title: Against-the-rule (ATR) astigmatism as a predicting factor for the outcome of amblyopia treatment.
abstract: OBJECTIVE
  To evaluate whether with-the-rule (WTR) or against-the-rule (ATR) astigmatism influences the treatment outcome of anisometropic amblyopia.
  
  
  METHODS
  A cohort study.
  
  
  METHODS
  Retrospective study of patients with unilateral amblyopia due to anisometropia without strabismus. Ninety-eight patients with simple, compound, mixed, oblique myopic, and hyperopic astigmatism were divided into seven groups based on the type of astigmatism. The groups were reviewed as to the amount of anisometropia, duration of occlusion, and best-corrected visual acuity (BCVA) before and after treatment.
  
  
  RESULTS
  There was statistically significant longer duration of occlusion and less lines gain of BCVA among patients with hyperopic ATR astigmatism compared with patients with hyperopic WTR astigmatism (P =.0143 and P =.0000, respectively) and myopic ATR patients compared with myopic WTR patients (P =.0392 and P =.0192, respectively). For the same parameters, group differences were also statistically significant when all hyperopic or myopic simple/compound/mixed ATR patients were compared with all hyperopic or myopic simple/compound/mixed WTR patients (P =.0015 and P =.0000, respectively).
  
  
  CONCLUSIONS
  The outcome of amblyopia treatment seems to be less favorable in patients with either hyperopic or myopic ATR astigmatism. Near vision impairment may be more amblyogenic than distance vision impairment during visual development.
authors.affiliation: Ankara Education and Research Hospital, Ankara, Turkey. dsomer@mc.metu.edu.tr
authors.forename: Deniz
authors.initials: D
authors.lastname: Somer
authors.forename: Koray
authors.initials: K
authors.lastname: Budak
authors.forename: Saniye
authors.initials: S
authors.lastname: Demirci
authors.forename: Sunay
authors.initials: S
authors.lastname: Duman
mesh_terms: D000550:Amblyopia / Q000209:etiology / Q000628:therapy*; D015858:Anisometropia / Q000150:complications; D001251:Astigmatism / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005139:Eyeglasses; D006801:Humans; D006956:Hyperopia / Q000150:complications; D009216:Myopia / Q000150:complications; D012189:Retrospective Studies; D012683:Sensory Deprivation; D016896:Treatment Outcome