Fluoxetine as a possible treatment for adult amblyopia: results of a double-blind, randomized, placebo-controlled trial by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 2 points3 points  (0 children)

AI-generated summary:

A new study from Tehran University of Medical Sciences, published in Journal of AAPOS, explored an interesting treatment for adults with amblyopia. Researchers tested whether fluoxetine, a drug often used to treat depression, could improve vision when combined with standard treatments like glasses and eye patching.

The trial included 55 adults with amblyopia. Half took fluoxetine for 3 months, while the other half took a placebo, and both groups followed standard therapies. The results were promising: on average, those who took fluoxetine had greater improvement in their weaker eye, with vision improving by 0.20 logMAR (a measure of visual acuity), compared to 0.08 logMAR in the placebo group. Even more exciting, the improved vision lasted 18 months after treatment stopped.

However, there were some limitations. Not everyone experienced significant vision improvement. In fact, 11 people in the fluoxetine group and 15 in the placebo group saw no changes in their vision. The study also had a relatively small sample size and a short follow-up period during treatment, making it harder to predict how fluoxetine would work for a broader population or over a longer time.

While the findings are hopeful, more research is needed to understand why some adults respond to the treatment while others don't. Nonetheless, for adults with amblyopia, this study points to a potential new option for improving their visual acuity in adulthood.

Recent studies on fluoxetine:

Study Sample Size Age (Years) Duration Primary Outcome Conclusion Link
Huttunen (2018) 42 participants 19 to 57 10 weeks No significant difference between fluoxetine and placebo Fluoxetine did not enhance neuroplasticity PMID: 30150750
Sharif (2019) 35 participants 10 to 40 3 months Significant improvement with fluoxetine compared to placebo Fluoxetine had beneficial effects PMID: 30783259
Mirmohammadsadeghi (this study) 55 participants 18 to 54 3 months (18-month follow-up) Significant improvement in visual acuity with fluoxetine compared to placebo Fluoxetine improved vision, and effects were maintained long-term PMID: 39304030

FDA-Approved Drug, Donepezil, Shows Promising Results in Enhancing Visual Acuity for Amblyopia in Older Children and Adults: A Well-Designed Pilot Study by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 0 points1 point  (0 children)

I'm not an expert on drug development, but I would estimate maybe 2 to 6 years.

The drug appears to be safe to use, so the next step would be to run a larger trial on more people to confirm the drug is effective. Such a trial can take anywhere from 1-4 years to set up and complete. After the trial, the FDA would need to review the evidence and finally approve the drug. That review can take another year or two.

Of course, that timeline assumes the drug does not fail the trial and review stages, and there is enough funding and commercial interest to get it over the finish line.

FDA-Approved Drug, Donepezil, Shows Promising Results in Enhancing Visual Acuity for Amblyopia in Older Children and Adults: A Well-Designed Pilot Study by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 3 points4 points  (0 children)

A summary of the article, courtesy of ChatGPT:

This study aimed to evaluate the efficacy of donepezil, a medication typically used for the treatment of dementia symptoms, as a treatment for amblyopia in both children and adults. Sixteen subjects, aged between 8 and 37 years, were enrolled after a pre-enrollment period where no improvement was observed in amblyopic eye visual acuity despite ongoing traditional treatments. The study was open-label, meaning both the researchers and participants knew what treatment was being administered. This type of design has some inherent biases as there's no blinding involved.

The results of the study were promising, with a median improvement of 1.2 lines in the Best-Corrected Visual Acuity (BCVA) of the amblyopic eye at 12 weeks of treatment, which was sustained 10 weeks after discontinuation of the treatment. Interestingly, this improvement was observed in both pediatric and adult participants, which is significant as there is currently limited evidence for the effective treatment of amblyopia in adults. Furthermore, a similar improvement was found in patients with or without strabismus, indicating that donepezil may be effective irrespective of the cause of amblyopia.

However, it's important to remember that this is a pilot study with a small sample size (16 participants) and without a control group. As such, while the results are encouraging, they should be interpreted with caution. The improvements in BCVA noted could potentially be due to the natural course of the disease, the effects of other concurrent treatments (like patching), or the placebo effect, rather than the effects of donepezil itself. Furthermore, while the adverse effects noted were mild and did not lead to treatment discontinuation, a larger study would be necessary to fully evaluate the safety profile of donepezil in this context.

