Treatment of amblyopia as a function of age
Treatment of amblyopia as a function of age
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DOI：
10.1017/s0952523817000220
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发表时间：
2018-04-16
影响因子：
1.9
通讯作者：
Levi, Dennis M.
中科院分区：
文献类型：
--
作者：
Holmes, Jonathan M.;Levi, Dennis M.
尽管历史上建议在视觉发育关键窗口关闭之前对弱视进行治疗，但该关键窗口的存在和持续时间目前尚不清楚。此外，动物和人类对剥夺性弱视的研究都有明确的证据表明，不同的视觉功能有不同的关键窗口，单眼和双眼剥夺会产生不同的神经和行为后果。鉴于不同视觉功能和不同类型弱视的关键窗口范围，再加上这些窗口的个体差异，弱视治疗越来越多地提供给年龄较大的儿童和成人。然而，平均而言，7 岁以上的治疗往往不如年幼儿童有效，而且治疗反应的高度可变性表明，年龄只是决定治疗反应的众多因素之一。新出现的治疗方式可能有望更有效地治疗老年弱视。需要进行更多研究，通过使用新的和现有的临床测试来表征弱视，从而改进临床分类并更好地预测治疗反应。还需要关注表征和测量弱视对患者功能性视力和健康相关生活质量的影响。
Although historically, treatment of amblyopia has been recommended prior to closure of a critical window in visual development, the existence and duration of that critical window is currently unclear. Moreover, there is clear evidence, both from animal and human studies of deprivation amblyopia, that there are different critical windows for different visual functions and that monocular and binocular deprivation have different neural and behavioral consequences. In view of the spectrum of critical windows for different visual functions and for different types of amblyopia, combined with individual variability in these windows, treatment of amblyopia has been increasingly offered to older children and adults. Nevertheless, treatment beyond the age of 7 years tends to be, on average, less effective than in younger children, and the high degree of variability in treatment response suggests that age is only one of many factors determining treatment response. Newly emerging treatment modalities may hold promise for more effective treatment of amblyopia at older ages. Additional studies are needed to characterize amblyopia by using new and existing clinical tests, leading to improved clinical classification and better prediction of treatment response. Attention also needs to be directed toward characterizing and measuring the impact of amblyopia on the patients' functional vision and health-related quality of life.