Part-time occlusion effective for mild to moderate amblyopia

Using part-time occlusion for at least 2 hours per day to treat mild to moderate pediatric amblyopia was as visually effective as full-time patching, a prospective, interventional case series found. However, patients with severe amblyopia had better visual performance results with a longer patching time.

Gagandeep S. Brar, MD, and colleagues looked at 100 children between the ages of 7 and 12 years; 57 subjects had anisometropic amblyopia, 25 had strabismic amblyopia and 18 had mixed unilateral amblyopia. Study results were published in the November/December issue of Indian Journal of Ophthalmology.

Patients were randomized into four groups of 25 subjects each, receiving one of four occlusion therapy time options: 2 hours, 4 hours, 6 hours or full-time.

All groups showed significant visual improvement after 18 weeks of therapy.

For mild to moderate amblyopia, with vision of 20/30 to 20/80, no significant differences in visual outcome were observed among the four groups. For severe amblyopia, with vision of 20/100 or worse, 6 hours of occlusion and full-time occlusion were significantly more effective than 2 hours of occlusion.

Mild to moderate amblyopia (best initial vision 20/30 to 20/80) in children ages 7 to 12 years can respond to part-time occlusion therapy with as little as 2 hours of patching daily. Children in the same age group with severe amblyopia may respond to 6 hours or full-time occlusion therapy. One might consider treating some children with amblyopia with occlusion therapy in the 7- to 12-year-old age group. In the past, many clinicians believed that occlusion therapy was never successful after 7 years of age. It would be nice to see if the results remain stable beyond 18 months of treatment, once occlusion therapy is discontinued.

– Rudolph Wagner, MD
OSN Pediatrics/Strabismus Section Member