You may have a friend or family member who has had or is currently undergoing treatment for amblyopia. Even if you don't know anyone with amblyopia, you likely have some idea that sometimes kids have to wear an eyepatch to improve the vision in their other eye. That treatment is indeed the time-honored, effective treatment of "lazy eye."
But have we learned anything since the first patch was used? How many hours are you supposed to patch? Are there other options? Do they work? How do we know?
Fortunately, visual scientists have been hard at work the last few years, giving us valuable information that can help doctors guide their patients and parents towards the best, most effective, best tolerated treatment. I have selected a few research studies to cover here. If you want more detail, follow the links provided to obtain your own copy of the studies.
Of course, (and this goes without saying, but I must say it) TALK TO YOUR DOCTOR before acting on anything written here or changing any part of your prescribed treatment. If you have questions about how this research affects your treatment, print out the study and take it with you to the next evaluation.
Now, on to the studies.........
A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years.
Pediatric Eye Disease Investigator Group, Repka MX, Kraker RT, Beck RW, Holmes JM, Cotter SA, Birch EE, Astle WF, Chandler DL, Felius J, Arnold RW, Tien DR, Glaser SR.
Arch Ophthalmol. 2008 Aug;126(8):1039-44.
Finding: Both eye drops and patching treat amblyopia, but they may not treat it completely.
Randomized trial of treatment of amblyopia in children aged 7 to 17 years.
Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA, Crouch ER Jr, Cruz OA, Davitt BV, Donahue S, Holmes JM, Lyon DW, Repka MX, Sala NA, Silbert DI, Suh DW, Tamkins SM; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2005 Apr;123(4):437-47.
Finding: Improvement can been seen in kids with amblyopia older than 6.
Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years.
Hertle RW, Scheiman MM, Beck RW, Chandler DL, Bacal DA, Birch E, Chu RH, Holmes JM, Klimek DL, Lee KA, Repka MX, Weakley DR Jr; Pediatric Eye Disease Investigator Group.
Arch Ophthalmol. 2007 May;125(5):655-9.
Finding: For most kids 7 to 12 years old, the benefits of patching become permanent.
A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors.
Pediatric Eye Disease Investigator Group.
Ophthalmology. 2003 Aug;110(8):1632-7; discussion 1637-8.
Finding: More patching may not really be better. Patients with significant amblyopia improve faster with more patching at first, but after 6 months of patching the effect is the same as with less patching.
A randomized pilot study of near activities versus non-near activities during patching therapy for amblyopia.
Holmes JM, Edwards AR, Beck RW, Arnold RW, Johnson DA, Klimek DL, Kraker RT, Lee KA, Lyon DW, Nosel ER, Repka MX, Sala NA, Silbert DI, Tamkins S; Pediatric Eye Disease Investigator Group.
J AAPOS. 2005 Apr;9(2):129-36.
Finding: Patients with amblyopia who are engaged in near activities while patching improve faster than those who do not do activities.
A randomized trial of near versus distance activities while patching for amblyopia in children aged 3 to less than 7 years.
Pediatric Eye Disease Investigator Group.
Ophthalmology. 2008 Nov;115(11):2071-8. Epub 2008 Sep 11.
Finding: Patients benefit from both distance and near activities while patching.
Risk of amblyopia recurrence after cessation of treatment.
Holmes JM, Beck RW, Kraker RT, Astle WF, Birch EE, Cole SR, Cotter SA, Donahue S, Everett DF, Hertle RW, Keech RV, Paysse E, Quinn GF, Repka MX, Scheiman MM; Pediatric Eye Disease Investigator Group.
J AAPOS. 2004 Oct;8(5):420-8.
Finding: To decrease the chance to the amblyopia getting worse after patching is stopped, tapering off the amount of patching is helpful.
The antidepressant fluoxetine restores plasticity in the adult visual cortex. Maya Vetencourt JF, Sale A, Viegi A, Baroncelli L, De Pasquale R, O'Leary OF, Castrén E, Maffei L. 2007 Jun;10(6):679-81. Epub 2007 Apr 29.
Finding: Prozac improved vision in adult amblyopic rats. This is yet more evidence that, under the right conditions, adults with amblyopia can have improved vision. As we learn more about this, eye doctors can provide more effective amblyopia treatments to adults.
So there you have it. It wasn't so bad, right? Maybe even a little bit interesting. In addition to reading these studies, I encourage you to check out the online groups Amblyopia Kids, Amblyopia Support, and Little Four Eyes. If you find any other good ones, let me know!
Nathan Bonilla-Warford, OD
Bright Eyes Family Vision Care
Located in the Westchase area of Tampa.