Retinal thickness and optic disc parameters in children with unilateral and bilateral amblyopia

Authors:Zhu Xixi, Zheng Qiaolan, Chen Jie, Chen Wuhe

Corresponding author:Chen Wuhe, Email:cwh@eye.ac.cn

Published:2026-07-10

DOI:10.3760/cma.j.cn115989-20241126-00323

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ABSTRACT 

Objective To investigate the differences in retinal layer thickness and optic disc parameters in children with unilateral and bilateral amblyopia.

Methods A cross-sectional study was conducted. Seventy-nine amblyopic children who were admitted to the Eye Hospital of Wenzhou Medical University from July 1, 2022, to January 31, 2024, were included, and 43 subjects with normal vision were included as the control group during the same period. Among the 79 amblyopic children, 39 had anisometropic amblyopia, 19 were strabismic amblyopia, and 21 had bilateral amblyopia. Retinal layer thickness and optic disc parameters of subjects were measured by spectral-domain optical coherence tomography. Differences in retinal layer thickness and optic disc parameters were compared between different types of amblyopia patients and control group, as well as unilateral and bilateral amblyopia patients. Correlation between retinal thickness, optic disc parameters, and best corrected visual acuity (BCVA) was assessed by Pearson correlation analysis. This study complied with the Declaration of Helsinki. The study protocol was reviewed and approved by the Ethics Committee of the Eye Hospital of Wenzhou Medical University (No. 2021-220-k-193). The subjects’ guardians were informed about the study and signed informed consent.

Results Compared with the control group, the retinal nerve fiber layer (RNFL) in the central fovea and parafovea in the anisometropic amblyopia group and strabismus amblyopia group were thicker, the outer plexiform layer (OPL) in the parafoveal and perifoveal regions was thicker, the superior and nasal circum papillary retinal nerve fiber layer (cpRNFL) around the optic disc was thinner, and the cup-disc area ratio, the cup-disc vertical ratio and the cup-disc horizontal ratio were smaller, with statistically significant differences (all P<0.05). There were no significant differences in retinal thickness and optic disc parameters between bilateral amblyopia group and the control group (both P>0.05). Compared with children with unilateral amblyopia, the central foveal RNFL, parafoveal OPL, perifoveal OPL were thicker, and nasal and inferior cpRNFL were thinner, and the optic cup area and optic cup volume were smaller in children with unilateral amblyopia (all P<0.05). BCVA in amblyopia children was positively correlated with the foveal RNFL thickness, the parafoveal RNFL thickness, the foveal OPL thickness, and the OPL thickness ( r=0.413, 0.186, 0.275, 0.311; all P<0.05). BCVA was negatively correlated with the cup-disc area ratio, the cup-disc vertical ratio, the cup-disc horizontal ratio, and the optic cup volume ( r=-0.362, -0.353, -0.349, -0.244; all P<0.05).

Conclusions Compared with the control group, children with unilateral amblyopia show distinct retinal morphological changes not observed in bilateral amblyopic children. There are significant differences in retinal thickness and optic disc parameters between unilateral amblyopic and bilateral amblyopia children.

KEYWORDS：

Amblyopia; Retinal thickness; Optic disc parameters

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Authors Info & Affiliations 

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References click to collapse

[1]Li Y ,Sun H ,Zhu X ,et al. Efficacy of interventions for amblyopia: a systematic review and network meta-analysis [J]. BMC Ophthalmol, 2020,20(1)∶203. DOI: 10.1186/s12886-020-01442-9.

[2]Lu L ,Li Q ,Zhang L ,et al. Altered cortical morphology of visual cortex in adults with monocular amblyopia[J]. J Magn Reson Imaging, 2019,50(5)∶1405-1412. DOI: 10.1002/jmri.26708.

[3]Barnes GR ,Li X ,Thompson B ,et al. Decreased gray matter concentration in the lateral geniculate nuclei in human amblyopes[J]. Invest Ophthalmol Vis Sci, 2010,51(3)∶1432-1438. DOI: 10.1167/iovs.09-3931.

[4]王鸽，靳雨佳，庆惠玲，等. 远视性屈光参差性弱视患者黄斑区视网膜和脉络膜血管及结构特征分析[J]. 中华实验眼科杂志， 2026,44(4)∶353-360. DOI: 10.3760/cma.j.cn115989-20250917-00304 .

Wang G , Jin YJ , Qing HL ,et al. Analysis of macular retinal and choroidal vascular and structural characteristics in patients with hyperopic anisometropic amblyopia[J]. Chin J Exp Ophthalmol, 2026,44(4)∶353-360. DOI: 10.3760/cma.j.cn115989-20250917-00304.

[5]Araki S ,Miki A ,Goto K ,et al. Macular retinal and choroidal thickness in unilateral amblyopia using swept-source optical coherence tomography[J]. BMC Ophthalmol, 2017,17(1)∶167. DOI: 10.1186/s12886-017-0559-3.

[6]Nishi T ,Ueda T ,Hasegawa T ,et al. Retinal thickness in children with an isohypermetropic amblyopia[J]. Br J Ophthalmol, 2015,99(8)∶1060-1064. DOI: 10.1136/bjophthalmol-2014-305685.

[7]Park KA ,Park DY ,Oh SY . Analysis of spectral-dom ain optical coherence tomography measurements in amblyopia: a pilot study [J]. Br J Ophthalmol, 2011,95(12)∶1700-1706. DOI: 10.1136/bjo.2010.192765.

