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New Amblyopia Therapy – Take a Pill Cure the Lazy Eye

by

L. E. Leguire Ph.D., MBA

One of the hardest and most difficult therapies for children with a vision problem is associated with amblyopia, commonly known as lazy eye.   If you can’t see out of one eye, the lazy eye, the main therapy is to place a patch on the good eye so you really can’t see.  Now, live like this for a month or two and then return to the eye doctor.  As one young boy proclaimed: Are you going to torture me any more?  He was referring to wearing the eye patch over his good eye for the treatment and cure of his lazy eye.  As an analogy, imagine breaking your right arm. The treatment would be to place a plaster cast on your left arm and force you to use only the broken arm – ouch!  This seems an appropriate analogy for what happens in patching therapy for lazy eye.  What even makes matters worse, patching therapy for lazy eye has been the same, more-or-less, for over 200 years!  Isn’t it about time for a change?  Indeed it is.

A group of pediatric eye doctors, called the PEDIG group, is about to start a multi-center, national clinical trial on the use of a certain drug to augment patching therapy for lazy eye.  The drug, L-dopa, has been used for 40 years or so to treat patients with Parkinson’s disease.  For the past 15 years, small pilot studies have been undertaken at Nationwide Children’s hospital in Columbus Ohio on the use of L-dopa to augment patching therapy in older amblyopic children when regular patching therapy was of limited success in these children¹.  These studies, many of which have been replicated around the world, have shown that L-dopa helps improve vision in the amblyopic eye when combined with part-time patching therapy of three hours per day.  Over the course of seven weeks, L-dopa plus part-time occlusion (patching) helped the recovery of vision in the amblyopic eye more than patching alone or L-dopa alone.  After seven, weeks, children had improved about two lines on the visual acuity chart, about a 33% improvement.  The L-dopa plus occlusion therapy also helped to improve the ability of the two eyes to combine or “fuse” the image from each eye into a single unified image.  The studies also showed that the L-dopa was well tolerated in the children and lead to minor side effects like stomach upset, mostly on initial dosing.

The drug has also been found to work almost immediately – temporarily improving vision by about one line of the visual acuity chart one hour after dosing.  The belief is that if one can improve vision by even a little bit that the amblyopic child would be more likely to leave the patch on his/her good eye and thus help with the patching therapy.

While there is a lot of work ahead in determining if this area of research bears fruit; additional research may show that this or other drugs could facilitate patching therapy and speed the permanent recovery of vision in amblyopic children.  Who knows, one day the treatment of lazy eye may only involve taking a medicine combined with a short time of patching therapy.  Let’s hope the research pans out.

1.  Research undertaken by Dr. Leguire and colleagues at Nationwide Children's Hospital, Department of Ophthalmology, ED 459, Columbus, OH 43205

For additional information on this topic, see: http://www.ohiolionseyeresearch.com/L-dopa.htm