OBJECTIVE: To explore the brain mechanism of acupuncture for children with anisometropic amblyopia using the voxel-mirror homotopic connectivity (VMHC) analysis method of resting functional magnetic resonance imaging (rs-fMRI) technology based on clinical effectiveness.
METHODS: Eighty children with anisometropic monocular amblyopia were randomly divided into two groups: control (40 cases, 1 case of shedding) and acupuncture (40 cases, 1 case of shedding) groups. The control group was treated with glasses, red flash, grating, and visual stimulations, with each procedure conducted for 5min per time. Based on routine treatment, the acupuncture group underwent acupuncture of \"regulating qi and unblocking meridians to bright eyes\", Jingming (BL1), Cuanzhu (BL2), Guangming (GB37), Fengchi (GB20) acupoints were taken on both sides, with the needle kept for 30min each time. Both groups were treated once every other day, three times per week, for a total of 4wk. After the treatment, the overall curative effect of the two groups and the latency and amplitude changes of P100 wave of pattern visual-evoked potential were counted. At the same time, nine children with left eye amblyopia were randomly selected from the two groups and were scanned with rs-fMRI before and after treatment. The differences in the brain regions between the two groups were compared and analyzed with VMHC.
RESULTS: Chi-square test showed a notable difference in the total efficiency rate between the acupuncture (94.87%) and control groups (79.49%). Regarding the P100 wave latency and amplitude, the acupuncture group had significantly shorter latency and higher amplitude of P100 wave than the control group. Moreover, the VMHC values of the bilateral temporal lobe, superior temporal gyrus, and middle temporal gyrus were notably increased in the acupuncture group after treatment.
CONCLUSIONS: Acupuncture combined with conventional treatment can significantly improve the corrected visual acuity and optic nerve conduction in children with anisometropic amblyopia. Compared with the conventional treatment, the regulation of acupuncture on the functional activities of the relevant brain areas in the anterior cerebellum may be an effective acupuncture mechanism for anisometropic amblyopia.

UNASSIGNED: To determine the choroidal thickness (mainly subfoveal) using spectral domain optical coherence tomography (SD-OCT) in amblyopic eyes and to compare it with the choroidal thickness (CT) of healthy fellow eyes.
UNASSIGNED: In this prospective study, 140 eyes of 70 patients (aged 5-40 years) with strabismic and anisometropic amblyopia were examined using enhanced depth imaging (EDI) mode in SD-OCT. The CT was measured directly below the fovea and six other locations: 500 μ, 1000 μ, and 1500 μ from fovea in both nasal and temporal quadrants.
UNASSIGNED: The mean age of the patients was 22.5 ± 11.2 years. The mean Best Corrected Visual Acuity (BCVA) in the amblyopic eyes was 0.87 ± 0.47 logMAR and 0 ± 0.02 logMAR in control eyes. The average subfoveal CT was 341.73 ± 60.39 μm in the amblyopic eyes and 314.77 ± 48.12 μm in the fellow eyes. Subgroup analysis showed that the patients with anisometropic amblyopia had a significantly thicker choroid as compared to the fellow healthy eyes (P = 0.00), whereas in strabismic amblyopic eyes, this difference was not significantly significant (P = 0.064).
UNASSIGNED: Significant choroidal thickening was observed in subjects with amblyopia, which may contribute to the amblyopia pathogenesis and this could be used as a diagnostic parameter for amblyopia. These changes were more pronounced in patients with anisometropic amblyopia than strabismic amblyopia.

BACKGROUND: Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia.
METHODS: We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex.
CONCLUSIONS: The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children.
BACKGROUND: This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.

While much is known about the psychosocial impacts of strabismus, little is known about the effects of non-strabismic amblyopia on quality of life (QoL). The aim of this study was to explore the long-term impacts of anisometropic amblyopia.
A phenomenological qualitative investigation was carried out on a sample of adults with anisometropic amblyopia. Subjects participated in in-depth telephone interviews and described how their eye condition affected different aspects of their life. The interviews were audio-recorded, transcribed verbatim and analysed iteratively to form emergent themes.
Sixteen participants took part in the study (median age: 21.5 years; range: 18-36 years; 11 male and 5 female). Six themes emerged: (1) symptoms experienced by participants, (2) concerns and apprehensions, (3) emotional impacts, (4) activity limitations, (5) hassle and inconveniences and (6) economic and career implications. Symptoms reported by participants ranged from glare to difficulty concentrating. They were extremely concerned about the safety of their better eye and lived with several doubts and anxieties. Negative emotions such as grief and disappointment due to eye care negligence in childhood was apparent. Guilt and regretful feelings were present in those who did not comply with past treatment. Participants expressed several limitations in driving, reading, mobility (e.g., using stairs) and tasks requiring high resolution. Reported inconveniences associated with coping with their eye condition included having to travel across the country in search of a cure for their amblyopia. Economic impacts ranged from costs associated with accessing eye care and management to career choices being compromised.
Lived experiences of people with anisometropic amblyopia indicate that the QoL impacts are multifaceted and substantial, even in the absence of strabismus. The results have the potential to influence patient-practitioner relationship by opening newer horizons to communication and care while managing adult amblyopes.

