[Spontaneous improvement of visual acuity in adult amblyopia after functional loss in the non-amblyopic eye?]

Background: The prognosis of functional improvement after vision loss in the non-amblyopic eye in adulthood is important for counselling of the patients, but uncertain for a number of reasons. Our study focuses on two aspects. Firstly, a questionnaire was developed asking ophthalmologists and orthoptists for their opinion about the chances of significant spontaneous improvement; secondly, patient data were analysed with respect to acuity data acquisition and documentation as reasons for uncertainty concerning the prognosis.

Materials and methods: In the context of a project about age limits of amblyopia treatment, a questionnaire was developed which comprised also an item about the estimation of the prognosis after loss of vision in the non-amblyopic eye. It was distributed to ophthalmologists and orthoptists, and the answers were analysed in connection with two large, published studies about this topic . Furthermore, acuity data of three adult amblyopes were analysed after loss of function in the non-amblyopic eye.

Results: The questionnaire was answered by 109 ophthalmologists and 128 orthoptists, all working in Germany. Almost 50% of the answers concerning the chances of spontaneous improvement were in agreement with the data of the two published studies, which stated that the chances of spontaneous improvement were 10% or 17.4%, respectively. More than 25% of the answers underestimated the chances for spontaneous improvement (answer: 0 to 5%). On the other hand, a number of orthoptists and ophthalmologists estimated the chances much too optimistically, some anticipating more than a 60% chance of spontaneous improvement. The analysis of the patient data showed that both acquisition and documentation of acuity data gave reasons for uncertainties concerning the prognosis for visual acuity.

Conclusions: In addition to new ways of assessing treatment compliance and quality of life, knowledge about the opinion of the treating personnel concerning various aspects of a disease may lead to more evidence-based treatment. In amblyopic patients, the inclusion of certain details into the documentation (type and separation of the optotypes, optical correction) may be essential.