Optometry & Visual Performance 175 Volume 14 | Issue 2 | June 2026 However, recent research indicates that older patients may benefit from treatment since the visual system’s plasticity persists into adulthood. Additionally, children and adults with amblyopia may benefit from treatment that focuses on the suppressive interactions within the visual cortex to enhance both binocular and monocular visual performance.3 Amblyopia is defined by diminished visual acuity in one or both eyes as a result of visual deprivation or aberrant interaction during vision development.7 There are three main types: strabismic, anisometropic, and deprivation.8,9 Atrophic alterations in the lateral geniculate nucleus have been observed in amblyopic eyes, leading to the hypothesis that retinal nerve fiber layer (RNFL) thickening is caused by a limitation of normal postnatal ganglionic cell reduction.10 Between the inner limiting membrane and the retinal ganglion cell layer, the RNFL is densely packed. It is made up of ganglion cell axons, astrocytes, retinal arteries, and Müller cell processes, constituting the inner limiting membrane, which covers the nerve fiber layer’s surface.11 Between roughly 18 and 30 weeks of gestation, the total population of cells in the ganglion cell layer in humans reaches its peak (2.2-2.5 million cells). The cell number rapidly decreases to 1.5 to 1.7 million cells. In the adult human optic nerve, there are 1.1 million axons.12 The RNFL thickness continues to diminish with advancing age. The assessment of the RNFL is of high significance for the identification of glaucoma, optic nerve abnormalities, and other diseases. Optical coherence tomography (OCT) can be used to assess RNFL.13 If amblyopia affects the process of postnatal reduction of ganglionic cells, RNFL thickness may be affected. Abnormal RNFL could lead to other diseases, such as glaucoma, optic neuropathies, and optic neuritis. Therefore, the purpose of this study was to find an association between amblyopia and RNFL thickness, as there are conflicting results in previous studies, and no such study has been conducted in Pakistan. This study will help us to determine the relationship between RNFL and amblyopia. Methods This study was conducted at the Orthoptics Department of Al-Shifa Trust Eye Hospital, Rawalpindi, a tertiary eye care facility. This comparative crosssectional study included patients of both genders, ages 5 to 16 years, with amblyopia. This study included strabismic and refractive (anisometropic, isometropic, and meridional) amblyopia, as well as unilateral and bilateral amblyopia. Unilateral amblyopia was characterized as a ≥two-line difference in best VA, when <20/30 in the poorer seeing eye and with presence of past or current strabismus and/or anisometropia. Bilateral amblyopia was characterized as best-corrected visual acuity (BCVA) in the two eyes <20/40 within the sight of factors that aggravated the amblyopia.14 All procedures and methods of data collection were conducted following the Declaration of Helsinki. Sample size The sample size of this study was calculated by using the WHO calculator at the confidence interval of 95%. The power of the test was 90%, and the population standard deviation was 16.2. The test value of the population mean was 107.2, and the anticipated population mean of the pilot study was 113.8. The sample size was 64. Seventy patients were included for this study. Sample selection criteria All types of amblyopia and both genders were included. Patients with any ocular pathology, such as glaucoma, optic nerve disease, cataract, or macular disease, as well as those not willing to participate, were excluded from the study. Ethical consideration Approval was given by the Ethical Review Committee at Al-Shifa Trust Eye Hospital (ERC71/AST-21) and by the head of the department of the hospital before data collection. Moreover, verbal informed consent was also taken from every individual before they participated in this study. Face and content validity was checked by circulating it to experts in the field. Confidentiality of the patient’s data was maintained, and ethical values of research were properly considered and followed at every step of the study. Data collection procedure Data collection for the study was done at the Paediatric and Diagnostic Department of Al-Shifa Trust Eye Hospital, Rawalpindi. By using the universal nonprobability sampling technique, data was collected from the patients for six months, from October 2021 to March 2022. This was done to ensure the inclusion of all patients fulfilling the study criteria during the study duration, as it would allow a more accurate analysis of the variables. A clinical Performa was used,
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