OBJECTIVE: To compare the ciliary muscle thickness (CMT) of the normal fellow eye to that of the amblyopic eye using ultrasound biomicroscopy (UBM) in patients with unilateral anisometropic amblyopia.
METHODS: Thirty patients with unilateral anisometropic amblyopia were involved. The patients were divided into two groups: 19 hyperopic and 11 myopic. Axial length (AL) was measured with optic biometry and anterior chamber depth (ACD), iris area, and CMT were measured with UBM.
RESULTS: The mean age was 34.10 ± 6.61 years. The mean spherical difference between two eyes was 2.59 diopter (D) in hyperopic patients and 3.77D in myopic patients. In the hyperopic patients, nasal CMT1(nCMT), temporal CMT1(tCMT), tCMT2, and tCMT3 values were statistically thinner in amblyopic eyes than healthy eyes (p = 0.036, p = 0.003, p = 0.023, p = 0.005, respectively). ACD values were statistically lower in amblyopic eyes (2.78 ± 0.26 mm) than healthy eyes (2.90 ± 0.21 mm) (p < 0.001). In the myopic patients, nCMT1, nCMT2, nCMT3, tCMT1, tCMT2, and tCMT3 values were statistically thicker in amblyopic eyes than healthy eyes (p = 0.003, p = 0.003, p = 0.005, p = 0.003, p = 0.003, p = 0.019, respectively). ACD values were statistically higher in amblyopic eyes (3.20 ± 0.30 mm) than healthy eyes (3.06 ± 0.29 mm) (p = 0.004). Also, there was no significant difference in the iris area between the amblyopic and normal eyes of the myopic and hyperopic patients (p > 0.05).
CONCLUSIONS: Amblyopic eyes in patients with unilateral myopic anisometropia have thicker CMT and deeper ACD than healthy eyes. Conversely, amblyopic eyes in patients with unilateral hyperopic anisometropia have thinner CMT and shorter ACD than healthy eyes. There is a positive correlation between AL and CMT.

Amblyopia is generally considered a neurodevelopmental disorder that results from abnormal visual experiences in early childhood and may persist to adulthood. The neural basis of amblyopia has been a matter of interest for many decades, but the critical neural processing sites in amblyopia are not entirely understood. Although many functional neuroimaging studies have found abnormal neuronal responses both within and beyond V1, few studies have focused on the neurophysiologic abnormalities in the visual cortex from the viewpoint of potential structural reorganization. In this study, we used a well-validated and highly accurate surface-based method to examine cortical morphologic changes in the visual cortex using multiple parameters (including cortical thickness, surface area, volume and mean curvature).
The cortical thicknesses of the bilateral V1, left V2, left ventral V3, left V4 and left V5/MT+ in patients were significantly thinner than that in controls. The mean curvature of the bilateral V1 was significantly increased in the patients compared with the controls. For the surface area and gray matter volume, no significant differences were found between patients and controls in all region of interests. The cortical thicknesses of the bilateral V1 were both negatively correlated with the amount of anisometropia. No significant correlations were found between any other surface parameters and clinical variables.
In addition to cortical thickness, the altered mean curvature of the cortex may indicate neuroanatomic impairments of the visual cortex in patients with anisometropic amblyopia. Moreover, the structural changes were bilateral in the primary visual cortex but were unilateral in the secondary and more senior visual cortex.

OBJECTIVE: To assess the proportion of pure anisometropic amblyopia in a sample Iranian (white) population.
METHODS: A total of 2800 consecutive individuals who presented at a referral eye clinic for any reason were examined for the presence of pure anisometropic amblyopia. Anisometropia was reported when a spherical equivalent refraction difference of at least 1.0 D with or without a cylinder refraction difference of at least 1.0 D was present between the two eyes. Amblyopia was defined as the best-corrected visual acuity of 20/30 or worse or a two-line interocular visual acuity difference between eyes that could not be attributed to any structural ocular pathology or visual pathway abnormality.
RESULTS: Subjects were 1528 females and 1272 males with a mean age of 30.25 ± 14.93 years (range, 5-65). Amblyopia was diagnosed in 192 cases (6.9%), significantly more frequent among females (7.9 vs. 5.7%, p = 0.02). Pure anisometropic amblyopia was present in 6.1% of the study population, significantly more common in patients with spherical hyperopic anisometropia (37.7%) compared to patients with spherical myopic anisometropia (21.3%), cylindrical myopic anisometropia (4.1%), and cylindrical hyperopic anisometropia (15%) (p < 0.001).
CONCLUSIONS: Pure anisometropic amblyopia is a common finding in Caucasians seeking eye care, particularly when anisometropia is of spherical hyperopic subtype.

OBJECTIVE: To detect the altered spontaneous brain activity patterns in children and adults with anisometropic amblyopia using resting-state functional magnetic resonance imaging (rs-fMRI) technique combined with the amplitude of low-frequency fluctuation (ALFF) method.
METHODS: Thirty-two monocular anisometropic amblyopia and 34 normal-sight controls were divided into child group and adult group. Rs-fMRI was performed in all participants and analysis of ALFF value within the whole brain was conducted in each subject. ALFF value differences between the patients and controls in the two groups were compared via an independent two-sample t test.
RESULTS: The amblyopic children mainly exhibited increased ALFF in part of the bilateral calcarine (BA17), the left middle occipital gyrus (BA18/19), and the left postcentral gyrus (BA2). By contrast, the amblyopic adults showed decreased ALFF in the bilateral precuneus cortex (part of BA7), and the standardized ALFF value of bilateral precuneus were correlated with the amount of anisometropia of the amblyopic adults.
CONCLUSIONS: Rs-fMRI is an effective noninvasive technique for exploring brain activity of the anisometropic amblyopia. Our findings demonstrated that brain activity changed both in amblyopic children and adults under the resting state, and revealed the differences in spontaneous activity patterns between the amblyopic children and adults.