International Journal of Current Advanced Research

ISSN: O: 2319-6475, ISSN: P: 2319 – 6505, Impact Factor: SJIF: 5.438

Available Online at www.journalijcar.org
Volume 6; Issue 2; Februay 2017; Page No. 2104-2107

Research Article

A COMPARATIVE STUDY ON COMBINATION THERAPY OF OCCLUSION AND H.B.STIMULATION

V/S OCCLUSION ALONE IN MANAGEMENT OF AMBLYOPIA IN 5 TO 16 YEARS CHILDREN OF
KAMRUP(METRO) DISTRICT OF ASSAM, A NORTH-EASTERN STATE OF INDIA
Sangeeta Kalita and Kabita Bora Baishya
MS Ophthalmology, RIO, Guwahati
AR T I C L E I NF O AB ST R A C T

Article History:
Received 11th November, 2016
Received in revised form 31thDecember, 2016
Accepted 24th January, 2017
Published online 28th February, 2017
Key words:
amblyopia, school children, occlusion
therapy, macular
stimulation, tertiary eye care hospital, north
east India
Introduction: Amblyopia is one of the most common causes of visual impairment in
children.Conventional treatment of amblyopia by patching of sound eye fails due to poor
patient compliance. Hence, Alternative technique of minimal occlusion with
H.B.stimulation of amblyopic eye has been studied.
Aims And Objectives: To compare efficacy of combination therapy of occlusion in good
eye andH.B.stimulation in amblyopic eye v/s occlusion therapy alone in 51 patients in the
age group of 5 to 16 years of Kamrup(Metro) district of Assam.
Materials And Methods: A prospective study of 51 amblyopic children in the age group
of 5 to 16 years collected from a cross sectional study, carried out in Government and
private schools of Kamrup (Metro) district of Assam, during the academic session 2013-15
from the period September, 2013 to August, 2015 who were treated and followed up in a
tertiary care hospital in Guwahati were divided into2groups.1group received patching of
the good eye,H.B.stimulation of the amblyopic eye with synoptophore,and the other group
received patching of good eye alone.The Va of B/E recorded each time. All children were
regularly examined every3months by the same ophthalmologist. The compliance of each
patient was reassessed and adjusted. At the end of the schedule, Va of the amblyopic and
the good eyes were measured plus the binocularity of B/E was recorded as the main
outcome measurement.
Results: Out of 12104 students screened, 845(7.0%) had refractive errors. Prevalence of
amblyopia was found to be 98(0.81%). However, only 51 had undergone treatment and
could be followed up for the said period(duration of the study was 2yrs). Final BCVA were
between6/6and6/12for 44 cases of 51cases (90%). Final best binocularity was maintained
in 38 of 51 patients (60%), including20 anisometropic patients,7 pseudophakic
patients,13strabismic patients and11combined group patients.
Conclusion: Combination therapy of minimal occlusion in good eye and H.B.stimulation
of the amblyopic eye was better than occlusion of the good eye alone, based on visual
acuity and compliance of the patient.

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restoration of central fixation, improvement in visual acuity

INTRODUCTION
Amblyopia is one of the most common causes of visual
impairment in children. Conventional treatment of amblyopia
by patching of sound eye fails due to poor patient compliance.
Hence, Alternative technique of minimal occlusion in the
good eye with Haidinger’s Brushes(H.B.)stimulation of
amblyopic eye has been studied.
The entoptic phenomenon of H.B. caused by the action of
polarised light falling on the macula, can be used in the
treatment of eccentric fixation and abnormal retinal
correspondence. The appreciation of the phenomenon is the
result of variations in absorption by the retinal pigment which
is oriented in front of photoreceptors in the parafoveal region.
After this exercise has been practised many times, the correct
spatial value of the fovea is gradually re awakened, leading to
and commencement of binocular vision.
The Haidinger’s brushes (H.B.) are always placed in front of
the amblyopic eye, so that foveal fixation is maintained
during the treatment. However, it is possible to commence
binocular treatment even before foveal fixation is established,
as long as the patient can appreciate H.B.
Very few literatures have been reported regarding efficacy of
H.B.stimulation in the treatment of amblyopia.
The AIMS AND OBJECTIVES of our study was to:
To compare efficacy of combination therapy of minimal
occlusion in good eye and H.B.stimulation in amblyopic eye
v/s occlusion therapy alone.
International Journal of Current Advanced Research Vol 6, Issue 02, pp 2104-2107, February 2017