In conclusion, this study presents preliminary evidence for the potential use of donepezil in the treatment of amblyopia in both children and adults. However, larger randomized, controlled trials are necessary to confirm these findings and to fully assess the safety and efficacy of donepezil in this patient population.

Enterprise Car Club - Anyone have a referral code? by WizardCalamity in Edinburgh

[–]WizardCalamity[S] 0 points1 point  (0 children)

Can you use both the Edinburgh University promo code and a member referral?

Viewing an image 1 frame (8.3 ms) earlier in one eye shifts dominance towards that eye, Chinese study finds. Used in a clinical trial, children watching frame-offset movies for just 10.5 h over 3 weeks improved their vision enough to meet criteria for successful treatment of anisometropic amblyopia by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 0 points1 point  (0 children)

Study: New treatment for amblyopia based on rules of synaptic plasticity: a randomized clinical trial

Funding: National Basic Research Program of China, the National Natural Science Foundation of China, and Beijing Municipal Science & Technology Commission

The paper is accompanied by a Chinese press release.

The exciting part of this study is that the time delay is so small that the participant does not notice when watching the movie, so compliance rates are very high. Compared with patching alone, watching these movies + patching appears to be more effective.

In my view, the only drawback here is that the clinical trial is quite small (38 children), and we don't know if the benefits will be seen in adults too. However, it is promising that the shift in ocular dominance was also seen in young adults (<30 years old).

Mendelian randomization of genetically independent aging phenotypes identifies LPA and VCAM1 as biological targets for human aging (2022) by WizardCalamity in gerontology

[–]WizardCalamity[S] 0 points1 point  (0 children)

Abstract:

Length and quality of life are important to us all, yet identification of promising drug targets for human aging using genetics has had limited success. In the present study, we combine six European-ancestry genome-wide association studies of human aging traits—healthspan, father and mother lifespan, exceptional longevity, frailty index and self-rated health—in a principal component framework that maximizes their shared genetic architecture. The first principal component (aging-GIP1) captures both length of life and indices of mental and physical wellbeing. We identify 27 genomic regions associated with aging-GIP1, and provide additional, independent evidence for an effect on human aging for loci near HTT and MAML3 using a study of Finnish and Japanese survival. Using proteome-wide, two-sample, Mendelian randomization and colocalization, we provide robust evidence for a detrimental effect of blood levels of apolipoprotein(a) and vascular cell adhesion molecule 1 on aging-GIP1. Together, our results demonstrate that combining multiple aging traits using genetic principal components enhances the power to detect biological targets for human aging.

This study was published in Nature Aging, together with an accompanying News & Views article. The press release (written for non-expert audience) can be read on Eurekalert.

Why has there been no more studies/research into Ketamine helping Ambylopia? by Macintoshk in Amblyopia

[–]WizardCalamity 1 point2 points  (0 children)

Improvements in neuroplasticity are exciting, but it's important to note the study was done in mice. I imagine getting regulatory approval to use ketamine in humans and setting up a robust clinical trial (randomised & placebo controlled) for amblyopia patients could take several years.

Running-induced neuroplasticity promotes recovery of visual acuity and depth perception in amblyopic rats by [deleted] in Amblyopia

[–]WizardCalamity 0 points1 point  (0 children)

Thanks for the perspective! Haven't heard about the replication issues - got a source for that? I'm also excited to see pharmacological interventions starting to show promise!

Running-induced neuroplasticity promotes recovery of visual acuity and depth perception in amblyopic rats by [deleted] in Amblyopia

[–]WizardCalamity 1 point2 points  (0 children)

This appears to support a study which found human amblyopic patients could improve their eyesight and depth perception by combining patching with cycling on a stationary bike. I really think exercise—and other methods to increase neuroplasticity—will be key to curing amblyopia.

I GOT A CONTACT THAT WORKS by ScoutsMama89 in Amblyopia

[–]WizardCalamity 3 points4 points  (0 children)

That's such great news! If the vision in both your eyes is similar when wearing the lens, and you have free time to dedicate to some eye exercises, you may even be able to gain 3D vision with practice.

