Abstract
Objective
The objective of this study is to assess the efficacy of oral fluoxetine therapy in improving the visual function of amblyopic patients aged between 10 and 40 years old.
Methods
In this double-blinded, randomized, controlled trial (IRCT2016052428046N1; registered retrospectively), 40 eligible participants with anisometropic or mixed amblyopia were randomly assigned to either fluoxetine or placebo groups. Participants with anisometropia and logMAR best spectacle-corrected visual acuity (BSCVA) worse than 0.2 logMAR in the amblyopic eye or at least a two-line of difference in the BSCVA between the fellow eyes were included. Participants with significant ocular or systemic diseases were excluded. In both groups, the better eye of each patient was patched for 4–6 h a day during the study period. Participants in the treatment group were treated with oral fluoxetine for 3 months. Change in the Snellen BSCVA (after 3 months) was regarded as the primary outcome measure.
Results
Data from 20 participants in the fluoxetine group and 15 participants from the placebo group were analyzed (aged 11–37 years). The magnitude of improvement in visual acuity (from baseline to 3 months after treatment) was significantly higher in the fluoxetine group (0.240 ± 0.068 logMAR; 2.4 line-gain) compared with the control group (0.120 ± 0.086 logMAR; 1.2 line-gain).
Conclusions
This study suggests beneficial effects of fluoxetine in the management of adult and adolescent amblyopia.
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References
Arnold RW. Amblyopia risk factor prevalence. J Pediatr Ophthalmol Strabismus. 2013;50:213–7.
Gokhale AM, Gokhale SA. Effect of occlusion treatment for amblyopia at various ages. J All India Ophthalmol Soc. 1969;17:256–8.
Holmes JM, Lazar EL, Melia BM, et al. Effect of age on response to amblyopia treatment in children. Arch Ophthalmol. 2011;129:1451–7.
Group. PEDI. A prospective, pilot study of treatment of amblyopia in children 10 to < 18 years old. Am J Ophthalmol. 2004;137:581–3.
Mohan K, Saroha V, Sharma A. Successful occlusion therapy for amblyopia in 11- to 15-year-old children. J Pediatr Ophthalmol Strabismus. 2004;41:89–95.
Leguire LE, Rogers GL, Bremer DL, Walson PD, McGregor ML. Levodopa/carbidopa for childhood amblyopia. Invest Ophthalmol Vis Sci. 1993;34:3090–5.
Leguire LE, Walson PD, Rogers GL, Bremer DL, McGregor ML. Longitudinal study of levodopa/carbidopa for childhood amblyopia. J Pediatr Ophthalmol Strabismus. 1993;30:354–60.
Leguire LE, Komaromy KL, Nairus TM, Rogers GL. Long-term follow-up of L-dopa treatment in children with amblyopia. J Pediatr Ophthalmol Strabismus. 2002;39:326–30. quiz345-326
Bhartiya P, Sharma P, Biswas NR, Tandon R, Khokhar SK. Levodopa-carbidopa with occlusion in older children with amblyopia. J AAPOS. 2002;6:368–72.
Gore C, Wu C. Medical therapies of Aamblyopia: translational research to expand our treatment armamentarium. Semin Ophthalmol. 2016;31:155–8.
Repka MX, Kraker RT, Dean TW, et al. A randomized trial of levodopa as treatment for residual amblyopia in older children. Ophthalmology. 2015;122:874–81.
Astle AT, Webb BS, McGraw PV. The pattern of learned visual improvements in adult amblyopia. Invest Ophthal Vis Sci. 2011;52:7195–204.
Park KH, Hwang JM, Ahn JK. Efficacy of amblyopia therapy initiated after 9 years of age. Eye (Lond). 2004;18:571–4.
Sen DK. Results of treatment of anisohypermetropic amblyopia without strabismus. Br J Ophthalmol. 1982;66:680–4.
Scheiman MM, Hertle RW, Beck RW, et al. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005;123:437–47.
Manev H, Uz T, Smalheiser NR, Manev R. Antidepressants alter cell proliferation in the adult brain in vivo and in neural cultures in vitro. Eur J Pharmacol. 2001;411:67–70.
Malberg JE, Eisch AJ, Nestler EJ, Duman RS. Chronic antidepressant treatment increases neurogenesis in adult rat hippocampus. J Neurosci. 2000;20:9104–10.
Bastos EF, Marcelino JL, Amaral AR, Serfaty CA. Fluoxetine-induced plasticity in the rodent visual system. Brain Res. 1999;824:28–35.
