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Patching, atropine similarly improve anisometropic amblyopia in older pediatric patients
J AAPOS. 2008;12(5):493-497.
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Patching and atropine therapy similarly resulted in improved visual acuity at 6 months in 57 patients aged 8 to 20 years with anisometropic amblyopia.
A prospective, randomized clinical trial conducted found that patching improved visual acuity by 2.38 lines and atropine improved visual acuity by 2.34 lines. Results were achieved faster with conventional patching (3.7 months) than with atropine treatment (4.7 months).
Protocol was either full-time patching of the sound eye for 6 days followed by patching of the amblyopic eye for 1 day or administration of one drop of 1% atropine sulfate daily into the conjunctival fornix of the unaffected eye.
No patient had reduced visual acuity in the unaffected eye, redness of eyes was observed more in the atropine group than in the patching group, and there was a suggestion that near acuity may improve more in patients treated with patching.
This prospective, randomized study validates two concepts recently published by PEDIG. Amblyopia in older children will respond to therapy, and no child should be denied a trial if it was never previously tried, even in children older than traditionally considered for a positive response and particularly in anisometropic amblyopia without strabismus. It also confirms that both patching and atropine penalization work similarly, but the former works faster. Whatever will be received better by the particular child should be attempted but always in conjunction with the best optical correction. The question remains whether glasses alone would achieve the same result, and one study seems to support this. I would still add either patching or atropine, but for how long and how should treatment be tapered to sustain a long-term effect? I personally wouldn’t patch full time (at most 6 hours a day) and would not use atropine daily (twice a week has been shown as effective). I would continue treatment longer than 6 months, tapering slowly throughout a full year with continued monitoring afterward.
− Roberto Warman, MD
OSN Pediatrics/Strabismus Section Member