Outcome of Amblyopia Treatment Better with Younger Age of Child

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Children who are younger when treated for amblyopia (commonly known as lazy eye) have a better response, according to a meta-analysis of previous studies published in the Archives of Ophthalmology, one of the JAMA/Archives journals.

Amblyopia is the most common cause of visual impairment in childhood, affecting approximately 2 to 3 out of every 100 children. It occurs when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. Amblyopia is commonly called lazy eye.

Treating amblyopia involves making the child use the eye with the reduced vision (weaker eye). Currently, there are two ways used to do this: atropine or patching. Both treatments are meant to stimulate vision in the weaker eye and help the part of the brain that manages vision develop more completely.

When atropine is used, a drop of the drug is placed in the stronger eye once a day to temporarily blur the vision so that the child will prefer to use the weaker eye with amblyopia.

Patching involves use of an opaque, adhesive patch worn over the stronger eye for weeks to months. This therapy forces the child to use the eye with amblyopia.

As there is some evidence that amblyopia treatment is effective in some older children, Jonathan M. Holmes, B.M., B.Ch., of the Mayo Clinic, Rochester, Minn. and the Jaeb Center for Health Research, Tampa, and colleagues wanted to determine whether age at initiation of treatment influences the response among children 3 to less than 13 years of age.

Holmes and colleagues conducted a meta-analysis of four previous randomized multicenter clinical trials for treatment of amblyopia, conducted by the Pediatric Eye Disease Investigator Group (PEDIG). The meta-analysis included data from 996 children who were 3 years to less than 13 years of age.

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These four trials were specifically chosen because all 4 protocols required stability of amblyopic eye visual acuity in spectacles prior to enrollment, defined as at least 4 weeks of stable visual acuity or 16 weeks of spectacle wear.

The treatment protocols were (1) patching 2 hours per day with near or distance activities for children 3 to less than 7 years of age, (2) treatment with atropine with or without a plano lens for children 3 to less than 7 years of age, (3) treatment with atropine or patching 2 hours per day for children 7 to less than 13 years of age, and (4) use of Bangerter filter or patching 2 hours per day for children 3 to less than 10 years of age.

Based on analysis of visual acuity change versus age by amblyopia severity at the time of enrollment in the study, the authors found there was improvement in visual acuity across all age ranges (from 3 to

Children from 7 to less than 13 years of age were significantly less responsive to treatment than were younger age groups (children from 3 to

There was no difference in treatment response between children 3 to less than 5 years of age and children 5 to less than 7 years of age for moderate amblyopia (P = .67), but there was a suggestion of greater responsiveness in children 3 to less than 5 years of age compared with children 5 to less than 7 years of age for severe amblyopia (P = .09).

Image credit: NEI Health

Sources
J. M. Holmes, E. L. Lazar, B. M. Melia, W. F. Astle, L. R. Dagi, S. P. Donahue, M. G. Frazier, R. W. Hertle, M. X. Repka, G. E. Quinn, K. K. Weise. Effect of Age on Response to Amblyopia Treatment in Children. Archives of Ophthalmology, 2011; DOI: 10.1001/archophthalmol.2011.179

National Eye Institute: Amblyopia

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