Atropine penalisation versus occlusion as the primary treatment for amblyopia. Comparative efficacy of penalization methods in moderate to mild amblyopia. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years. A combined therapy using stimulating auricular acupoints enhances lower-level atropine eyedrops when used for myopia control in school-aged children evaluated by a pilot randomized controlled clinical trial. Treatment of anisometropic amblyopia with spectacles or in combination with translucent Bangerter filters. Objectively monitored patching regimens for treatment of amblyopia: randomised trial. Evaluation of the CAM treatment for amblyopia: a controlled study. A randomized trial of near versus distance activities while patching for amblyopia in children aged 3 to less than 7 years.
Pharmacological penalisation of non-amblyopic eyes is an infrequently used alternative to occlusion for treating amblyopia. The authors compared the efficacy of atropine penalisation and that of occlusion as a primary treatment for amblyopia.
                Thirty six newly diagnosed patients with amblyopia were allocated to two groups for treatment. Eighteen patients in each group were treated either with atropine penalisation (group A) or occlusion therapy (group P).
                There was a statistically significant improvement in visual acuity in both groups treated. In group A improvement of the geometric mean visual acuity of the amblyopic eye was from 6/50 to 6/11 (p < 0.001). In group P improvement of the geometric mean visual acuity was from 6/60 to 6/19 (p < 0.001). In group A non-compliance with treatment was only 6% (2/18). Non-compliance in group P was 45% (8/18) at some stages of the treatment. Neither group produced an incidence of occlusion amblyopia.
                In this study atropine penalisation has been shown to be as effective as occlusion therapy in the treatment of amblyopia. Patient acceptance of atropine penalisation was superior to that for occlusion therapy as was shown by the compliance rate. Atropine treatment was also advantageous in that compliance could be readily checked by inspection. To compare the efficacy and sensory outcome of pharmacologic and optical penalization in the treatment of moderate to mild amblyopia.
                Randomized clinical trial.
                In an institutional setting, two- to 10-year-old children with strabismic or anisometropic amblyopia (visual acuity in the amblyopic eye at least 20/60) who were cooperative to measure visual acuity using the logarithm of the minimum angle of resolution (logMAR) crowded Glasgow acuity cards were randomized into two groups of therapy (n=35 in each group), 1% atropine, and optical penalization with positive lenses, after stratification by cause of amblyopia. Visual acuity was tested by the logMAR crowded Glasgow acuity cards, after retinoscopic refraction, and deviation angle were measured by the simultaneous prism and cover or Krimsky test. Stereoacuity was determined using the Titmus fly test and Randot preschool or Randot circles stereoacuity test. Change in visual acuity of the amblyopic eye and in interocular difference of visual acuity after six months of amblyopia therapy was the main outcome measure; stereoacuity at six months of therapy was a secondary outcome measure.
                Thirty-one and 32 children completed the outcome examination in the atropine and optical penalization group, respectively. Average improvement in visual acuity of the amblyopic eye was larger in the atropine than in the optical penalization group (3.4 and 1.8 logMAR lines, respectively), as well as average improvement in interocular difference of visual acuity (2.8 and 1.3 logMAR lines, respectively). Better stereoacuity, but nonsignificantly different, was detected in the atropine group.
                Atropine penalization may be considered more effective than optical penalization with positive lenses. To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years.
                At 49 clinical sites, 507 patients with amblyopic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then randomized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (> or =2 lines) by 24 weeks were considered responders.
                In the 7- to 12-year-olds (n = 404), 53% of the treatment group were responders compared with 25% of the optical correction group (P<.001). In the 13- to 17-year-olds (n = 103), the responder rates were 25% and 23%, respectively, overall (adjusted P = .22) but 47% and 20%, respectively, among patients not previously treated with patching and/or atropine for amblyopia (adjusted P = .03). Most patients, including responders, were left with a residual visual acuity deficit.