57
 International Journal of Current Advanced Research Vol 6, Issue 02, pp 2104-2107, February 2017

M occlusion  Uniocular or
1 binocular
A o
1 best
f
T - corrected
E s
visual
RI t
r acuity(BCVA
e ) less than 6/9
A u
c in either or
LS d
e both eyes.
A y i  Children with
N The period of study v Strabismus,
extended from e
D Anisometropi
September, 2013 to d a, Paediatric
M A cataract(post
E u o operative)
T g n etc. With
H u l BCVA less
s y than
O t 6
D , o /
S 2 c 9
0 c
P 1 l i
l 5 u n
a . s
c i
S o
e o
t n
n e
o u
f d t o
y h r
s e
t s r b
u a a o
d m p t
y p y h
l
It is a retrospective e I
n e
study, carried out in 51
c y
amblyopic children in the
c e
age group of 5 to 16 years l
o s
,which are collected by a u
n .
cross sectional study, s
s  Patient with a
carried out in Government i
i history of
and Private schools of o
s previous
Kamrup(Metro) district of n
t treatment/curr
Assam, a North Eastern
e ently taking
state of India. Out of C
d amblyopia
12,104 children screened, r treatment.
98 children were found to i
o  Patient with
be amblyopic. However, t
only 51 children had f prior intraocular
e
undergone treatment or refractive
51 r
successfully and were ambly i surgery.
followed up in a tertiary opic o E
care hospital of Assam for childr n x
the duration of study i.e.2 en c
yrs.  School going
attend l
children in the
P ing u
age group of 5-
e RIO,O s
15 years
r PD. i
irrespective of
i 40- receiving o
gender of
o combination therapy of n
Kamrup metro
d H.B.stimulation and
region.
58
 International Journal of Current Advanced Research Vol 6, Issue 02, pp 2104-2107, February 2017
C  The Va of B/E Fig showing 2 patients
r recorded each receiving H.B.stimulation
with Synaptophore model
i time. All 2051
t children were
e regularly
r examined every
i 3 months by the
o same
n ophthalmologist
.
 Age less than 5
 The compliance
years and more than
of each patient
15 years. was reassessed
 Any organic and adjusted.
ocular pathology  At the end of
B the schedule,
e Visual acuity
f of the
o amblyopic and
r the good eyes
e were measured
and was
s recorded as the
t main outcome
a measurement.
r
t
i
n
g Fig showing 2 children
receiving occlusion of good
eye by an occlusion patch in
t the first case and an occluder
r attached to a spectacle in the
second case.
e
a
t
m
e
n
t
 initial visual
acuity,
 Cycloplegic and
non cycloplegic
refraction,
 proper orthoptic
examination in
strabismic
patients was
carried out.
 They were
divided into 2 groups.
st
 1 group received
patching of the
good eye and H.B.
stimulation of the
amblyopic eye
with synoptophore
Model 2051 and
nd
 2 group
received patching of
good eye alone.
59
International Journal of Current Advanced Research Vol 6, Issue 02, pp 2104-2107, February 2017

60
 International Journal of Current Advanced Research Vol 6, Issue 02, pp 2104-2107, February 2017

RESULTS AND OBSERVATIONS

overall improvement in amblyopia with occlusion of the
Out of 47 patients 18 - anisometropic 12 - strabismic 10 - good eye alone

combined 7 –sensory deprivation amblyopia.

100 80
Out of 47 amblyopics, 28(57.6%) were male children and rest
80
19(42.4%) were females. Males were more than females 60
50

in all the different types of amblyopia. 40 20

20 children(42.5%) were in the age group of 5-7 yrs, 20
overall improvement in
20(42.5%) in the age group of 8-10 yrs and rest 7 0
amblyopia with occlusion of
children(15%) were in the age group of 11-15 yrs. the good eye alone

The mean initial log MAR visual acuity of the 47 amblyopia

patient is 0.70 ±0.14.
Comparison of mean initial and final visual acuity between
the two groups at the end of 3 months Fig 4
visual acuity at the end of
2yrs
1
1
0.8 0.8
0.8
0.6 0.6 0.8 0.7
0.6 0.7
0.41 0.4 0.6
0.4 0.3 0.41
0.5
mean initial log MAR 0.4
0.2 visual acuity at the end of
mean final log MAR 0.3 2 yrs
0 0.2
0.1
0
mean initial log mean final log
MAR MAR

Fig 5 showing visual acuity of Group receiving H.B. and occlusion

Fig1 showing Group1 with occlusion of the good eye alone. therapy at the end of 2 yrs

1 visual acuity at the end of 2yrs

1
0.9 0.8 0.8
0.8
0.7 0.6 0.6 0.7
0.8
0.6
0.5 0.4 0.7
0.4 0.3 0.3 0.6 0.5
0.3 mean initial log MAR 0.5
0.2
0.1 0.4 visual acuity at the end
mean final log MAR
0 0.3 of 2 yrs
0.2
0.1
0
mean initial mean final
log MAR log MAR

Fig2 showing Group 2 with part time occlusion of the good eye and
H.B.stimulation in the amblyopic eye. Fig6 showing visual acuity of Group receiving occlusion therapy alone
at the end of 2 yrs

overall improvement in amblyopia with

H.B.stimulation and occlusion
DISCUSSION
89.4
100
84 The results and observations in this study is comparable with
80
60 observations made by Subharngkasen et al, 2003, Journal of
40 10.6
20
overall improvement in
Medical Association of Thailand).89.4% of patients had one
0
amblyopia with Snellen’s line improvement within a month of starting H.B.
H.B.stimulation and
occlusion Stimulation and occlusion therapy. However, the rest 10.6%
patients with no improvement are the ones with sensory
deprivation amblyopia.
Only one patient during the entire study period deteriorated
Fig 3 due to discontinuation of the H.B.stimulation.

61
The compliance of the patient was found to be better in
patients receiving combination therapy of H.B.stimulation
and occlusion.
Bilateral amblyopia can be treated with H.B. Stimulation.
CONCLUSION
Combination therapy of minimal occlusion in good eye and
H.B.stimulation of the amblyopic eye was better than
occlusion of the good eye alone, based on visual acuity and
compliance of the patient.
*******
ACKNOWLEDGEMENT
I am indebted and very grateful to optical technician Mr. K.
Mahanta and Mr. Dutta, orthoptist Mrs. Aruna Baido and
optometrist Mr. Hassan for helping me out in every possible
way from time to time.
References
Practical orthoptics in the treatment of squint and
amblyopia- Lyle and Wybar, 5th edition
Von Noorden Binocular vision and ocular motility,
6th edition
Journal of medical association of Thailand, 2003