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Refractive correction alone may resolve strabismic and combined-mechanism amblyopia
Ophthalmology. 2012;119(1):150-158.
Treatment of strabismic and combined-mechanism amblyopia with spectacles alone yielded significant improvement in visual acuity without additional treatment in a vast majority of patients, a study found.
"Improvement occurred whether or not the spectacles improve ocular alignment," the study authors said. "Consideration should be given to prescribing refractive correction as the sole initial treatment for children with strabismic or combined-mechanism amblyopia before initiating other therapy."
The prospective, multicenter cohort study included 146 children aged 3 years to less than 7 years, 52 with previously untreated strabismic amblyopia and 94 with combined-mechanism amblyopia.
Spectacle prescriptions were based on cycloplegic refraction. Spectacles were worn for the first time at the baseline visit. Investigators used the HOTV protocol to measure visual acuity at baseline and subsequently every 9 weeks until no further improvement could be gained.
Follow-up examinations were undertaken at 9 weeks and 18 weeks after the baseline visit. The 18-week visit was designated as the primary outcome visit. The primary outcome measure was visual acuity 18 weeks after baseline.
Study results showed a mean improvement of 2.6 lines in amblyopic eye visual acuity at 18 weeks. Vision improved by two or more lines in 97 children (75%) and by three or more lines in 70 children (54%). Amblyopia resolved in 41 children (32%).
Overall treatment improved strabismic myopia by 3.2 lines and combined-mechanism amblyopia by 2.3 lines; the between-group difference was statistically significant (P = .003).
Visual acuity improved whether or not eye alignment improved, the authors said.