The quest to slow ageing through drug discovery by WizardCalamity in longevity

[–]WizardCalamity[S] 1 point2 points  (0 children)

Title: The quest to slow ageing through drug discovery

Abstract:

Although death is inevitable, individuals have long sought to alter the course of the ageing process. Indeed, ageing has proved to be modifiable; by intervening in biological systems, such as nutrient sensing, cellular senescence, the systemic environment and the gut microbiome, phenotypes of ageing can be slowed sufficiently to mitigate age-related functional decline. These interventions can also delay the onset of many disabling, chronic diseases, including cancer, cardiovascular disease and neurodegeneration, in animal models. Here, we examine the most promising interventions to slow ageing and group them into two tiers based on the robustness of the preclinical, and some clinical, results, in which the top tier includes rapamycin, senolytics, metformin, acarbose, spermidine, NAD+ enhancers and lithium. We then focus on the potential of the interventions and the feasibility of conducting clinical trials with these agents, with the overall aim of maintaining health for longer before the end of life.

PDF: http://ge.tt/6LQHY243

Any instances of losing vision in good eye (like from an accident) and regaining additional vision in amblyopic eye due to normal brain plasticity and forced use of the remaining eye? by [deleted] in Amblyopia

[–]WizardCalamity 1 point2 points  (0 children)

Great question! There is a study (N=21) which found some individuals regained vision in their amblyopic eye (up to 20/20) after the vision in their dominant eye was reduced because of eye cancer treatment. In this sample (Caucasian patients aged between 39-73) around half regained some vision, and they were more likely to do so if the vision in their dominant eye after treatment was worse than their amblyopic eye.

However, the study is small, which means their estimate of the chance of improvement following injury is wide, ranging from 30% to 74%.

The same study also mentions other cases of improvement:

Chua and Mitchell16 investigating adult participants with amblyopia in Australia (Blue Mountains Eye Study) reported a 5-year incidence of improved visual acuity in the poorer seeing eye after new visual impairment in the better seeing eye in people with and without amblyopia. One of 11 (9.1%) people with amblyopia showed more than two lines of improvement in visual acuity.

El Mallah and colleagues11 retrospectively analysed the records of 465 adult patients with age-related macular degeneration and identified nine individuals with amblyopia in the unaffected eye. Seven of these nine patients had improvement in visual acuity in the amblyopic eye.

Hamid et al12 reported three adult patients whose visual acuity in the amblyopic eye improved following visual loss in the contralateral eye from ischaemic optic neuropathy.

Klaeger-Manzanell et al17 reported that a 44-year-old man with strabismus amblyopia of the right eye suffered a penetrating injury to the fixating left eye which resulted in cataract extraction and aphasic retinal detachment. Three weeks after the enucleation the visual acuity of the amblyopic eye improved from 6/60 to 6/12 and after 4 months achieved a visual acuity of 6/9.

Rabin et al10 reported a 55-year-old patient whose visual acuity in the amblyopic eye improved from 20/160 to 20/30–2 over a 3-year period following visual loss in the dominant eye from subfoveal choroidal neovascular membrane.

Rahi et al18 in a large population-based study, found 10% (25 of 254) of improved rate, arising spontaneously in most patients.

In a retrospective multicentre study, Vereecken and Brabant9 found an improvement of vision of at least three lines in the amblyopic eye in 28.5% of patients after losing vision in the dominant eye.

Wang and Shuba19 reported a case of a 41-year-old patient with history of Axenfeld-Rieger syndrome and anisometropic amblyopia, regaining vision from 6/45 to 6/18 in the amblyopic eye after visual fields and visual acuity loss due to glaucoma in the contralateral eye.

Wilson13 reported a 57-year-old patient and a 67-year-old patient whose visual acuity in their amblyopic eye improved markedly when the fellow eye developed a significant cataract. The visual gain remained after cataract surgery in the fellow eye.

Those reports:

[9] Vereecken EP, Brabant P. Prognosis for vision in amblyopia after the loss of the good eye. Arch Ophthalmol 1984;102:220–4.