                Amblyopia improves with optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acuity when amblyopia has not been previously treated but appears to be of little benefit if amblyopia was previously treated with patching. We do not yet know whether visual acuity improvement will be sustained once treatment is discontinued; therefore, conclusions regarding the long-term benefit of treatment and the development of treatment recommendations for amblyopia in children 7 years and older await the results of a follow-up study we are conducting on the patients who responded to treatment. To assess the stability of visual acuity improvement during the first year after cessation of amblyopia treatment other than spectacle wear in children aged 7 to 12 years.
                At the completion of a multicenter randomized trial during which amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving treatment (other than spectacle wear) for 1 year.
                Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following treatment discontinuation.
                During the year following cessation of treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting treatment.
                Visual acuity improvement occurring during amblyopia treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing treatment other than spectacle wear.
                ClinicalTrials.gov identifier: NCT00094692. This study was designed to compare the reduction in myopia progression in patients treated with atropine eyedrops alone with patients treated with a combined treatment of atropine and stimulation of the auricular acupoints.
                This study was a randomized single-blind clinical controlled trial. A total of 71 school-aged children with myopia, who fulfilled the eligibility criteria, were recruited. They were randomly assigned into three groups. These were 22 treated with the 0.25% atropine (0.25A) only, 23 treated with the 0.5% atropine (0.5A) only and 26 treated with 0.25% atropine together with stimulation of the auricular acupoints (0.25A+E). The differences in the post-treatment effects among these three groups were statistically assessed. The primary outcome parameter was myopia progression, which was defined as diopter change per year (D/Y) after cycloplegic refraction measurement.
                The mean myopia progression of the 0.25A group was 0.38+/-0.32 D/Y. No significant difference in mean myopia progression was found between the 0.5A (0.15+/-0.15 D/Y) and 0.25A+E (0.21+/-0.23 D/Y) groups. However, there was a markedly reduced myopia progression in the 0.25A+E group compared to the 0.25A group (p<0.05). Furthermore, there was no statistical difference among these three groups in axial length elongation (ALE) of eye during this stage of the investigation.
                This study demonstrates that there was efficacy in stimulating the auricular acupoints and this enhanced the action of 0.25% atropine as a means of myopia control. The result was an effect almost equal to that of 0.5% atropine alone. There is also a need that the ALE of the eye should be further investigated over a longer period using the combined therapy. To compare spectacle correction alone with spectacle correction with Bangerter filters to treat anisometropic amblyopia in children.
                Prospective, randomized clinical trial.
                Eighty children (mean age, 4.4 years) with untreated anisometropic amblyopia and a median best-corrected visual acuity (BCVA) in the amblyopic eye of 0.4 logarithm of the minimum angle of resolution (logMAR).
                Optimal refractive correction was provided, and the children were assigned to treatment with either spectacles or spectacles in combination with a Bangerter filter worn on the spectacle lens of the better eye. The BCVA, binocular function, and refractive errors were measured repeatedly over the course of 1 year.
                The time course to resolution of the amblyopia (interocular difference, < or =1 line).
                The difference in the mean time to the resolution of amblyopia was 3.9+/-3.2 months for the spectacles group versus 2.2+/-1.9 months for the filter group, and the difference reached significance (P<0.05). The BCVA in the amblyopic eye improved significantly (P<0.001 for both comparisons) in both groups. After 1 year, there was no significant difference in the BCVA between the groups. The binocular function improved in both groups; at 1 year there was no significant difference between the groups. The median spherical equivalent refractive error increased significantly during the study in the amblyopic eyes (P<0.05) and the fellow eyes (P<0.001). The median anisometropia decreased significantly from the first visit to the 1-year visit in both groups (P<0.001 for both comparisons).
                We found a more rapid visual acuity recovery with the Bangerter filters than with spectacles alone in eyes with anisometropic amblyopia. However, the 1-year visual acuity outcome was not statistically significantly different between the 2 treatments. To compare visual outcome in response to two prescribed rates of occlusion (six hours a day and 12 hours a day).
