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Near activities combined with occlusion, refractive correction may be better treatment option for strabismic amblyopia
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Combining occlusion and refractive correction with near activities may be more effective than occlusion and refractive correction alone for treating strabismic amblyopia, according to a meta-analysis published in the Cochrane Database of Systematic Reviews.
However, "further study of the role of near activities is necessary before a more definitive conclusion can be made. Results of a full trial are expected within the coming year," the authors said. "No [randomized controlled trials] were found that assessed the role of either partial occlusion or optical penalization to refractive correction for strabismic amblyopia."
Study authors Kate Shotton and Sue Elliot searched the CENTRAL, MEDLINE, EMBASE and LILACS databases to identify randomized controlled trials evaluating the efficacy of different methods for treating strabismic amblyopia among patients of all ages. Specifically, the systematic review assessed the efficacy of conventional occlusion therapy, partial occlusion and optical penalization for treating the disorder.
From the search, the researchers identified two studies that reported mean logMAR visual acuities achieved among patients aged between 3 and 7 years. These two studies had different comparison groups, the authors noted.
In the larger study, 39 of 180 patients were diagnosed with moderate or severe amblyopia with strabismus. These participants were randomly assigned to receive either spectacle correction only or 2 hours of daily occlusion and spectacle correction for 5 weeks. The researchers in this study found that occlusion with refractive correction was more effective than refractive correction alone.
There was a statistically significant average difference in visual acuity of –0.18 logMAR between the two treatment groups. However, because the results of this trial were reported after 5 weeks of treatment, "reported acuities are unlikely to reflect optimal treatment effect but rather show the difference between the two treatments at the 5-week outcome," the authors said.
The second study included in the review — a pilot study — included 20 of 64 strabismic amblyopic patients who were randomly assigned to receive 2 hours of daily occlusion with near or non-near activities for 4 weeks. The researchers found that supplementing occlusion therapy with near activities produced better average visual outcomes compared with patients instructed to carry out non-near activities.
The average difference in visual acuity between the groups was –0.17 logMAR. "However, this data is from a pilot study, and the full data set will be added to updates of the review when available," the authors said.