No abstract

No abstract

To compare patching and atropine as treatments for moderate amblyopia in children younger than 7 years. Methods: In a randomized clinical trial, 419 children younger than 7 years with amblyopia and visual acuity in the range of 20/40 to 20/100 were assigned to receive either patching or atropine at 47 clinical sites. Main Outcome Measure: Visual acuity in the amblyopic eye and sound eye after 6 months. Results: Visual acuity in the amblyopic eye improved in both groups (improvement from baseline to 6 months was 3.16 lines in the patching group and 2.84 lines in the atropine group). Improvement was initially faster in the patching group, but after 6 months, the difference in visual acuity between treatment groups was small and clinically inconsequential (mean difference at 6 months, 0.034 logMAR units; 95% confidence interval, 0.005-0.064 logMAR units). The 6-month acuity was 20/30 or better in the amblyopic eye and/or improved from baseline by 3 or more lines in 79% of the patching group and 74% of the atropine group. Both treatments were well tolerated, although atropine had a slightly higher degree of acceptability on a parental questionnaire. More patients in the atropine group than in the patching group had reduced acuity in the sound eye at 6 months, but this did not persist with further follow-up. Conclusion: Atropine and patching produce improvement of similar magnitude, and both are appropriate modalities for the initial treatment of moderate amblyopia in children aged 3 to less than 7 years.

Purpose-To determine the amount and time course of binocular visual acuity improvement during treatment of bilateral refractive amblyopia in children age 3 to <10 years old Design-Prospective, multicenter noncomparative interventionMethods-113 children (mean age = 5.1 years) with previously untreated bilateral refractive amblyopia were enrolled at 27 community-and university-based sites and were provided optimal spectacle correction. Bilateral refractive amblyopia was defined as 20/40 to 20/400 best-corrected binocular acuity in the presence of ≥ 4.00 D hypermetropia by spherical equivalent and/or ≥ 2.00 D astigmatism in each eye. Best-corrected binocular and monocular visual acuities were measured at baseline and at 5, 13, 26 and 52 weeks. The primary study outcome was binocular acuity at one year.Results-Mean binocular visual acuity improved from 0.50 logMAR (20/63) at baseline to 0.11 logMAR (20/25) at one year (mean improvement 3.9 lines, 95% confidence interval [CI] = 3.5 to 4.2). Mean improvement at one year for the 84 children with baseline binocular acuity of 20/40 to 20/80 was 3.4 lines (95% CI = 3.2 to 3.7) and for the 16 children with baseline binocular acuity of 20/100 to 20/320 was 6.3 lines (95% CI = 5.1 to 7.5). The cumulative probability of binocular acuity of 20/25 or better was 21% at 5 weeks, 46% at 13 weeks, 59% at 26 weeks, and 74% at 52 weeks.Conclusions-Treatment of bilateral refractive amblyopia with spectacle correction improves binocular visual acuity in children age 3 to <10 years old, with most improving to 20/25 or better within one year.

Background: Previous studies have suggested that infant photoscreening yields better results than visual acuity screening in preschool-aged children. With conventional vision screening, the patient must be able to provide monocular visual acuity cooperation, whereas objective screening for amblyogenic factors can be done at much younger ages.Methods: From February 1996 through February 2006, Alaska Blind Child Discovery photoscreened 21 367 rural and urban Alaskan children through grade 2, with an 82% positive predictive value (ie, true number of those referred); 6.9% were referred for a complete eye examination and treatment. All "referred" interpreted images for children younger than 48 months who were then followed up and treated for more than 2 years were reviewed to determine whether treatment was successful.Results: Of 411 "positive" screening photos from chil-dren younger than 4 years, 94 patients had more than 2 years follow-up. The 36 children photoscreened before age 2 years had a mean treated visual acuity of 0.17 logarithm of the minimum angle of resolution (log-MAR), which was significantly better than that of 58 children screened between ages 25 and 48 months (mean, 0.26 logMAR). Despite similar levels of amblyogenic risk factors, the proportion of children failing to reach a visual acuity of 20/40 was significantly less among those screened before age 2 years (5%) than in those screened from ages older than 2.0 years and younger than 4.0 years (17%). Conclusion:Very early photoscreening yields better visual outcomes in amblyopia treatment compared with later photoscreening in preschool-aged children.