• amblyopia
• atropine
• occlusion therapy

The evidence base for amblyopia treatments is not well developed.^1,2 A study by Tan et al in this issue of the BJO (p 291) documents differences in amblyopia treatments between the UK and Germany, Switzerland, and Austria (“German speaking countries”). A recent study from the United States also showed significant differences in treatments between centres.³

What gaps in our evidence base for amblyopia treatment does the study by Tan et al expose?

The upper age limit for treatment of newly diagnosed cases was significantly higher in German speaking countries than in the United Kingdom. Our knowledge of the responsiveness to treatment of each type of amblyopia in each age group is limited.^4–7

The dose of part time occlusion therapy prescribed was significantly greater in German speaking countries than in the UK. There were also differences in the circumstances in which full time occlusion was prescribed. When treatment failed, occlusion treatment was discontinued at a younger age in the UK than in German speaking countries. Only limited studies of occlusion dose-response have been published.^8,9

Spectacles alone, in place of spectacles plus occlusion, were used more widely in the UK than in German speaking countries for the initial treatment of severe anisometropic amblyopia. Only limited studies of spectacles only treatment of amblyopia are available in the literature at present.¹⁰ In addition, the therapeutic effects of spectacle wear may …