A Randomized Trial of Atropine vs Patching for Treatment of Moderate Amblyopia

Repka, Michael X.; Kraker, Raymond T.; Beck, Roy W.; Holmes, Jonathan M.; Cotter, Susan A.; Birch, Eileen E.; Astle, William F.; Chandler, Danielle L.; Felius, Joost; Arnold, Robert W.; Tien, David Robbins; Glaser, Stephen R.

doi:10.1001/archopht.126.8.1039

Cited by 98 publications

(33 citation statements)

References 22 publications

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“…20 At the age 10-year outcome examination we found no difference in stereoacuity outcome between children originally treated with patching and those originally treated with atropine. 14 The results at age 15 years are similarly reassuring as they show no difference in stereoacuity by original treatment for the entire cohort as well as for subjects with no ocular deviation at age 15 years.…”

Section: Discussionmentioning

confidence: 72%

“…14 As a result, our observed amblyopic-eye visual acuity at age 15 years may be slightly biased towards better acuity. We could not identify other sources of bias to explain our findings.…”

Section: Discussionmentioning

confidence: 78%

“…3 We concluded that much of this reduction was due to persistent cycloplegia and consequently incorrect spectacle correction at the time the vision was measured. 3 Further support for this conclusion comes from the absence of a fellow-eye acuity difference by treatment group at each of the planned outcome intervals: the 2-year outcome exam, 13 the age 10-year exam, 14 and the age 15-year exam.…”

Section: Discussionmentioning

confidence: 96%

“…As we reported at age 10 years, the visual acuity outcome at age 15 years was slightly better in subjects who were 3 to <5 years old at enrollment compared with those 5 to <7 years. 14 The significant effect of younger age on treatment outcome seen at age 10 years and age 15 years could be because younger age at initiation of treatment might be advantageous if plasticity decreases with age or a shorter duration of amblyogenic insult might reduce the severity of the effect on the visual sensory system. Although, we had not observed an age relationship between age at initiation of treatment and final visual acuity at 6 months and two years after randomization in the full randomized cohort, 3, 13 a meta-analysis from 4 other PEDIG studies did find greater improvement with younger age.…”

Section: Discussionmentioning

confidence: 99%

“…13 At the next study outcome exam at age 10 years, the treatment benefit was maintained, with 46% of amblyopic eyes 20/25 or better. 14 …”

Section: Introductionmentioning

confidence: 99%

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Atropine vs Patching for Treatment of Moderate Amblyopia

Repka¹,

Kraker

Holmes

et al. 2014

JAMA Ophthalmol

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Initial treatment for amblyopia of the fellow eye with patching and atropine sulfate eyedrops improves visual acuity. Long-term data on the durability of treatment benefit are needed.OBJECTIVE To report visual acuity at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia. DESIGN, SETTING, AND PARTICIPANTSIn a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40 to 20/100) were randomly assigned to patching (minimum of 6 h/d) or atropine sulfate eyedrops, 1% (1 drop daily), for 6 months. Treatment after 6 months was at the discretion of the investigator. Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up. INTERVENTION Initial treatment with patching or atropine with subsequent treatment at investigator discretion. MAIN OUTCOMES AND MEASURES Visual acuity at 15 years of age with the electronic Early Treatment Diabetic Retinopathy Study test in amblyopic and fellow eyes. RESULTS Mean visual acuity in the amblyopic eye measured in 147 participants at 15 years of age was 0.14 logMAR (approximately 20/25); 59.9% of amblyopic eyes had visual acuity of 20/25 or better and 33.3%, 20/20 or better. Mean interocular acuity difference (IOD) at 15 years of age was 0.21 logMAR (2.1 lines); 48.3% had an IOD of 2 or more lines and 71.4%, 1 or more lines. Treatment (other than spectacles) was prescribed for 9 participants (6.1%) aged 10 to 15 years. Mean IOD was similar at examinations at 10 and 15 years of age (2.0 and 2.1 logMAR lines, respectively; P = .39). Better visual acuity at the 15-year examination was achieved in those who were younger than 5 years at the time of entry into the randomized clinical trial (mean logMAR, 0.09) compared with those aged 5 to 6 years (mean logMAR, 0.18; P < .001). When we compared subgroups based on original treatment with atropine or patching, no significant differences were observed in visual acuity of amblyopic and fellow eyes at 15 years of age (P = .44 and P = .43, respectively).CONCLUSIONS AND RELEVANCE At 15 years of age, most children treated for moderate amblyopia when younger than 7 years have good visual acuity, although mild residual amblyopia is common. The outcome is similar regardless of initial treatment with atropine or patching. The results indicate that improvement occurring with amblyopia treatment is maintained until at least 15 years of age. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00000170

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Section: Discussionmentioning

confidence: 72%

“…14 As a result, our observed amblyopic-eye visual acuity at age 15 years may be slightly biased towards better acuity. We could not identify other sources of bias to explain our findings.…”

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

“…13 At the next study outcome exam at age 10 years, the treatment benefit was maintained, with 46% of amblyopic eyes 20/25 or better. 14 …”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Atropine vs Patching for Treatment of Moderate Amblyopia

Repka¹,

Kraker

Holmes

et al. 2014

JAMA Ophthalmol

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Contrast Sensitivity Following Amblyopia Treatment in Children

Repka

Kraker²,

Beck³

et al. 2009

Arch Ophthalmol

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Comparison Between the plusoptiX and MTI Photoscreeners

Matta¹,

Arnold

Singman³

et al. 2009

Arch Ophthalmol

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Both the Medical Technology and Innovations (MTI) and plusoptiX photoscreeners are used to objectively screen for amblyogenic risk factors in children. The MTI has been extensively studied, but the limited availability of film may render it obsolete. We compared the MTI with the plusoptiX, a newer digital photoscreener, for the ability to detect amblyogenic factors when compared with a comprehensive pediatric ophthalmic examination. We believe our results will help to guide community-based vision screening programs.Methods: One hundred fifty-one children were examined consecutively in our office. Each patient was screened with the MTI and plusoptiX devices on the same day as part of a comprehensive pediatric ophthalmic examination. Results via MTI were evaluated by an expert masked examiner (R.W.A.), and the plusoptiX results were interpreted by the incorporated software.Results: Sixty-five percent of patients were found to have amblyopia or amblyogenic risk factors during the pediatric ophthalmic examination conducted via the American Association of Pediatric Ophthalmology and Strabismus referral criteria. We found the MTI photoscreener to have a sensitivity of 83.6%, specificity of 90.5%, falsepositive rate of 9.4%, false-negative rate of 16.3%, and positive predictive value of 94.2%. The plusoptiX demonstrated a sensitivity of 98.9%, specificity of 96.1%, falsepositive rate of 3.7%, false-negative rate of 1.0%, and positive predictive value of 97.9%. Conclusion:The MTI and plusoptiX photoscreeners proved to be effective when compared with a comprehensive cycloplegic pediatric ophthalmic examination. The plusoptiX, however, was found to have a higher sensitivity and specificity than the MTI.

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A Randomized Trial of Atropine vs Patching for Treatment of Moderate Amblyopia

Cited by 98 publications

References 22 publications

Atropine vs Patching for Treatment of Moderate Amblyopia

Atropine vs Patching for Treatment of Moderate Amblyopia

Contrast Sensitivity Following Amblyopia Treatment in Children

Comparison Between the plusoptiX and MTI Photoscreeners

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