More Patch Time Repairs Amblyopia Faster, Full Study Report

Linda Roach

July 12, 2013

Residual amblyopia improves more with 6 hours of daily eye patching than it does if a 2-hour patching regimen is continued, researchers report in an article published online June 5 in Ophthalmology.

The trial results mean that pediatric ophthalmologists and optometrists now have an evidence-based, stepwise management strategy for children with moderate amblyopia resulting from anisometropia and/or strabismus, write David K. Wallace, MD, MPH, from the Duke University Eye Center, Durham, North Carolina, and colleagues.

"Amblyopia treatment may begin with spectacles alone, followed by a choice of low-dose patching, weekend atropine, or a Bangerter filter. If significant amblyopia persists, we now know that it is reasonable to increase the dose of patching therapy," they note.

The study, which was also presented April 6 at the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 39th Annual Meeting, is the latest to be published by the Pediatric Eye Disease Investigator Group (PEDIG).

Because study participants were recruited from their clinical practices, PEDIG studies have been large enough to achieve statistical significance in a series of controlled, randomized clinical trials of amblyopia therapies. Before 2002, when the first PEDIG trial's conclusions were published, treatment was based on consensus guidelines, rather than on evidence gathered in systematic clinical trials.

In the current article, the investigators said their accumulated studies of amblyopia therapy, now support the following treatment guidelines for moderate amblyopia (defined in the study as 20/40 to 20/160 in the affected eye) resulting from anisometropia, strabismus, or both:

  • Use spectacle correction until there is no further improvement.

  • If improvement is inadequate, begin treatment with 2 hours of daily patching, weekend atropine, or a Bangerter filter, to blur vision in the unaffected eye, continuing until there is no further improvement.

  • If amblyopia persists, begin eye patching for 6 hours daily until there is no further improvement. (The effectiveness of atropine and a Bangerter filter at this therapeutic stage remains unknown.)

  • Taper or halt treatment when the child reaches maximum acuity.

Clinicians should monitor the child’s progress every 6 to 10 weeks during this stepwise treatment protocol and should continue regular monitoring afterward for recurrence, the authors recommend.

However, not every child with this type of amblyopia is helped by these treatments, and research looking for ways to help them is continuing, 2 leaders in PEDIG noted in an editorial published in the April 2012 issue of Ophthalmology.

"Even when treatment is administered as part of a clinical trial...a substantial proportion of children are left with residual amblyopia. We are currently exploring the value of levodopa for such patients," write PEDIG chair Jonathan M. Holmes, BM, BCh, from the Mayo Clinic in Rochester, Minnesota, and Michael X. Repka, MD, MBA, professor of ophthalmology and pediatrics at Johns Hopkins University in Baltimore, Maryland.

The study was funded by the National Eye Institute. The authors have disclosed no relevant financial relationships. Dr. Holmes and Dr. Repka, a former PEDIG chair, are members of the steering committee for the amblyopia treatment trials. Dr. Repka also is a paid Physician Member Consultant to the American Academy of Ophthalmology, serving as its Medical Director for Governmental Affairs.

Ophthalmology. Published online June 5, 2013. Abstract

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