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Treatment of Moderate Amblyopia: Atropine Drops vs. Patching

Atropine drops are as effective as eye patches and may be more acceptable to children.

Patching of the sound eye has been the standard approach to amblyopia in children, although patient adherence is difficult to obtain. In a multisite U.S. trial, 419 children younger than 7 years (mean age, 5.3 years) with mild amblyopia (visual acuity, 20/40 to 20/100 in the amblyopic eye) were assigned to blocking of vision in the sound eye with either patching (from 6 hours/day to all waking hours) or atropine drops (twice a day). Both patching and atropine drops were titrated based on improvement in vision during follow-up.

Patients in the patching group improved before those in the atropine group did, but by 6 months, the difference in mean visual acuity between the groups was clinically inconsequential. Six-month visual acuity, the primary outcome, was 20/30 or better in the amblyopic eye (or improved from baseline by 3 or more lines) in 79% of the patching group and in 74% of the atropine group. The differences between groups were unrelated to patient age, cause of amblyopia, or baseline acuity. Parents rated atropine drops as causing fewer adverse effects, less social stigma, and better adherence compared with patching. At 6 months, more patients in the atropine group (14%) than in the patching group (7%) had reduced visual acuity in the sound eye, but this did not persist.

Comment: Although most pediatricians refer young children with strabismus or decreased visual acuity to ophthalmologists, these findings help us know what to say to parents. Patching and atropine drops appear to be equally effective, so parents and ophthalmologists must determine which treatment is best for each child.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 16, 2002

Citation(s):

The Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2002 Mar; 120:268-78.

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