Amblyopia, or ‘lazy eye’, is the most common vision deficit in children. Due to a difference in glasses prescription between the two eyes (anisometropia) or misalignment of the eyes (strabismus), the brain begins to neglect visual information from one eye. Together with scientists at University College London we are developing new treatment approaches, which will make treatment more enjoyable for children and may shorten the duration of treatment. This, in turn, will mean fewer hospital clinic appointments which is good news for busy families!
Amblyopia Projects VIDEO
Professor Dakin (UCL Institute of Ophthalmology) and his team have developed a technology based on 3D- movie technology which involves children watching a movie interspersed regularly with short games to ensure continuous attention and engagement for one hour a day.
The image seen by the better eye is manipulated to match the visual ability of the amblyopic eye. Gradually, the brain uses the amblyopic eye more and the resolution of both images can be increased until normal vision is reached. We have evaluated this technology on a small group of children and are now at the stage of moving this technology into a larger and more formal evaluation such as a randomised controlled trial.
Dr John Greenwood (UCL Experimental Psychology) and his team are investigating the mechanisms underlying amblyopia. A particular focus is on visual crowding which is the ‘disruptive’ effect of clutter on object recognition. Crowding is normally associated with peripheral vision, where objects can be highly visible in isolation and extremely difficult to identify when surrounded by clutter. Ordinarily, crowding does not occur in central vision (i.e. directly where you are looking). In cases of anisometropic amblyopia however, crowding is strongly elevated in the central vision of the amblyopic eye. Crowding is not, however, a typical therapeutic target in the treatment of amblyopia, and we hope through gaining a better understanding of this process that we can better treat the full range of visual deficits. In addition, we also contribute to a large European multicentre trial of standard current treatment called the EUPATCH [http://www.isrctn.com/ISRCTN8511091] study, funded by Action for Medical Research and led by Professor Irene Gottlob (University of Leicester). Strabismus
Strabismus, or misalignment of the eyes, is one of the most common childhood eye problems and affects 2-4% of children.
Misalignment of the eyes in children is predominantly in the horizontal plane (i.e. one eye drifts inwards or outwards). However, strabismus can also be in the vertical plane, i.e. one eye appears higher or lower than the other.
Strabismus Projects Strabismus detection
We work with industry to evaluate new methods of diagnosing and measuring strabismus. Previous work includes testing a prototype of the Volk Eye CheckTM on 400 children attending our clinics which is a study evaluating the latest version of the device.
Genetics of horizontal strabismus
We have carried out research to find genetic changes that can be linked with strabismus. The inheritance of eye movement control is highly complex and studying families where strabismus is present in some individuals may improve our understanding of how eye alignment and strabismus develop.
Congenital superior oblique muscle weakness
The most common vertical strabismus, that is present from birth, is due to an under-action of one of the six eye muscles - the “superior oblique” muscles. This under-action of the muscle seems to be caused by the nerve that carries signals from the brain to the muscle - the trochlear nerve - which has not developed at all or is smaller than normal. However, there may also be other causes. We have teamed up with scientists and clinicians at the UCL Institute of Child Health and the Lysholm Department of Neuro-Imaging to study the trochlear nerve and superior oblique muscle on high-resolution MRI scans to find out whether genetic changes may contribute to this condition.
Outcomes of strabismus treatment
Investigators at the NIHR Moorfields BRC have also contributed to large, multi-centre studies to improve treatment outcomes in common types of strabismus, such as exotropia (an out-turn type of strabismus). The treatment approach varies between different centres where observational studies and a randomised controlled trial (Surgery versus Active Monitoring in Intermittent Exotropia, SamExo) have for the first time collected outcome data systematically across several centres in the UK.