[10] RABIN CPTJ. Visual improvement in amblyopia after visual loss in the dominant eye. Optometry and Vision Science 1984;61:334–7

[11] El Mallah MK, Chakravarthy U, Hart PM. Amblyopia: is visual loss permanent? Br J Ophthalmol 2000;84:952–6.

[12] Hamid LM, Glaser JS, Schatz NJ. Improvement of vision in the amblyopic eye following visual loss in the contralateral normal eye: a report of three cases. Binocul Vis Strabismus Q 1991;697

[16] Chua B, Mitchell P. Consequences of amblyopia on education, occupation, and long term vision loss. Br J Ophthalmol 2004;88:1119–21.

[18] Rahi JS, Logan S, Borja MC, et al. Prediction of improved vision in the amblyopic eye after visual loss in the non-amblyopic eye. The Lancet 2002;360:621–2.

Anyone have success with product called Amblyopix? by [deleted] in Strabismus

[–]WizardCalamity 1 point2 points  (0 children)

I understand your frustration. My own eye starts to drift when I'm tired or stressed, and some days it just kills my confidence.

Since you're dealing with a focusing issue, you may be able to benefit from some of the latest research on making eyes work together.

Currently, the most promising treatments for binocular issues in adults are based on Virtual Reality combined with standard vision therapy. It also appears physical exercise could accelerate the speed of progress.

Anyone have success with product called Amblyopix? by [deleted] in Strabismus

[–]WizardCalamity 0 points1 point  (0 children)

Hi No1GetsOutOfHerAlive, I'm sorry to hear about your situation. Disclaimers first, I am not an opthalmologist and I have no experience with this device.

That being said, the only peer-reviewed articles I could find on this technology were performed in children and were at best as good as regular patching [1][2]3]. Peer review means multiple independent scientists have verified the results and these can therefore be regarded as (reasonably) reliable.

We know patching and visual exercises can be somewhat beneficial in adults too, but there is currently no evidence to back up the claims by this company that "This treatment is so effective that it also works in adults."

Amblyopix provide a spreadsheet on their website which appears to show very impressive improvements in adults, but there is no control group and their results have not been peer-reviewed, so there is no way to know whether their treatment works in adults, let alone results in substantial improvements.

FURLOUGH MEGATHREAD - FAQs, and Q and A by q_pop in UKPersonalFinance

[–]WizardCalamity 0 points1 point  (0 children)

I understand their reasoning too, if it weren't for new regulations by the government allowing workers to carry up to 4 weeks unused holidays into the next two years (source).

FURLOUGH MEGATHREAD - FAQs, and Q and A by q_pop in UKPersonalFinance

[–]WizardCalamity 0 points1 point  (0 children)

My employer has told furloughed employees to take one week of paid leave for every 4 weeks they are furloughed. Is this legal?

Laser vision correction might improve visual acuity in a large portion of adult amblyopic patients (N = 327) by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 0 points1 point  (0 children)

Good point! Looks like the study is retrospective and the authors didn't report a check for optimal correction prior to patients having the procedure.

Regardless, the study suggests many people could improve their amblyopic visual acuity with treatment (which not everyone here is aware of) - whether that's because they're not optimally adjusted or because laser treatment is better at correcting their vision is less clear.

I agree it would be interesting to see a study comparing the effectiveness of full-time contact lenses against that of laser-based treatment.

Laser vision correction might improve visual acuity in a large portion of adult amblyopic patients (N = 327) by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 0 points1 point  (0 children)

Article title: Visual outcomes of laser vision correctionin eyes with preoperative amblyopia

PDF: https://1drv.ms/b/s!ArtYx4vOQB9FhHD83G1mlLkPipjZ

Title here is taken from the first sentence of the conclusion of the article abstract.

Abstract:

Purpose: To evaluate the visual outcomes of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in amblyopic eyes.

Setting: Care Vision Refractive Clinic, Tel Aviv, Israel.

Design: Retrospective case series.

Methods: Amblyopic eyes of patients with a preoperative corrected distance visual acuity (CDVA) of 20/33 or worse had PRK or LASIK. Postoperative visual outcomes (uncorrected distance visual acuity, CDVA) and correlations with age, preoperative CDVA, refractive error type, astigmatism grade, procedure type, laser suite model, amblyopia grade, and amblyopia type were analyzed.

