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Using various treatments together is best method for strabismus, physician says
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BUENOS AIRES — The combination of occlusion and atropine is the best method for treating pediatric strabismus, a surgeon said here.
 Vincent Paris |
"Our position is not to choose between occlusion, optical penalization and pharmacological penalization, but take it all together as standard procedure," Vincent Paris, MD, said at the Argentinean Society of Ophthalmology Annual Course.
Dr. Paris showed a 95% success rate in two studies using the combination therapy; the most common reason for failure was noncompliance with penalization.
An initial problem in the first study was an excess of dose-response occlusion, he said, which was lessened in the second study. The adaptation was if a child was younger than 2 years old, they were occluded for 30 hours; younger than 3 years, for 50 hours; younger than 4 years, for 100 hours; and older than 4 years, for 130 hours to 200 hours. Dr. Paris also said that in severe strabismic amblyopia cases, there is a consistent efficacy plateau for occlusion of 100 hours to 150 hours.
Other issues revealed by the research were frames that permitted cheating, relative emmetropia in the dominant eye and latent underestimated hyperopia that decreased the penalization effect.
In the second study, the occlusion timetable was adopted, and systematic atropine during the 3- to 12-week time period was implemented to create an unconditional reflex in children who required the use of their glasses, Dr. Paris said.
Therefore, children were not permitted to use metal frames, and atropine 1% was given once every 2 days, depending on the compliance of the child.
"It's important to give a conditional reflex to a young child. It's possible to do, and it's also the best method to reveal latent hyperopia in some cases," Dr. Paris said.
To avoid recurrence, Dr. Paris said ophthalmologists should maintain overcorrection of +2.5 D over a course of 2 years, check latent hyperopia, repeat cycloplegia after 7 or 8 months, maintain careful follow-up after terminating atropine and give the parents repeated explanations for the course of action.