Ophthalmol Strabismus 1992;29:219-23.
  38. Sparrow JC, Flynn JT. Amblyopia: a long term follow up. J Pediatr Ophthalmol 1977;14:333-6.
  39. Schroopfer HD, Meinert K. Late results of the treatment of amblyopia. Klin Monastsbl Augenheikd 1972;166:315-20.