Amblyopia

Adults who had amblyopia ('lazy eye') in childhood are more likely to experience hypertension, obesity, and metabolic syndrome in adulthood, as well as an increased risk of heart attack, finds a new study. Adults who had amblyopia ('lazy eye') in childhood are more likely to experience hypertension, obesity, and metabolic syndrome in adulthood, as well as an increased risk of heart attack, finds a new study led by UCL researchers. In publishing the study in eClinicalMedicine, the authors stress that while they have identified a correlation, their research does not show a causal relationship between amblyopia and ill health in adulthood. The researchers analysed data from more than 126,000 participants aged 40 to 69 years old from the UK Biobank cohort, who had undergone ocular examination. Participants had been asked during recruitment whether they were treated for amblyopia in childhood and whether they still had the condition in adulthood. They were also asked if they had a medical diagnosis of diabetes, high blood pressure, or cardio/cerebrovascular disease (ie. angina, heart attack, stroke). Meanwhile, their BMI (body mass index), blood glucose, and cholesterol levels were also measured and mortality was tracked. The researchers confirmed that from 3,238 participants who reported having a 'lazy eye' as a child, 82.2% had persistent reduced vision in one eye as an adult. The findings showed that participants with amblyopia as a child had 29% higher odds of developing diabetes, 25% higher odds of having hypertension and 16% higher odds of having obesity. They were also at increased risk of heart attack -- even when other risk factors for these conditions (e.g. other disease, ethnicity and social class) were taken into account. This increased risk of health problems was found not only among those whose vision problems persisted, but also to some extent in participants who had had amblyopia as a child and 20/20 vision as an adult, although the correlation was not as strong. Corresponding author, Professor Jugnoo Rahi (UCL Great Ormond Street Institute for Child Health, UCL Institute of Ophthalmology and Great Ormond Street Hospital), said: "Amblyopia is an eye condition affecting up to four in 100 children. In the UK, all children are supposed to have vision screening before the age of five, to ensure a prompt diagnosis and relevant ophthalmic treatment. "It is rare to have a 'marker' in childhood that is associated with increased risk of serious disease in adult life, and also one that is measured and known for every child -- because of population screening. "The large numbers of affected children and their families, may want to think of our findings as an extra incentive for trying to achieve healthy lifestyles from childhood." Amblyopia is when the vision in one eye does not develop properly and can be triggered by a squint or being long-sighted. It is a neurodevelopmental condition that develops when there's a breakdown in how the brain and the eye work together and the brain can't process properly the visual signal from the affected eye. As it usually causes reduced vision in one eye only, many children don't notice anything wrong with their sight and are only diagnosed through the vision test done at four to five years of age. A recent report from the Academy of Medical Sciences* involving some researchers from the UCL Great Ormond Street Institute for Child Health, called on policymakers to address the declining physical and mental health of children under five in the UK and prioritise child health. The team hope that their new research will help reinforce this message and highlight how child health lays the foundations for adult health. First author, Dr Siegfried Wagner (UCL Institute of Ophthalmology and Moorfields Eye Hospital), said: "Vision and the eyes are sentinels for overall health -- whether heart disease or metabolic disfunction, they are intimately linked with other organ systems. This is one of the reasons why we screen for good vision in both eyes. "We emphasise that our research does not show a causal relationship between amblyopia and ill health in adulthood. Our research means that the 'average' adult who had amblyopia as a child is more likely to develop these disorders than the 'average' adult who did not have amblyopia. The findings don't mean that every child with amblyopia will inevitably develop cardiometabolic disorders in adult life." The research was carried out in collaboration with the University of the Aegean, University of Leicester, King's College London, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital and UCL Institute of Ophthalmology and the NIHR BRC at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital. The work was funded by the Medical Research Council, the NIHR and the Ulverscroft Foundation.

