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OBJECTIVE:
To evaluate the effectiveness of treatment of amblyopia in children aged
7 to 17 years. METHODS: At 49 clinical sites, 507 patients with amblyopic
eye visual acuity ranging from 20/40 to 20/400 were provided with optimal
optical correction and then randomized to a treatment group (2-6 hours per
day of prescribed patching combined with near visual activities (including study-provided GameBoy proximal video games) for all
patients plus atropine sulfate for children aged 7 to 12 years) or an optical
correction group (optical correction alone). Patients whose amblyopic eye
acuity improved 10 or more letters (> or =2 lines) by 24 weeks were considered
responders. RESULTS: In the 7- to 12-year-olds (n = 404), 53% of the treatment
group were responders compared with 25% of the optical correction group
(P<.001). In the 13- to 17-year-olds (n = 103), the responder rates were
25% and 23%, respectively, overall (adjusted P = .22) but 47% and 20%, respectively,
among patients not previously treated with patching and/or atropine for
amblyopia (adjusted P = .03). Most patients, including
responders, were left with a residual visual acuity deficit. CONCLUSIONS:
Amblyopia improves with optical correction alone in
about one fourth of patients aged 7 to 17 years, although most patients
who are initially treated with optical correction alone will require additional
treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2
to 6 hours per day of patching with near visual activities and atropine
can improve visual acuity even if the amblyopia has been previously treated.
For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with
near visual activities may improve visual acuity when amblyopia has not
been previously treated but appears to be of little
benefit if amblyopia was previously treated with patching. We do
not yet know whether visual acuity improvement will be sustained once treatment
is discontinued; therefore, conclusions regarding the long-term benefit
of treatment and the development of treatment recommendations for amblyopia
in children 7 years and older await the results of a follow-up study we
are conducting on the patients who responded to treatment.[1]
Pilot Study
PURPOSE: To determine whether amblyopia can be successfully treated in older
children and adolescents. DESIGN: Prospective, single group treatment trial.
METHODS: Sixty-six amblyopic patients aged 10 to <18 years with amblyopic
eye acuity of 20/40 to 20/160 were treated with daily patching (> or
=2 hours a day) combined with at least 1 hour of near activities. Visual
acuity was measured before and after 2 months of prescribed treatment. RESULTS:
Visual acuity improved 2 or more lines from baseline in 18 (27%) of the
66 patients (95% confidence interval, 17%-40%), and the improvement appeared
similar in 10- to <14-year-olds and 14- to <18-year-olds. CONCLUSIONS:
Amblyopia treatment can improve visual acuity in older children and adolescents.
A randomized controlled trial is needed to determine if there is an upper
age limit for which amblyopia treatment is successful.[2]
1. PEDIG, Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA,
Crouch ER, Jr., Cruz OA, Davitt BV, et al: Randomized trial of treatment
of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 2005, 123:437-447.
2. PEDIG: A prospective, pilot study of treatment of amblyopia in children
10 to <18 years old. Am J Ophthalmol 2004, 137:581-583. |
