Two-year follow-up of a randomized trial of spectacles plus alternate-day patching to treat strabismic amblyopia

Abstract

ABSTRACT.Purpose: To compare spectacles plus alternate-day patching for 8 hr or more with spectacles plus patching for 8 hr or more 6 days weekly to treat strabismic amblyopia 1 year after a 1-year randomized trial. Methods: Forty children (mean age, 4.3 years) participated. Refractive correction was provided. The children were assigned to alternate-day patching for 8 hr or more or patching for 8 hr or more daily 6 days weekly. VA, binocular function, and refractive errors were measured after 2 years. The main outcome measure was the median VA change in the amblyopic eye after 2 years. Results: The median VA change in the amblyopic eye at the 2-year visit was significantly (p = 0.0453) greater with alternate-day patching (0.8 log unit) versus patching daily 6 days weekly (0.6 log unit). The final median VA in the amblyopic eyes was 0.0 logMAR in the alternate-day patching group and 0.1 logMAR in the daily patching group. Binocular function improved with both treatments. The median spherical equivalent (SE) refractive error increased in the fellow eyes (alternate-day patching, p < 0.0001; patching daily 6 days weekly, p = 0.0033); no change was found in the amblyopic eyes in either group. Conclusions: The magnitude of the VA change 2 years after treatment with spectacles plus alternate-day patching for 8 hr or more was significantly greater than with spectacles plus daily patching for 8 hr or more 6 days weekly for strabismic amblyopia. However, the final median VA did not differ significantly between the two treatments.

Danish Rural Eye Study: the association of preschool vision screening with the prevalence of amblyopia

“…It typically affects 3% of the population, depending on the definition (Attebo et al 1998;Wang et al 2000). Early detection of amblyopia along with improvement in treatment and compliance (Agervi et al 2010(Agervi et al , 2013 has been found to be associated with a decreased prevalence of amblyopia (Kvarnstr€ om et al 1998;Eibschitz-Tsimhoni et al 2000;Williams et al 2002;Carlton et al 2008;Beauchamp et al 2010;de Koning et al 2013).…”

Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures

“…The types of amblyopia targeted in included studies ranged from childhood amblyopia [1, 11–42] to residual amblyopia in older children [43, 44], adolescents or adults [40, 41, 45, 46], unilateral [3, 12] and bilateral [3], refractive [3], anisometropic [19, 23], strabismic [24, 47], and stimulus deprivation amblyopia [48].…”

“…Interventions varied from the “gold standard” refractive correction and occlusion or atropine penalization [24, 27, 30, 31] to the more modern controversial treatments such as low-level laser [46], photic stimulation [43], and medical and behavioural treatment [45] which were more likely to be used beyond the visual maturation age when conventional treatments often fail.…”

“…The majority of studies (86%) measured visual acuity (VA) as the primary outcome measure. Variable descriptions used included improvement in VA [11, 18, 25, 28, 32, 35, 39, 45, 47], mean VA [3, 12, 13, 23, 40, 44, 48], median change in VA [23, 24], and “an increase of two or more lines of visual acuity or a final visual acuity of 20/25 or better” [20]. We identified a minority of subdomains of the outcome VA being reported by single studies such as near VA to compare it to distance visual acuity prior to amblyopia treatment [17] and “binocular VA” [39].…”

“…Seven out of 17 of the studies did not report a particular outcome measurement, however the unit was given as “seconds of arc” in six studies [11, 12, 20, 23, 28, 42]. To measure near stereoacuity, “Randot Preschool test” was reported in four studies [27, 31, 34, 45], “Frisby test” in two [26, 45], and “Lang stereo test II” in two studies [23, 24]. “Bagolini glasses at distance & near” was used in addition, to determine lower levels of binocularity in the same previous two studies by Agervi et al [23, 24].…”