Damian McNamara

April 22, 2013

Boston, Massachusetts — Getting some children with amblyopia to wear an eye patch 6 hours a day vs 2 may sound like a challenge, but if parents can encourage this, the payoff can be a significant improvement at 10 weeks.

David Wallace, MD, from Duke University in Durham, North Carolina, presented new findings on behalf of the Pediatric Eye Disease Investigator (PEDI) group here at the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 39th Annual Meeting.

Dr. Wallace's team tested the strategy in 167 children whose amblyopia failed to improve after 12 weeks of 2 hours daily prescribed eye patching. The stable residual amblyopia in participants ranged from 20/32 to 20/160.

After the initial 12-week or more run-in period, researchers assessed any improvement in visual acuity at 10 weeks between the children randomly assigned to continue the 2-hour protocol vs those prescribed the patch for 6 hours per day.

Researchers discovered more improvement in visual acuity with the more intense patching protocol, supporting the utility of this strategy as one option among children with residual amblyopia.

Table. Change in Visual Acuity at 10 Weeks

Outcome 2-hour Patch 6-hour Patch P Value
Mean change from randomization (lines) 0.5 1.2 .003
≥2 lines improvement (%) 19 40 .004

 

Most of the 146 children in this study experienced clinically meaningful improvement in their amblyopic eye visual acuity — for example, 75% improved 2 lines or more — by wearing eyeglasses alone.

"This is really useful data from PEDI because it's everyday stuff," session discussant Alistair Fielder, MD, from City University, London, United Kingdom, said after the presentation at the meeting.

"There are 2 different conclusions: first, if after 2-hour patching for 12 weeks you have stable residual amblyopia, you can increase to 6 hours and get further improvement." In addition, "Instead of starting with 2 hours and increasing, you could say if we want to achieve the optimum outcome in the shortest possible time, let's start with a higher dose in the first place," Dr. Fielder said.

What if children still have mild amblyopia after a protocol of 6-hour daily patching? PEDI investigators have already tried to answer this question (Arch Ophthalmol. 2011;129:960-962).

They found that among 27 children who stopped improving with the more intensive patching or daily atropine drops, 10 weeks of a more intense combination of the 2 therapies did not significantly improve visual acuity compared with a control group of children who had interventions gradually tapered.

According to a previous PEDI multicenter study, corrective spectacles might be the appropriate initial strategy for children aged 3 to less than 7 years with strabismus or combined strabismic-anisometropic amblyopia (Ophthalmology. 2012;119:150-158).

Consistent and early wearing of glasses works best for children with bilateral amblyopia, according to an AAPOS amblyopia fact sheet.

Early means early — the fact sheet says children as young as 1 week old can wear corrective eyeglasses or contact lenses. For children with asymmetric amblyopia, eye glasses may be insufficient; prescribed patching or eye drops may be added to force the brain to process images from the weaker eye.

Dr. Fielder says his team plans to present new research at the upcoming Association for Research in Vision and Ophthalmology (ARVO) meeting in Seattle, Washington, that will evaluate the factors associated with patch compliance and noncompliance among children with amblyopia.

Among the findings, he said during an interview, is a drop in compliance on weekends, suggesting counseling should stress the importance of wearing the patch 7 days a week.

Medscape Medical News will be onsite reporting from this meeting.

No matter how many hours of daily patching are prescribed, careful counseling about the importance of compliance is warranted. The AAPOS fact sheet points out that many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, neighbors, teachers, and so forth. "Children will often throw a temper tantrum, but then they eventually learn not to remove the patch. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period."

Dr. Wallace and Dr. Fielder have disclosed no relevant financial relationships.

American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 39th Annual Meeting. Abstract 25. Presented April 6, 2013.

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