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Treatment of amblyopia (lazy eye) caused by strabismus (squint) with patching or optical treatment (glasses or penalisation) or both

Review question: Treatment of amblyopia (lazy eye) caused by strabismus (squint) with patching or optical treatment (glasses or penalisation) or both.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Botulinum toxin for the treatment of strabismus

Strabismus is a condition in which the eyes are out of alignment; one eye may turn inwards, outwards, upwards or downwards. Strabismus may develop in childhood or may be acquired as an adult. Treatment options include eye therapy, glasses, prisms, occlusion, botulinum toxin or surgery, to reduce the deviation of the eyes. Currently there is no clear recommendation on the use of botulinum toxin in the treatment of strabismus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Adjustable versus non‐adjustable sutures for the eye muscles in strabismus surgery

Strabismus occurs when the eye deviates from its normally perfect alignment, and can be corrected with surgery. A variety of surgical techniques are available, including the use of adjustable or non‐adjustable sutures for the muscles surrounding the eye. There is uncertainty as to which of these suture techniques results in a more accurate alignment of the eye, and whether there are specific situations in which it is of benefit to use a particular technique. This review could not find enough evidence to answer these questions and suggests that more research is needed. The review authors used existing evidence to propose that future randomised controlled trials should directly compare the adjustable to the non‐adjustable suture technique, in co‐operative patients with any type of strabismus. Trials should have a minimum of six months follow‐up and should include important outcome measures such as re‐operation rates, accuracy of ocular alignment, complications, economics and patient satisfaction. The information generated from well‐designed studies could support a change in the conventional surgical management of strabismus and help to direct planning of surgical training.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treatment for a type of childhood strabismus where one or both eyes intermittently turn outwards

Strabismus is a condition in which the eyes are not normally aligned, that is one eye looks straight ahead whilst the other eye turns inwards, outwards, up or down. Most cases of childhood onset strabismus are present constantly, but some types are intermittent that is only present sometimes. In intermittent exotropia (X(T)) an eye intermittently turns outwards (exotropia), typically more when looking into the distance, when tired or day‐dreaming. When the child focuses on something close, the eye usually moves back to the centre. The eyes typically work together normally when the exotropia is controlled. When the exotropia occurs, the image from one eye is usually switched off or 'suppressed'. Treatment for X(T) may be sought to improve the appearance of misalignment or if there is concern that it is affecting the ability of the eyes to work together. Treatment typically consists of surgery on the muscles around the eye, either on the outside muscle of both eyes or on the inside and outside muscle of one eye. Exercises to strengthen the muscles may sometimes be used; sometimes patching or glasses for short or near sightedness can be tried. There is currently not a clear understanding of which treatments work most effectively and at what point any treatment should be given. We searched for studies where participants with X(T) had been randomised to receive treatment. The aim was to understand which treatments are most effective at correcting the exotropia without causing any harm. The one study included in this review was conducted by a single surgeon in the USA and compared surgery on one eye to surgery on both eyes in 36 children with the basic type of X(T). Success was defined as no exotropia (or other strabismus) one year following surgery. The study found that surgery on one eye was more effective (82% success) than surgery on both eyes (52% success). There are many studies of X(T) in the current literature but the methods used make it difficult to reliably interpret the results. Furthermore, there is a worrying lack of evidence regarding the natural history of X(T) and poor validation of measures of severity. There is a clear need for further randomised studies to provide more reliable evidence for the management of this condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

The clinical effectiveness and cost-effectiveness of screening programmes for amblyopia and strabismus in children up to the age of 4–5 years: a systematic review and economic evaluation

Amblyopia and strabismus are both common conditions in childhood. A Health Technology Assessment report published in 1997 concluded that the evidence for the value of screening for such conditions did not support any expansion of the current screening programme; indeed, it recommended that the National Screening Committee should consider halting the existing programme. The authors specifically highlighted the lack of evidence on the long-term impact of amblyopia, the extent of disability that amblyopia and strabismus have and their impact on quality of life. This study aims to re-examine the literature and to use this to inform a decision-analytic model to determine the cost-effectiveness of screening for amblyopia and strabismus.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2008

Is it better to do strabismus (squint) surgery before or after completing amblyopia (lazy eye) treatment?