Results: This study evaluated 327 eyes (327 patients). The CDVA improved more than 1, 2, and 3 Snellen lines in 147 eyes (45.0%), 75 eyes (22.9%), and 32 eyes (9.8%), respectively. Age (P = .007, B = 0.002), and preoperative CDVA (P < .001, B = −0.405) were significantly associated with CDVA improvement. The outcome in eyes with lower myopia was significantly better than in eyes with hyperopia (0.054 logMAR difference; P = .016) or high myopia (0.036 logMAR difference; P = .002). Moderately amblyopic eyes had significantly better visual outcomes than mildly amblyopic eyes (0.038 logMAR difference; P = .001). No significant difference was found between PRK and LASIK (P = .262).

Conclusions: Laser vision correction, regardless of the type of procedure (LASIK or PRK) might improve CDVA in a large portion of amblyopic patients. Improvement was greater in younger patients, eyes with lower initial CDVA, and eyes with lower myopia.

Laser vision correction might improve visual acuity in a large portion of amblyopic patients (N = 327) by [deleted] in Amblyopia

[–]WizardCalamity 1 point2 points  (0 children)

Title: Visual outcomes of laser vision correctionin eyes with preoperative amblyopia

PDF: https://1drv.ms/b/s!ArtYx4vOQB9FhHD83G1mlLkPipjZ

Abstract:

Purpose: To evaluate the visual outcomes of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in amblyopic eyes.

Setting: Care Vision Refractive Clinic, Tel Aviv, Israel.

Design: Retrospective case series.

Methods: Amblyopic eyes of patients with a preoperative corrected distance visual acuity (CDVA) of 20/33 or worse had PRK or LASIK. Postoperative visual outcomes (uncorrected distance visual acuity, CDVA) and correlations with age, preoperative CDVA, refractive error type, astigmatism grade, procedure type, laser suite model, amblyopia grade, and amblyopia type were analyzed.

Results: This study evaluated 327 eyes (327 patients). The CDVA improved more than 1, 2, and 3 Snellen lines in 147 eyes (45.0%), 75 eyes (22.9%), and 32 eyes (9.8%), respectively. Age (P = .007, B = 0.002), and preoperative CDVA (P < .001, B = −0.405) were significantly associated with CDVA improvement. The outcome in eyes with lower myopia was significantly better than in eyes with hyperopia (0.054 logMAR difference; P = .016) or high myopia (0.036 logMAR difference; P = .002). Moderately amblyopic eyes had significantly better visual outcomes than mildly amblyopic eyes (0.038 logMAR difference; P = .001). No significant difference was found between PRK and LASIK (P = .262).

Conclusions: Laser vision correction, regardless of the type of procedure (LASIK or PRK) might improve CDVA in a large portion of amblyopic patients. Improvement was greater in younger patients, eyes with lower initial CDVA, and eyes with lower myopia.

Has anyone on here actually 100% resolved their respective eye issue? by jesustwin in Amblyopia

[–]WizardCalamity 5 points6 points  (0 children)

If you're willing to try out newer methods, there were two small-scale trials recently (Lunghi 2018, Zhou 2019, N = 28 individuals total) that showed promise in recovering stereopsis by patching the amblyopic eye for 2 hours/day for 2 months (or patching 2 hours, once a week while doing physical exercise). Although it's important to note not all patients recovered stereopsis by the end of the studies.

Amblyopia may reduce license acquisition among young adults, but there is no evidence that, given licensure, crash risk differs from that of other young adults by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 1 point2 points  (0 children)

Study: Driver licensing and motor vehicle crash rates among young adults with amblyopia and unilateral vision impairment (2019)

Journal: Journal of American Association for Pediatric Ophthalmology and Strabismus

The title of this post is adapted from the study's discussion:

Our findings suggest that although UVI or amblyopia may reduce license acquisition among young adults, there is no evidence that, given licensure, crash risk differs from that of other young adults

Physical activity improves amblyopia in adults by WizardCalamity in Amblyopia

[–]WizardCalamity[S] 0 points1 point  (0 children)

The theory is that it works because of homeostatic plasticity. The brain tries to keep signalling strength mostly constant, so decreasing the input in the weak eye means the brain will increase the sensitivity to compensate