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Wallace DK, Lazar EL, Crouch ER, et al. Time Course and Predictors of Amblyopia Improvement With 2 Hours of Daily Patching. JAMA Ophthalmol. 2015;133(5):606–609. doi:10.1001/jamaophthalmol.2015.6
For children with amblyopia secondary to strabismus and/or anisometropia, many clinicians initiate treatment with spectacles alone, if needed.1,2 When improvement of the amblyopic eye stops after a period of treatment with spectacles alone, prescription of 2 hours of daily patching is often the next step.2,3 Our purpose was to evaluate the amount and time course of amblyopia improvement with 2 hours of prescribed daily patching in children aged 3 years but younger than 8 years, and to determine predictors of improvement in visual acuity (VA) and amblyopia resolution.
Analyses were limited to children aged 3 years but younger than 8 years with strabismic and/or anisometropic amblyopia and no prior amblyopia treatment except spectacles (if needed) who participated in the run-in phase of a clinical trial (protocol at http://www.pedig.net).4 The protocol and Health Insurance Portability and Accountability Act–compliant informed consent forms were approved by the institutional review boards of all institutions involved in this multicenter study, and a parent or guardian of each participant gave written informed consent. Before enrollment, children requiring spectacles wore them for 16 weeks or more or until there was no improvement in VA of the amblyopic eye between 2 consecutive visits. At enrollment, 2 hours of daily patching was prescribed for 12 weeks or more and until there was no improvement in VA of the amblyopic eye between 2 consecutive visits at least 6 weeks apart, confirmed by a retest. We analyzed VA outcomes for 196 children who had a minimum follow-up of 11 weeks: 135 with moderate amblyopia (VA of 20/50 to 20/80 in the affected eye) and 61 with severe amblyopia (VA of 20/100 to 20/400 in the affected eye). We evaluated the relationship between improvement at best VA during the run-in phase and baseline factors of age, amblyopic-eye VA, and cause of amblyopia (strabismus, anisometropia, or both) by fitting an analysis of covariance model. We used logistic regression to evaluate the relationship between these baseline factors and achieving amblyopia resolution (amblyopic-eye VA of 20/25 or better and ≤1 line interocular difference).
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