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Stepwise approach recommended for treating amblyopia
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ATLANTA – After reviewing the results of numerous Amblyopia Treatment Studies conducted by the Pediatric Eye Disease Investigator Group, presenter Zachary McCarty, OD, recommended to SECO attendees an evidence-based stepwise approach to treating children with moderate amblyopia due to anisometropia or strabismus.
First, prescribe glasses and follow the patient every 6 to 10 weeks until you no longer see improvement, he said.
Once there is no improvement, patch for 2 hours a day with the same follow-up schedule.
“Keep patching as long as the patient is improving,” McCarty said.
If these results level off, increase the patching to 6 hours per day until no further improvement.
“When maximum acuity is achieved, taper or stop treatment and monitor for amblyopia recurrence,” he said.
McCarty also discussed atropine use.
The Amblyopia Treatment Study-1 (ATS-1) found that “improvement was almost identical” with 6 hours of daily patching when compared with atropine, he said.
ATS-4 found that both study groups improved about 2 lines when daily atropine was compared to weekend atropine, McCarty said, but it is important to consider potential side effects of atropine.
McCarty compared “dogma vs. evidence-based treatment.”
“We found out that our mainstay of treatment, occlusion, can still be used, but you can consider atropine, and you don’t have to prescribe glasses and start patching at the same time,” he said. “And if you patch, you don’t have to do it full-time. If the amblyopia is severe, do it 6 hours a day; for moderate amblyopia, 2 hours of patching is better than atropine.”
The next study being planned by the Pediatric Eye Disease Investigator Group will evaluate the use of video games vs. placebo, he said.
“Anecdotal evidence says patching and video game play may improve vision,” McCarty said. – by Nancy Hemphill, ELS