Marshall Parks Lecture
Amblyopia Treatment Outcomes

Presented at the American Academy of Ophthalmology, November, 2003, Anaheim, CA. The Fourth Annual Marshall M. Parks Lecture.
https://doi.org/10.1016/j.jaapos.2004.12.003Get rights and content

Purpose: To determine the effectiveness and side effects of full-time occlusion for the treatment of amblyopia. Methods: Patients with unilateral amblyopia secondary to strabismus, anisometropia, or a combination of the two were retrospective reviewed. All patients had full-time occlusion encompassing 24 hours per day or all waking hours, followed to a defined endpoint. Success was defined as 20/30 or better or equal visual acuity by fixation pattern between the two eyes. The ultimate goal was equal visual acuity. Results: Six hundred patients fit the inclusion criteria. Mean follow-up after the cessation of full-time patching was 7.2 years. Eighty-nine percent were followed for more than 1 year. Mean age at last follow-up visit was 10.82 years. Ninety-six percent of patients attained a successful visual result. Sixty percent attained equal visual acuity. Younger patients required less occlusion time to endpoint and had a better visual outcome (P < 0.0001). Initial visual acuity was significantly related to best visual acuity attained (P < 0.0001). The incidence of occlusion amblyopia was 25.8%. Conclusions: Full-time occlusion produces excellent visual acuity results. It was shown to be effective with no long-term complications if patients proceed as directed.

Section snippets

Methods

The charts of 1541 patients seen at the University of Iowa Hospitals and Clinics Pediatric Ophthalmology clinic between the years 1970 and 2000 with the diagnosis of amblyopia were retrospectively reviewed. IRB review in compliance with HIPAA regulations was obtained. The reasons for exclusion from the study are listed in Table 1. Patients described as “too old” were those whose parents determined that visual demands precluded compliance.

All patients included in this study had amblyopia caused

Results

Six hundred patients met the inclusion criteria. Four hundred thirty-nine had strabismic (S), 56 anisometropic (A), and 105 combination (C) amblyopia. Descriptions of the types of strabismus and anisometropia are listed in Table 2.

The type of visual acuity test used to determine amblyopia at the onset of treatment and to determine best visual acuity is listed in Table 3. At the initiation of FTO, 317 patients had measurable visual acuity as shown in Figure 1.

The age treatment was started,

Discussion

The study by Flynn and coworkers3 retrospectively reviewed 23 studies in the literature from 1965 to 1994, reporting outcomes of amblyopia occlusion treatment in a total of 961 patients. Various methods of occlusion were used and vision of 20/40 or greater was found in 74.3% of patients, 50% 20/30 or better, and 16% 20/20 or better. In contrast, the current study found 97% achieved 20/40 or better following full-time occlusion, 96% 20/30 or better, and 50% 20/20 or better.

The ATS14 enrolled

References (6)

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    A greater degree of anisometropia and possibly a poorer initial visual acuity were also associated with a relatively poor visual outcome. The anisometropic amblyopia treatment success rate of 58% falls within the range of 47%–95% cited in previous literature.9-14 Similar to previous studies,15,16 in 31% of subjects, amblyopia was resolved through refractive treatment alone.

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    Occlusion amblyopia, or the development of amblyopia in the originally better-seeing, patched eye, is a risk commonly cited by opponents of FTO. Although the incidence of occlusion amblyopia in children treated with FTO is admittedly significant (19.3%,16 25.8%,14), it is almost always reversible.12 Furthermore, after cessation of treatment, the final interocular difference in visual acuity was actually less in children with a history of occlusion amblyopia, suggesting that occlusion amblyopia can herald a better visual potential in the initially amblyopic eye.14,16

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    Thirty-nine percent of children in the daily patching group and 45% of children in the alternate-patching group had anisometropia of ≥4 D. Other studies have reported successful amblyopia treatment in 19% to 96% of patients,15,29–31 the wide range is probably due to differences in defining treatment outcomes, patient selection, treatment modalities, and follow-up periods. Studies by the PEDIG reported a mean of 2.4 lines of improvement from baseline to 4 months and a mean VA of 0.24 logMAR at 4 months in both groups in children with moderate amblyopia treated with 2 versus 6 hours of daily patching.10

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