Treatment Of Moderate Amblyopia Research Articles

Two-Year Follow-up of a 6-Month Randomized Trial of Atropine Vs Patching for Treatment of Moderate Amblyopia in Children

To compare patching and atropine sulfate as treatments for moderate amblyopia in children 18 months after completion of a 6-month randomized trial. In a randomized, multicenter (47 sites) clinical trial, 419 children younger than 7 years with amblyopia (20/40 to 20/100 in the affected eye) were assigned to receive either patching or atropine eye drops for 6 months. Between 6 months and 2 years, treatment was at the discretion of the investigator. Main Outcome Measure Visual acuity in the amblyopic eye and sound eye after 2 years. At 2 years, visual acuity in the amblyopic eye improved from baseline a mean of 3.7 lines in the patching group and 3.6 lines in the atropine group. The difference in visual acuity between treatment groups was small: 0.01 logMAR (95% confidence interval, -0.02 to 0.04). In both treatment groups, the mean amblyopic eye acuity was approximately 20/32, 1.8 lines worse than the mean sound eye acuity, which was approximately 20/20. Atropine or patching for 6 months followed by best clinical care until 2 years produced similar improvement of moderate amblyopia in children between 3 and 7 years of age at enrollment. However, on average the amblyopic eye acuity was still approximately 2 lines worse than the sound eye.

In 1997, the Pediatric Eye Disease Investigator Group (PEDIG) was formed to conduct clinical research in eye disorders that affect children.1,2 The primary focus of PEDIG involves studies that can be conducted through simple protocols with limited data collection and implemented by both university-based and community-based pediatric eye care practitioners as part of their routine practice. As of October 1, 2003, 135 investigators at 97 sites in North America have participated in at least 1 PEDIG study. A major focus of PEDIG has been the evaluation of different treatment modalities for amblyopia (the Amblyopia Treatment Study). Amblyopia was selected for study because it is the most common cause of monocular visual impairment in children and young and middle-aged adults,3,4 and opinions vary on the appropriate treatment regimens. Three randomized trials have been completed thus far, and 3 trials and 2 observational studies are currently in progress. The first PEDIG amblyopia trial compared patching of the sound eye versus instillation of atropine drops in the sound eye as treatments for moderate amblyopia (20/40 to 20/100) in children 3 to 7 years old.5–9 Amblyopia was due to unequal refractive error, strabismus, or both. Atropine blurs the vision in the sound eye through its cycloplegic effect that can last, at least partially, for up to 14 days. The group of children randomized to atropine treatment received 1 drop of 1% atropine in the sound eye daily; if by 4 months acuity had not reached 20/30 or improved from baseline by ≥3 lines, then any far-sighted correction in the spectacle lens of the sound eye was removed to augment the effect of the atropine. The patching group was initially prescribed daily patching for a minimum of 6 hours up to all waking hours at investigator … Address correspondence to Graham E. Quinn, MD, MSCE, Division of Pediatric Ophthalmology, Children’s Hospital of Philadelphia, One Children’s Center, Philadelphia, PA 19104. E-mail: quinn{at}email.chop.edu

A Randomized Trial of Patching Regimens for Treatment of Moderate Amblyopia in Children

A Comparison of Atropine and Patching Treatments for Moderate Amblyopia by Patient Age, Cause of Amblyopia, Depth of Amblyopia, and Other Factors

Patching of the sound eye has been the standard approach to amblyopia in children, although patient adherence is difficult to obtain. In a multisite

The amblyopia treatment index

PurposeTo investigate Bangerter foils as an alternative method of treating amblyopia.Patients and MethodsThirty-three amblyopic children with vision of 20/60 or better in the amblyopic eye were treated with Bangerter foils. The foils were used as primary treatment in 15 patients and after initial occlusion therapy in 18 patients. The Bangerter foils were worn full-time on the spectacle lens in front of the dominant eye. The density of the foil was decreased as vision improved.ResultsThirty-one patients had good compliance. All of these achieved 20/30 vision or better in the amblyopic eye with an average of 1.4 years follow-up after cessation of treatment. Over half retained 20/20 acuity.ConclusionBangerter foils are effective for treatment of amblyopia with 20/60 or better vision. They can be used as primary treatment or as alternative treatment in cases where patching therapy is not providing further benefit.