In normal development of vision, children are able to use the visual information from each of their two eyes to form a single image. When an infant or child's eyes are not properly aligned, this is called strabismus (also known as squint). With misalignment, the two eyes do not work together to relay visual information. The brain may suppress the image that comes from the squinting (weaker) eye in order to perceive a single image. When this happens, the weaker eye may develop into a lazy eye. This is a condition known as amblyopia. Lazy eye can be treated by covering the normal eye (called occlusion therapy) for varying periods of time. This is so that the child is forced to use and strengthen the weaker eye. Treatment continues until the weaker eye reaches normal vision or no change in vision is seen over several follow‐up visits. In the past, we have believed that good, long lasting results could be achieved by surgically aligning the eyes, but only if both eyes had equally good vision before the surgery. So, in children with both squint and lazy eye, this meant delaying squint surgery until the lazy eye had been corrected. However, we also know that for a child to develop three‐dimensional vision with a normal ability to recognize depth (depth perception), the eyes have to be aligned from a very early age. After the age of two to three years, proper three‐dimensional vision fails to develop completely. Although this is not necessarily a major handicap, it can be important because some professions require perfect depth perception.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Complications of strabismus surgery: incidence and risk factors

PURPOSE: To perform a systematic review of the complications of strabismus surgery, focusing on incidence and risk factors.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Fibrin glue for closure of conjunctival incision in strabismus surgery: a report by the American academy of ophthalmology

OBJECTIVE: To evaluate the severity of postoperative inflammation, degree of patient discomfort, adequacy of wound closure, and length of operating time when using fibrin glue compared with sutures to close limbal conjunctival incisions after strabismus surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Different treatments for a squint (deviation of the eye) that occurs within the first six months of life

Infantile esotropia can affect the vision in the eye, the ability to use the two eyes together (binocularity) and also be a cosmetic issue to the child/parents. Treatment includes surgical and non‐surgical interventions to reduce the squint and to enhance/aid binocularity in children. This review looks at the various interventions and also the timing of such treatment. The review did not find any randomised trials that compared treatment to another treatment or to no treatment. A large, multi‐centre, non‐randomised trial found that children operated on earlier had better binocularity at age six compared to the late surgery group. This group had been operated on more frequently however and there was no significant difference in the angle of the squint after surgery in either group. This review does not resolve the controversy regarding the best type of surgery, the value of non‐surgical interventions and the optimal timing of either type of intervention. It highlights a need for further research in this area.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Screening for visual impairment in children younger than 6 years: Executive summary of final report S05-02, Version 1.0

The main aim of this review was the benefit assessment (i.e. the assessment of patient-relevant outcomes) of screening for visual impairment (universal vision screening) in children up to the age of 6. By diagnosing and treating amblyopia or amblyogenic risk factors as early as possible, paediatric developmental delay and its potentially lifelong consequences should be prevented, or at least ameliorated.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 1, 2008

Dexamethasone, ondansetron, and their combination and postoperative nausea and vomiting in children undergoing strabismus surgery: a meta-analysis of randomized controlled trials

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after pediatric strabismus surgery. Steroids and ondansetron (a 5-HT3 antagonist) can effectively reduce nausea, vomiting, and pain and thus might be useful agents for the prevention of PONV in pediatric patients. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the prophylactic effects of dexamethasone and ondansetron on PONV after strabismus surgery in pediatric patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Amblyopia in children: Overview

In some children one eye is favored by the brain because it provides a better image. If this happens, the other eye is neglected from childhood on, and it does not get the chance to fully develop. This is known as amblyopia or “lazy eye.”

