In the JournalsPerspective

Increase in amount of patching for residual amblyopia improves visual acuity

An increase to 6 hours of daily patching for residual amblyopia yielded greater improvement in visual acuity than continuing with 2 hours of daily patching.

A prospective, randomized, multicenter study included 169 children between the ages of 3 years up to 8 years with stable residual amblyopia after 12 weeks of 2-hour daily patching.

Patients were randomly selected to either continue 2 hours of daily patching or increase patching to 6 hours daily.

Mean baseline logMAR best corrected visual acuity was 0.44 for all subjects.

After 10 weeks, visual acuity in the amblyopic eye improved an average of 0.5 lines in the 2-hour group and an average of 1.2 lines in the 6-hour group (P = .002). The 6-hour group yielded improvement of two lines or greater in 40% of patients compared with 18% of patients in the 2-hour group; the difference was statistically significant (P = .003).

“If significant amblyopia persists, we now know that it is reasonable to increase the dose of patching therapy,” the study authors said.

Disclosure: The study authors have no relevant financial disclosures.

An increase to 6 hours of daily patching for residual amblyopia yielded greater improvement in visual acuity than continuing with 2 hours of daily patching.

A prospective, randomized, multicenter study included 169 children between the ages of 3 years up to 8 years with stable residual amblyopia after 12 weeks of 2-hour daily patching.

Patients were randomly selected to either continue 2 hours of daily patching or increase patching to 6 hours daily.

Mean baseline logMAR best corrected visual acuity was 0.44 for all subjects.

After 10 weeks, visual acuity in the amblyopic eye improved an average of 0.5 lines in the 2-hour group and an average of 1.2 lines in the 6-hour group (P = .002). The 6-hour group yielded improvement of two lines or greater in 40% of patients compared with 18% of patients in the 2-hour group; the difference was statistically significant (P = .003).

“If significant amblyopia persists, we now know that it is reasonable to increase the dose of patching therapy,” the study authors said.

Disclosure: The study authors have no relevant financial disclosures.

    Perspective

    The initial PEDIG studies that demonstrated the effectiveness of less intense patching stimulated a great deal of discussion within the pediatric ophthalmology community. This study will likely do the same. These findings will continue to support the debate between advocates of less patching who may feel that their regimen creates less disruption of their patients’ daily routine and advocates of more aggressive patching who feel families are better served by reaching their treatment goal faster. While this study provides data to support the practice of increased patching in patients whose vision is not improving, it should be noted that the study does not answer the question about what to do with those patients who do not get better with 6 hours of patching and how full-time patching should be utilized in these patients. For a number of pediatric ophthalmologists, full-time occlusion remains the gold standard treatment for amblyopia.

    • Scott E. Olitsky, MD
    • OSN Pediatrics/Strabismus Board Member

    Disclosures: Olitsky has no relevant financial disclosures.