Maya Vetencourt JF, Sale A, Viegi A, et al. The antidepressant fluoxetine restores plasticity in the adult visual cortex. Science. 2008;320:385–8.
Maya Vetencourt JF, Tiraboschi E, Spolidoro M, Castren E, Maffei L. Serotonin triggers a transient epigenetic mechanism that reinstates adult visual cortex plasticity in rats. Eur J Neurosci. 2011;33:49–57.
Gu Q, Singer W. Involvement of serotonin in developmental plasticity of kitten visual cortex. Eur J Neurosci. 1995;7:1146–53.
Guirado R, Sanchez-Matarredona D, Varea E, Crespo C, Blasco-Ibáñez JM, Nacher J. Chronic fluoxetine treatment in middle-aged rats induces changes in the expression of plasticity-related molecules and in neurogenesis. BMC Neurosci. 2012;13:5–5.
Stewart CE, Moseley MJ, Fielder AR, Stephens DA. Refractive adaptation in amblyopia: quantification of effect and implications for practice. Br J Ophthalmol. 2004;88:1552–6.
Watts PO, Neveu MM, Holder GE, Sloper JJ. Visual evoked potentials in successfully treated strabismic amblyopes and normal subjects. J AAPOS. 2002;6:389–92.
Talebnejad MR, Hosseinmenni S, Jafarzadehpur E, Mirzajani A, Osroosh E. Comparison of the wave amplitude of visually evoked potential in amblyopic eyes between patients with esotropia and anisometropia and a normal group. Iran J Med Sci. 2016;41:94–101.
Oner A, Coskun M, Evereklioglu C, Dogan H. Pattern VEP is a useful technique in monitoring the effectiveness of occlusion therapy in amblyopic eyes under occlusion therapy. Doc Ophthalmol. 2004;109:223–7.
Sodhi MS, Sanders-Bush E. Serotonin and brain development. Int Rev Neurobiol. 2004;59:111–74.
Fink KB, Gothert M. 5-HT receptor regulation of neurotransmitter release. Pharmacol Rev. 2007;59:360–417.
Baroncelli L, Sale A, Viegi A, et al. Experience-dependent reactivation of ocular dominance plasticity in the adult visual cortex. Exp Neurol. 2010;226:100–9.
Chatzistefanou KI, Theodossiadis GP, Damanakis AG, Ladas ID, Moschos MN, Chimonidou E. Contrast sensitivity in amblyopia: the fellow eye of untreated and successfully treated amblyopes. J AAPOS. 2005;9:468–74.
Huang C, Tao L, Zhou Y, Lu ZL. Treated amblyopes remain deficient in spatial vision: a contrast sensitivity and external noise study. Vision Res. 2007;47:22–34.
Wallace DK, Lazar EL, Melia M, et al. Stereoacuity in children with anisometropic amblyopia. J AAPOS. 2011;15:455–61.
Stewart CE, Wallace MP, Stephens DA, Fielder AR, Moseley MJ. The effect of amblyopia treatment on stereoacuity. J AAPOS. 2013;17:166–73.
Shan Y, Moster ML, Roemer RA, Siegfried JB. Abnormal function of the parvocellular visual system in anisometropic amblyopia. J Pediatr Ophthalmol Strabismus. 2000;37:73–78.
Demirci H, Gezer A, Sezen F, Ovali T, Demiralp T, Isoglu-Alkoc U. Evaluation of the functions of the parvocellular and magnocellular pathways in strabismic amblyopia. J Pediatr Ophthalmol Strabismus. 2002;39:215–21.
FDA (US Food and Drug Administration). Suicidality and antidepressant drugs. Available from: https://www.fda.gov/downloads/drugs/drugsafety/informationbydrugclass/ucm173233.pdf.
Nationals Institutes of Mental Health. Antidepressant medications for children and adolescents: information for parents and caregivers. Available from: https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml.
Acknowledgements
This research funded by the Department of Physiology at Shiraz University of Medical Sciences, Grant Number GRCT00 926471.
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Sharif, M.H., Talebnejad, M.R., Rastegar, K. et al. Oral fluoxetine in the management of amblyopic patients aged between 10 and 40 years old: a randomized clinical trial. Eye 33, 1060–1067 (2019). https://doi.org/10.1038/s41433-019-0360-z
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DOI: https://doi.org/10.1038/s41433-019-0360-z
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