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Original Investigation
October 2017

Spectral-Domain Optical Coherence Tomographic Angiography in Children With Amblyopia

Author Affiliations
  • 1Department of Ophthalmology, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
  • 2UCLA Stein Eye Institute, Los Angeles
  • 3Doheny Eye Center, UCLA, Los Angeles
  • 4Department of Ophthalmology, Olive View–UCLA Medical Center, Sylmar
  • 5Department of Ophthalmology, UCLA, Los Angeles
  • 6Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles
JAMA Ophthalmol. 2017;135(10):1086-1091. doi:10.1001/jamaophthalmol.2017.3423
Key Points

Question  Are there microvascular abnormalities on optical coherence tomographic angiography in children (<18 years) with amblyopia?

Findings  In this case-control study of 63 eyes of 59 patients, reduced capillary density in the superficial and deep plexus in the central 6 × 6 mm of the macula was noted in amblyopic eyes but not in control eyes.

Meaning  This finding suggests amblyopic eyes have reduced retinal capillary density in the macula, but the clinical relevance of this finding remains to be determined.


Importance  Amblyopia is the most common cause of visual impairment in childhood, with a prevalence of 1% to 4% in children in the United States. To date, no studies using noninvasive optical coherence tomographic angiography (OCTA) have measured blood flow in the retinal capillary layers in children with amblyopia.

Objective  To evaluate the retinal and microvascular features using OCTA in children (<18 years) with amblyopia.

Design, Setting, and Participants  This observational case-control study enrolled patients from September 1, 2016, through May 31, 2017, and was conducted from September 1, 2016, through June 30, 2017, at the Stein Eye Institute at UCLA (University of California, Los Angeles). Participants included 59 children (<18 years) with amblyopia and without amblyopia examined at a pediatric ophthalmology clinic or referred to the clinic by coinvestigators. All patients underwent comprehensive ophthalmological examination, including visual acuity, refraction, and ocular motility tests; anterior and posterior segment examination; and OCTA.

Main Outcomes and Measures  Reduced superficial and deep retinal capillary vessel density on OCTA.

Results  Of the 63 eyes evaluated, 13 (21%) were amblyopic and 50 (79%) were control eyes. Of the 59 patients, the mean (SD) age of patients with amblyopia was 8.0 (4.0) years and 10.3 (3.3) years for the controls; 33 patients (56%) were female; and 5 of 13 (39%) and 27 of 46 (54%) patients in the amblyopic and control groups, respectively, were identified as white. The macular vessel density of the superficial capillary plexus was lower in the amblyopic group than in the control group in both 3 × 3-mm and 6 × 6-mm scans. After adjusting for age and refractive error, the mean (SD) difference in the superficial capillary plexus in the 6 × 6-mm scan was statistically significant (49.3% [4.1] vs 51.2% [2.9]; P = .02). Macular vessel density of the deep capillary plexus in the 6 × 6-mm scans was also considerably different between groups: mean (SD) vessel density of the deep retinal capillary plexus was 54.4% (4.7%) in the amblyopia group and 60.1% (3.3%) in the control group, with a difference of 5.7% (95% CI, 3.4%-8.1%; P = .002).

Conclusions and Relevance  The study found that OCTA reveals subnormal superficial and deep retinal capillary density in the macula of patients with amblyopia. Further studies are needed to determine the clinical relevance of this finding.