Early Patching More Effective in Treating Children With Amblyopia vs Extended Period of Optical Treatment

In a randomized clinical trial presented at the Association for Research in Vision and Ophthalmology Annual Meeting in New Orleans, Louisiana, researchers found that treating children with amblyopia with 3 weeks of glasses wear prior to patching had a higher level of success compared with a similar group treated with 18 weeks of glasses wear prior to patching.

Amblyopia (lazy eye) is the leading cause of decreased vision in children. Although millions of children are treated every year, the best treatment strategies for amblyopia remain unclear, according to the researchers. One management strategy involves having children wear glasses for an extended period of time before they wear patches, called extended period of optical treatment (EOT). However, EOT has never been formally compared to treatment without EOT.

In the current study, researchers stratified 334 children for type and severity of amblyopia. They compared EOT, which was defined as 18 weeks of glasses wear prior to patching (n = 170) to an early patching (EP) group, which was considered 3 weeks of glasses wear prior to patching (n = 164). The researchers electronically monitored glasses wear and patching in half the cohort. The primary outcome was success (≤ 0.200 interocular difference in logMAR visual acuity) after 12 weeks of patching, but they also looked at other definitions of success after 18 and 24 weeks as well.

The researchers found that the EP group had a higher level of success compared with the EOT group (66.7% vs 53.9%, respectively; p = 0.022). Similar outcomes were also observed after 18 weeks and 24 weeks of patching, using other definitions of success, and with imputation of missing values. Although prescribed and electronically monitored hours of patching were not significantly different between the two groups, the researchers found that younger children with less severe amblyopia had a higher likelihood of successfully responding to EOT only.

“EOT is not an effective treatment strategy for amblyopia as a whole, providing a lower success rate compared to treatment without EOT and offering no advantage in terms of visual outcomes or the amount of patching required,” the researchers concluded. “However, younger children, with less severe amblyopia are more likely to successfully respond to EOT. Hence a personalized approach to the use of EOT is recommended.”

Reference:

Proudlock FA, Hisaund M, Machonachie G, Papageorgiu E, Manouchehrinia A, Gottlob I.  A multicentre randomized trial comparing treatment for amblyopia with and without extended optical treatment. Paper presented at: The Association for Research in Vision and Ophthalmology Annual Meeting; April 23-27; New Orleans, LA. Accessed June 8, 2023. https://www.arvo.org/annual-meeting/program/online-planner/.