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Recent Advances in Amblyopia Treatment

by

Richard Liston, MD

Ophthalmology Medical Director

Ohio Amblyope Registry

Your child has just been diagnosed with amblyopia. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself may appear normal, but it is not being used normally because the brain is favoring the other eye.

You are understandably concerned. You have many questions. “Can my child’s vision be improved?” “What treatment is most effective?” “How will amblyopia treatment affect my child?”

New Treatment Regimens for Amblyopia

Full time patching of the better-seeing eye (all waking hours) has been a mainstay of amblyopia treatment for many years. Although this patching treatment is generally very successful, children often find the recommended patching daily duration difficult. For example, children are often embarrassed to wear their patch in public. Also, when adhesive “skin patches” (which look like a large “Band-Aid”) are used, skin reactions may occur. Further, a child’s depth perception is reduced when their patch is in place. Although parents can often encourage their child to overcome these difficulties, patching a child’s eye for the treatment of amblyopia can be a difficult experience for the child and family.

Recent research has shown that many children with amblyopia may improve with less intensive treatment (i.e., less hours) than were previously recommended. These alternate treatment options have shown to be nearly as effective as the previous “gold standard” treatment of full time skin adhesive patching of the better-seeing eye. These newer treatment options are summarized below. Please note that the children in the following studies were all less than 7 years of age. It is more difficult to improve the vision of older children and may require more aggressive treatment (i.e., more hours of patching per day).

Moderate amblyopia (visual acuity from 20/40 to 20/80 in children less than age 7)

In children with moderate amblyopia, patching 2 hours per day is as effective as patching 6 hours per day when combined with one hour of near visual activities (e.g., video game play) while patching.[1]

Daily, long-lasting dilating eye drops (atropine) instilled in the better-seeing eye are nearly as effective as daily patching. However, when compared to patching, the use of dilating eye drops may increase the chance of a decrease in visual acuity of the better-seeing, non-amblyopic eye.[2] A recent study found that using the dilating drops only on weekends is as effective as daily administration.[3]

Severe amblyopia (visual acuity between 20/100 and 20/400 in children less than age 7)

In children with severe amblyopia, patching 6 hours per day was found to be as effective as patching full time (i.e, all day) when the patching was combined with one hour of near visual activities.[4]

If your child does not improve with the less intensive treatment regimens (e.g., 2 hours per day) described above, your doctor may recommend more aggressive treatment (i.e., more hours of patching).

Other Recent Amblyopia Studies

Amblyopia treatment in older children (age 7 to 17)

Successful amblyopia treatment is more likely when amblyopia is detected in early childhood (less than 7 years of age). Previously, many eye doctors believed that patching treatment was not felt to be effective in older children. However, a recent study of amblyopia treatment in older children (between ages 7 and 17 years) found that some improvement may occur in about half of children ages 7 to 12 years and in about a quarter of children ages 13 to 17. Please note that most of these children were left with some loss of vision in the amblyopic eye despite some improvement in their vision with treatment.

Recurrence of amblyopia after successful treatment

A recent study confirmed what doctors have long suspected: As many as 25% of amblyopic children whose vision was successfully improved with treatment experienced a recurrence of the amblyopia when treatment was discontinued. In children with more aggressive treatment regimens (6 or more hours of patching daily), the recurrence rate was even higher (40%) when the treatment was stopped abruptly. These children may benefit from gradually “weaning” treatment.[5] In other words, amblyopic children who are being patched 6 hours or more per day may benefit from the gradual reduction of patching hours/day, say from 6 to 4 to 2 to no patching versus stopping patching suddenly. All children who undergo amblyopia treatment should be followed closely by their eye doctor for the possibility of recurrence.

Summary

Today, more treatment options are available for children with amblyopia. Many of these treatment options are more acceptable to children (and their parents) and are still quite effective. Your doctor will discuss these treatment options with you and help you select the best treatment for your child. Don’t be afraid to ask questions.

Finally, don’t forget that all the hard work is worth the effort. Most young children (and even some older children) who follow their doctors' recommended treatment are rewarded with improved vision.

For more information about the amblyopia studies discussed by Dr. Liston, please visit the NEI-NIH news page on this web site.