[8]Rajavi Z ,Sabbaghi H ,Behradfar N ,et al. Macular thickness in moderate to severe amblyopia[J]. Korean J Ophthalmol, 2018,32(4)∶312-318. DOI: 10.3341/kjo.2017.0101 .

[9]Duranoglu Y . Optic nerve head topographic analysis and retinal nerve fiber layer thickness in strabismic and anisometropic amblyopia[J]. Ann Ophthalmol (Skokie), 2007,39(4)∶291-295. DOI: 10.1007/s12009-007-9014-z.

[10]Lempert P . The axial length/disc area ratio in anisometropic hyperopic amblyopia: a hypothesis for decreased unilateral vision associated with hyperopic anisometropia[J]. Ophthalmology, 2004,111(2)∶304-308. DOI: 10.1016/j.ophtha.2003.05.020.

[11]Levi DM ,Klein S . Differences in vernier discrimination for grating between strabismic and anisometropic amblyopes[J]. Invest Ophthalmol Vis Sci, 1982,23(3)∶398-407.

[12]Wong-Kee-You A ,Wei H ,Hou C . Feature counting under dichoptic viewing in anisometropic and strabismic amblyopia[J]. Transl Vis Sci Technol, 2020,9(6)∶13. DOI: 10.1167/tvst.9.6.13.

[13]王智，袁学双，费志刚，等. 脑衰反应调节蛋白2在单眼形觉剥夺性弱视大鼠视皮层的表达[J]. 中华实验眼科杂志， 2019,37(2)∶88-92. DOI: 10.3760/cma.j.issn.2095-0160.2019.02.003 .

Wang Z , Yuan XS , Fei ZG ,et al. Expression of collapsin response mediator protein 2 in visual cortex of form deprivation amblyopic rats[J]. Chin J Exp Ophthalmol, 2019,37(2)∶88-92. DOI: 10.3760/cma.j.issn.2095-0160.2019.02.003.

[14]Chen W ,Lou J ,Thorn F ,et al. Retinal microvasculature in amblyopic children and the quantitative relationship between retinal perfusion and thickness[J]. Invest Ophthalmol Vis Sci, 2019,60(4)∶1185-1191. DOI: 10.1167/iovs.18-26416.

[15]Chen W ,Xu J ,Zhou J ,et al. Thickness of retinal layers in the foveas of children with anisometropic amblyopia[J/OL]. PLoS One, 2017,12(3)∶e0174537[2025-10-26]. https://pubmed.ncbi.nlm.nih.gov/28328978/. DOI: 10.1371/journal.pone.0174537.

[16]Bruce A ,Pacey IE ,Bradbury JA ,et al. Bilateral changes in foveal structure in individuals with amblyopia[J]. Ophthalmology, 2013,120(2)∶395-403. DOI: 10.1016/j.ophtha.2012.07.088.

[17]Lekskul A ,Wuthisiri W ,Padungkiatsagul T . Evaluation of retinal structure in unilateral amblyopia using spectral domain optical coherence tomography[J]. J AAPOS, 2018,22(5)∶386-389. DOI: 10.1016/j.jaapos.2018.05.014.

[18]Nishikawa N ,Chua J ,Kawaguchi Y ,et al. Macular microvasculature and associated retinal layer thickness in pediatric amblyopia: magnification-corrected analyses[J]. Invest Ophthalmol Vis Sci, 2021,62(3)∶39. DOI: 10.1167/iovs.62.3.39.

[19]Bringmann A ,Syrbe S ,Görner K ,et al. The primate fovea: structure, function and development[J]. Prog Retin Eye Res, 2018,66：49-84. DOI: 10.1016/j.preteyeres.2018.03.006.

[20]Headon MP ,Powell TP . Cellular changes in the lateral geniculate nucleus of infant monkeys after suture of the eyelids[J]. J Anat, 1973,116(Pt 1)∶135-145.

[21]Guagliano R ,Barillà D ,Bertone C ,et al. Evaluation of macular and optic nerve head parameters in amblyopic eyes: an optical coherence tomography study[J]. Eur J Ophthalmol, 2022,32(4)∶1991-1996. DOI: 10.1177/11206721211036811.

[22]Kee SY ,Lee SY ,Lee YC . Thicknesses of the fovea and retinal nerve fiber layer in amblyopic and normal eyes in children[J]. Korean J Ophthalmol, 2006,20(3)∶177-181. DOI: 10.3341/kjo.2006.20.3.177 .

[23]Yoon SW ,Park WH ,Baek SH ,et al. Thicknesses of macular retinal layer and peripapillary retinal nerve fiber layer in patients with hyperopic anisometropic amblyopia[J]. Korean J Ophthalmol, 2005,19(1)∶62-67. DOI: 10.3341/kjo.2005.19.1.62 .

[24]Yen MY ,Cheng CY ,Wang AG . Retinal nerve fiber layer thickness in unilateral amblyopia[J]. Invest Ophthalmol Vis Sci, 2004,45(7)∶2224-2230. DOI: 10.1167/iovs.03-0297.

[25]Zhou Y ,Lai B ,Gan WB . Monocular deprivation induces dendritic spine elimination in the developing mouse visual cortex[J]. Sci Rep, 2017,7(1)∶4977. DOI: 10.1038/s41598-017-05337-6.

[26]Baldwin AS ,Hess RF . The mechanism of short-term monocular deprivation is not simple: separate effects on parallel and cross-oriented dichoptic masking[J]. Sci Rep, 2018,8(1)∶6191. DOI: 10.1038/s41598-018-24584-9.