Am J Ophthalmol. 2026 May 6:S0002-9394(26)00224-2. doi: 10.1016/j.ajo.2026.04.029. Online ahead of print. ABSTRACT OBJECTIVE: An aspiration of modern medicine is for disease treatment to improve progressively. Here we examine outcomes of treatment for monocular deprivation ambly…
Am J Ophthalmol. 2026 May 6:S0002-9394(26)00224-2. doi: 10.1016/j.ajo.2026.04.029. Online ahead of print.
ABSTRACT
OBJECTIVE: An aspiration of modern medicine is for disease treatment to improve progressively. Here we examine outcomes of treatment for monocular deprivation amblyopia, caused by a congenital cataract, at an academic medical center over several decades. Have outcomes improved substantially, or have they remained stubbornly disappointing?
DESIGN: Trend study.
SUBJECTS: Patients with deprivation amblyopia due to primary monocular congenital cataract removed before one year of age.
METHODS: Pre-operative and outcome data were collated from sequential examinations to document corrected distance visual acuity (CDVA), binocular visuomotor behaviors, anterior segment and vitreo-retinal health, adherence to therapies, demographic variables, and the need for subsequent surgical interventions. Biometry measurements were recorded at the time of initial cataract surgery.
MAIN OUTCOME MEASURES: The primary outcome measure was corrected distance visual acuity (CDVA). Additional outcomes measures were: prevalence of nystagmus, strabismus, ocular hypertension (OHT)/glaucoma and the number of ocular surgeries.
RESULTS: 80 children met inclusion criteria with a median follow-up age of 12 years. Median CDVA of amblyopic eyes at last follow-up was 1.40 LogMAR or 20/500 (IQR 0.75 - CF). There were no significant differences in CDVA for patients with cataract extraction between 1990-1999, 2000-2009, and 2010-2022 (p=0.25), with medians of 1.00, 1.44, and 1.40 LogMAR respectively. Better CDVA was related systematically to earlier age at surgery but the correlation was weak (p = 0.06). 96% (77/80) of children had secondary implantation of an intraocular lens. Strabismus developed in 98% (78/80) of the children and fusion maldevelopment nystagmus in 73% (58/80). 43% (34/80) required subsequent surgery for removal of a secondary cataract, and 30% (24/80) required surgery to treat aphakic or pseudophakic OHT/glaucoma. The median number of total ophthalmic surgeries was 5 (IQR 3 - 6).
CONCLUSIONS: Visual acuity outcomes for monocular deprivation amblyopia remain disappointing. Adherence to patching therapy and contact lens wear is burdensome and often unachieved. Children with the condition require an average of four subsequent surgeries in the first decade of life for intraocular lens implantation, removal of a secondary cataract, strabismus, or glaucoma.
PMID:42102948 | DOI:10.1016/j.ajo.2026.04.029