                Unmasked randomised trial.
                Research clinics in two London hospitals.
                97 children with a confirmed diagnosis of amblyopia associated with strabismus, anisometropia, or both.
                18 week period of wearing glasses (refractive adaptation) followed by occlusion prescribed ("patching") for six or 12 hours a day.
                Visual acuity measured by logMAR letter recognition; objectively monitored rate of occlusion (hours a day).
                The mean age of children at study entry was 5.6 (SD 1.5) years. Ninety were eligible for occlusion but 10 dropped out in this phase, leaving 80 children who were randomised to a prescribed dose rate of six (n=40) or 12 (n=40) hours a day. The mean change in visual acuity of the amblyopic eye was not significantly different (P=0.64) between the two groups (0.26 (95% confidence interval 0.21 to 0.31) log units in six hour group; 0.24 (0.19 to 0.29) log units in 12 hour group). The mean dose rates (hours a day) actually received, however, were also not significantly different (4.2 (3.7 to 4.7) in six hour group v 6.2 (5.1 to 7.3) in 12 hour group; P=0.06). The visual outcome was similar for those children who received three to six hours a day or more than six to 12 hours a day, but significantly better than that in children who received less than three hours a day. Children aged under 4 required significantly less occlusion than older children. Visual outcome was not influenced by type of amblyopia.
                Substantial (six hours a day) and maximal (12 hours a day) prescribed occlusion results in similar visual outcome. On average, the occlusion dose received in the maximal group was only 50% more than in the substantial group and in both groups was much less than that prescribed. Younger children required the least occlusion.
                Clinical Trials NCT00274664. Single letter and linear acuity (near and distance) and contrast sensitivity were measured in 15 amblyopes (ages 5 to 12) before, during, and after four weekly 7 min sessions of CAM treatment. Six of the children, however, played games over a homogeneous grey disc having the same space-averaged luminance as that of the striped stimuli. Experimental and controls results were indistinguishable. In a few subjects from both groups, contrast sensitivity and slight linear acuity improvement was observed. We conclude that these vision changes can be attributed to the short-term occlusion experienced by all subjects during treatment and that grating stimulation did not contribute to this improvement. To determine whether performing near activities while patching for amblyopia enhances improvement in visual acuity.
                Randomized clinical trial.
                A total of 425 children, aged 3 to <7 years, with amblyopia (20/40-20/400) that was caused by anisometropia, strabismus, or both, and that persisted after treatment with spectacles.
                Children were randomized to 2 hours of patching per day with near activities or 2 hours of patching per day with distance activities. Instruction sheets describing common near and distance activities were given to the parents. Study visits were scheduled at 2, 5, 8, and 17 weeks. In weeks without a visit, weekly telephone calls were made to the parent to monitor and encourage compliance during the first 8 weeks.
                Masked assessment of visual acuity by isolated crowded HOTV optotypes at 8 weeks.
                At 8 weeks, improvement in amblyopic eye visual acuity averaged 2.6 lines in the distance activities group and 2.5 lines in the near activities group (mean difference in acuity between groups, adjusted for baseline acuity, 0.0 lines 95% confidence interval, -0.3 to 0.3). The 2 groups also appeared statistically similar at the 2-, 5-, and 17-week visits. At the 17-week examination, children with severe amblyopia improved a mean of 3.6 lines with 2 hours of daily patching.
                Performing common near activities does not improve visual acuity outcome when treating anisometropic, strabismic, or combined amblyopia with 2 hours of daily patching. Children with severe amblyopia may respond to 2 hours of daily patching.
Both conventional occlusion and atropine penalization produce visual acuity improvement in the amblyopic eye. Atropine penalization appears to be as effective as conventional occlusion, although the magnitude of improvement differed among the three trials. Atropine penalization can be used as first line treatment for amblyopia.