The Amblyopia Treatment Essay

Nevertheless, after treatment with glasses and two-hours patching, patients usually experience residual amblyopia. Hence, If amblyopia is still present and no improvement in vision is seen with initial patching, treatment choices include maintaining the two-hours patching, increasing the dose of the patching or switching to another treatment. (10) Increasing the patching dosage is the most common choice, but whether this approach is effective is unknown. (10) This study was done to evaluate the effectiveness of increased prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. (8)
Methodology
First, Children who did not finish twelve weeks of two-hours of daily patching with stable visual acuity were enrolled into a run-in phase. Hence, these patients were treated with two hours of daily patching with follow-ups every six weeks until no improvement was noted in their vision. Amblyopic children aged three to eight years with strabismus, anisometropia, or both were included in this study. Treatment of amblyopia with two-hours of daily patching for twelve weeks, with stable visual acuity at two visits at least six weeks apart. Moreover, best amblyopic eye visual acuity of 20/40 to 20/160 with an interocular difference of 2 lines.
Nevertheless, follow-ups included a primary outcome examination at 10+-1 weeks after the initial visit and additional visits every 10+-1 weeks until there was no improvement in the visual acuity of at least one line.
At each visit, visual acuity (VA) was measured in each eye using the Amblyopia Treatment Study-HOTV protocol. Ocular alignment was also measured with a simultaneous prism and cover test, and stereoacuity was measured with the Randot Preschool Stereoacuity Test at randomization and each follow-up visit.
Results
At the 10-week primary outcome visit, amblyopic eye VA improved from randomization by an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group. The treatment group difference in mean VA after 10 weeks, was 0.6 line (2-sided 95% confidence interval [CI], +0.3 to +1.0 line P=0.002) which was better in the 6- hour group. The difference in the treatment group in the mean interocular difference after 10 weeks was 0.5 line (2-sided 95% CI, +0.1 to +1.0 line P=0.01), which was also better in the 6- hour group. Interestingly, amblyopia cause and degree of amblyopic eye spherical equivalent at baseline did not affect the results of the primary outcome analysis. Moreover, the best visual acuity after randomization at the 10-week primary outcome or any subsequent visit improved by an average of 1.5 lines from randomization in the 6-hour group and 0.9 line in the 2-hour group (treatment group difference adjusted for baseline visual acuity +0.5 line 2-sided 95% CI, +0.04 to +1.0 line).
However, Randot Preschool Stereoacuity results did not differ between the treatment groups at the 10- week primary outcome relative to randomization for the overall cohort (P = 0.28).
In conclusion, improvement of two or more lines occurred in 40% of participants patched for six hours rather than 18% of those who continued to patch for two hours (P=0.003).