Physician shares key differences between strabismus and amblyopia RAHWAY, N.J., Nov. 2, 2023 /PRNewswire/ -- As children grow and develop, some parents may notice that their eyes begin to point in different directions and become misaligned. This condition is known as strabismus, and it's relatively common. About 3% of children have strabismus. In a new editorial from MerckManuals.com, Leila M. Khazaeni, MD, Loma Linda University School of Medicine, shares what parents need to know about strabismus and some key differences between the condition and amblyopia. 1. There are several types of strabismus Strabismus is the medical term for misalignment of the eyes. There are many different types, and most people know the condition by its more informal names like crossed-eyed or wandering eye. Some types are characterized by inward turning of the eye (esotropia or cross-eye) and some by outward turning of the eye (exotropia or walleye). Other types are characterized by upward turning of the eye (hypertropia) or downward turning of the eye (hypotropia). 2. Strabismus can lead to amblyopia, known as lazy eye There's often confusion between strabismus and amblyopia. All types of strabismus can lead to amblyopia, also known as lazy eye. Amblyopia is a decrease in vision that occurs because the brain ignores the image received from an eye and can be caused by misalignment of the eye. If left untreated, about 50% of children with strabismus have some vision loss due to amblyopia. 3. Strabismus does not go away on its own If a child is showing signs of misalignment in their eyes, parents may want to wait and see if the condition goes away on its own. The reality is, people do not grow out of strabismus. It will continue to impact an individual's vision until it's treated. Anyone displaying signs of strabismus should be seen by a doctor promptly to determine the right treatment plan and avoid potential vision loss. 4. Strabismus is most often treated with surgery In most cases, treatment entails outpatient surgery to either weaken or strengthen the eye muscles to align the eyes. In some cases, full-time glasses are recommended. Depending on the severity and progression of the condition, doctors may first work to equalize vision and correct amblyopia that has occurred. This can be achieved through eye patches or drops that strengthen the vision in the weaker eye. These are only treatments for amblyopia (decrease in vision), not strabismus (misalignment). 5. Every child should have regular vision screenings Children should be examined periodically to measure vision and to detect strabismus starting at a few months of age. Traditional screening methods or photo screenings are both effective. You can read more about osteoporosis in Dr. Khazaeni editorial on MerckManuals.com. About The Merck Manuals and MSD Manuals First published in 1899 as a small reference book for physicians and pharmacists, The Merck Manual grew in size and scope to become one of the world's most widely used comprehensive medical resources for professionals and consumers. As The Manual evolved, it continually expanded the reach and depth of its offerings to reflect the mission of providing the best medical information to a wide cross-section of users, including medical professionals and students, veterinarians and veterinary students, and consumers. In 2015, The Manuals kicked off Global Medical Knowledge 2020, a global initiative with the goal to make the best current medical information accessible by up to three billion professionals and patients around the world by 2020. The Manuals achieved that goal, and today its medical information is available in more than 241 countries and in 13 languages. 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Digital therapeutics (DTx) continue to gain momentum as a promising form of treatment for various diseases. While they are widely considered to be behavioral interventions, the reality is that these therapeutics are used for a wide variety of conditions. DTx are software-based medical treatments that treat various medical conditions. As defined by the Digital Therapeutics Alliance: DTx “delivers evidence-based therapeutic interventions that are driven by high quality software programs to prevent, manage, or treat a medical disorder or disease.” Those familiar with DTx are likely aware of its potential to provide behavioral interventions, including support for conditions like ADHD, substance abuse, and depression. But DTx can also support physical intervention via neuro-motor training for conditions such as multiple sclerosis, stroke, and amblyopia. By utilizing software-based solutions, DTx offers targeted approaches to address a wide variety of healthcare needs. Despite its growing interest, the subset of DTx prescribed by a physician, known as PDTs (Prescription Digital Therapeutics), are facing substantial challenges. PDTs have the potential to act as a solution to not only reduce rising healthcare costs but also to accelerate clinical outcomes. In fact, it has the potential to revolutionize the way healthcare