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 24, 2014

Amblyopia in children: Treatment options for amblyopia

There are different options for treating amblyopia in children, mostly depending on the type and severity of the condition.Some children only have one eye that focuses properly. This is known as amblyopia or "lazy eye" and is caused by the eyes sending two different images to the brain, which can happen when a child has strabismus (a squint) or is more nearsighted or farsighted in one eye than the other. The brain then ends up preferring the information coming from the stronger eye and neglecting the other.The severity of amblyopia largely determines the kind of treatment needed. The standard treatment options are:Glasses to correct refractive errors (nearsightedness or farsightedness, distorted vision).Eye patching (occlusion therapy): The stronger eye is covered with an eye patch for several hours a day. Children who wear glasses can fit the patch over one of the lenses. This is done to encourage the weaker eye to work harder so that vision improves. The word occlusion comes from Latin and means "closed."Drug therapy: Eye drops containing atropine or a similar drug are used to temporarily blur vision in the "good" eye. They relax the muscles in the eye so that the lens will not focus for a few hours.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 24, 2014

Screening for visual impairment in children younger than age 5 years: a systematic evidence review for the U.S. Preventive Services Task Force

Bibliographic details: Kemper A, Harris R, Lieu T A, Homer C J, Whitener B L.  Screening for visual impairment in children younger than age 5 years: a systematic evidence review for the U.S. Preventive Services Task Force. Rockville, MD, USA: U.S. Department of Health and Human Sciences, Public Health Service, Agency for Health Care Policy and Research. Systematic Evidence Review; 27. 2004 Available from: http://www.ahrq.gov/clinic/serfiles.htm

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Patient support programmes (psychosocial interventions) for improving quality of life in adults undergoing squint surgery

Strabismus, also known as squint, is the misalignment of a person's eyes. It can result in an obvious squint noticeable by other people, as well as symptoms of double vision or blurred vision. Adults who have a squint often undergo surgery to alleviate these signs and symptoms. Although people report improvements in quality of life as a result of strabismus surgery, some people experience no change or a deterioration in quality of life, despite good clinical outcomes. Pre‐surgery psychosocial interventions can improve patient reported outcomes in other long‐term conditions. In this Cochrane review we aimed to evaluate the effectiveness of psychosocial interventions delivered prior to strabismus surgery in order to optimise quality of life postoperatively. We searched up to February 2016. We found no studies that evaluated the impact of psychosocial interventions on patients undergoing squint surgery. We believe future research should focus on developing and evaluating the use of targeted psychosocial interventions to improve a patient's quality of life after strabismus surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Screening for Visual Impairment in Children Ages 1-5 Years: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation [Internet]

Impaired visual acuity is common in preschool-aged children. Screening for impaired visual acuity in primary care settings could identify children with vision problems at a critical period of visual development and lead to interventions to improve vision, function, and quality of life.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: February 2011
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Glasses to prevent eye misalignment in far‐sighted children

We compared the benefits and harms of wearing glasses to other interventions in far‐sighted children to prevent the development of eye misalignment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treatment for eyes that drift upwards

The aim of this review was to evaluate the effectiveness of surgical and non‐surgical treatments for dissociated vertical deviation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Treatments to stimulate eye co‐operation versus standard patching or blurring treatment for amblyopia (lazy eye) in children aged three to eight years

Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]

Nausea and vomiting are major concerns for patients undergoing chemotherapy, radiation therapy and surgery with general anesthesia. Risk factors associated with chemotherapy-induced nausea and vomiting include emetogenicity of the chemotherapy regimen, dose, speed of intravenous infusion, female gender, age under 50 years, history of ethanol consumption, and history of prior chemotherapy. Factors predictive of radiation therapy-induced nausea and vomiting include site of irradiation (in particular, total body irradiation and radiation fields that include the abdomen), total field size, dose per fraction, age, and predisposition for emesis (history of sickness during pregnancy or motion sickness). Female gender, a history of motion sickness or prior postoperative nausea and vomiting, nonsmoking status, and use of postoperative opioids have been suggested as factors predictive of postoperative nausea and vomiting. The objective of this review was to evaluate the comparative effectiveness and harms of newer antiemetic drugs including the 5-HT3 and NK-1 antagonists.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2009
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