Patching found effective in older children

Children up to 17 years of age can benefit from patching therapy for the treatment of amblyopia, according to a large nationwide study. Prior to this study there had been no consensus on whether older children with amblyopia could benefit from patching, researchers noted.

In children older than 13 years who had been previously treated for amblyopia with patching, little benefit was seen, but in patients in this age group not previously treated there was a “strong suggestion of improvement,” the researchers said.

Members of the Pediatric Eye Disease Investigator Group studied the efficacy of patching for amblyopia in 507 children ranging in age from 7 to 17 years, including 103 children between 13 and 17 years old. Visual acuity in the patients ranged from 20/40 to 20/400; all children were provided with optimal optical correction and then randomized to a treatment group. Most patients had moderate to high degrees of hyperopia in the amblyopic eye.

The patients were randomly assigned to either new prescription glasses only or to the new glasses prescription plus patching therapy for 2 to 6 hours daily. Children in the 7- to 12-year-old range received atropine in addition to patching. The children were also asked to perform near vision activities.

Successful vision improvement was defined as the ability to read at least two more lines on a standard eye chart in the eye with amblyopia after treatment completion.

In preparation for conducting the randomized trial, the study group performed a pilot study in 66 patients between 10 and 17 years old to estimate the response rate to treatment with part-time patching combined with near visual activities.

In that preliminary study, the researchers “found improvement in visual acuity of two or more lines in 27% of patients,” they reported in the April issue of Archives of Ophthalmology.

In the randomized study, 53% of the 7-to-12 year old children who received both glasses and treatment with patches and near activity had vision improved by at least two lines. Only 25% of children in that age group who received glasses alone had vision improved by at least two lines.

In 47% of the children between 13 and 17 who had not been previously treated for amblyopia but were prescribed glasses, patching and near activity work, VA improved by at least two lines. Twenty percent of those treated with glasses alone improved by that amount.

“Despite the benefits of the treatment, most children, including those who responded to treatment, were left with some visual impairment,” according to a National Eye Institute press release on the study. NEI funds were used to support the study.

It is not known whether vision improvement will be sustained in the children once treatment is discontinued, according to the NEI. A follow-up study to assess the long-term benefits in these older children is planned.