is delivered across the country. Demand is increasing, yet many payers are still hesitant to cover them – in large part thanks to laws that govern coverage, a lack of clarity regarding coverage approaches, and questions regarding evidence generation for these solutions. Consider these obstacles: – Unlike traditional drugs, PDTs are not required to be covered by payers; as a result, payers must make a conscious decision to cover them. This distinction is important because since their inception, payers have not typically covered PDT solutions. Recall when legislation like Medicare was first created in the 1960s, lawmakers could not anticipate innovations like the existence of PDTs and defined covered benefits in a narrow manner relative to our understanding today. Unfortunately, laws on the books have lagged behind technological advancements. Consider the similarities to the past situation with pharmaceutical drug coverage. Before the introduction of Medicare Part D in 2006, drugs were not universally covered. A growing population of seniors helped lead the way for change. Similarly, with PDTs, there will come a time when the evidence supporting their effectiveness becomes undeniable, and a larger population will require access to these treatments. Legislation to include PDT coverage is not an impossible task, as we consider similar reforms from our past. Beyond improved patient outcomes and real-time data collection, the adoption of PDTs can lead to significant cost savings in the healthcare industry. By empowering patients to take control of their own healthcare and manage their conditions using safe and effective digital treatments, the trajectory of healthcare costs can be altered. – Payers also encounter logistical challenges when it comes to implementing PDTs. As they navigate this new territory, payers find themselves grappling with several questions that require careful consideration. How to assess the quality of evidence supporting PDTs? And should PDTs adhere to the same standards as pharmaceuticals to be reimbursed? Many perceive PDT coverage as complicated, but it may not be as complex as it initially appears. The challenge lies in the fact that payers are accustomed to making decisions for treatments via well-defined pathways; however, these pathways are not yet agreed upon for PDTs. The unfamiliarity and lack of a clear roadmap can make them seem like a logistical nightmare from the payer’s perspective. It’s, therefore, crucial to demonstrate that incorporating PDTs into the reimbursement process can be similar to the current practices for traditional treatments. Experiences in this area are still in their infancy, but feedback from payers shows that existing processes do not need to be entirely revamped for these products. – Finally, another key issue is the expectation of demonstrating outcomes and tangible results – drugs have a clear pathway for this requirement, but PDTs do not. In addition, smaller PDT companies do not have the same level of resources as biopharma to invest in large-scale, costly clinical trials. This has led many to question whether PDTs should be required to follow the same clinical development pathway as drugs. We all know that movement is beneficial to health outcomes. The question is, does a PDT need to prove the outcomes from motor training? Or does it just need to demonstrate that the training is delivering the requisite heart rate and that the range of motion for the patient is changing? The same question applies for behavioral interventions There is a large body of evidence that training the mind can help reduce pain, anxiety, and other conditions. Given those results, where does the burden of proof lie for a PDT – to demonstrate that behavioral interventions work or to demonstrate that the delivery mechanism of the PDT works? Given that many treatments are often criticized for being too expensive, is there a way to reduce the cost burden of clinical trials? If the goal is to reduce the cost of the healthcare system and improve outcomes, we must also create a pathway for pragmatic clinical trials. Let’s recognize that change is hard – but we should be encouraged by the questions that payers are asking. The fact that questions exist means that there is an inherent value in the dialogue. Where there are questions, there will be answers. Today, many insurance companies are creating innovation arms – a welcome step in the right direction, including their emphasis on exploring pathways to develop value-based agreements that are aligned with generating evidence. These pilot approaches linking early access to the development of real-world evidence to positive outcomes will be critical in ultimately offsetting the cost of PDT products – a win-win situation for all stakeholders involved. There’s a reason to be optimistic about the future of PDTs. Innovation can and should be disruptive. The challenges that are initially met with resistance will almost always turn into viable, sustainable solutions. The key is that we continue to engage in dialogue that leads to real change.