Risk of amblyopia recurrence after cessation of treatment.

Abstract

BACKGROUND:

Although amblyopia can be successfully treated with patching or atropine, there have been few prospective studies of amblyopia recurrence once treatment is discontinued.

METHODS:

We enrolled 156 children with successfully treated anisometropic or strabismic amblyopia (145 completed follow-up), who were younger than 8 years of age and who received continuous amblyopia treatment for the previous 3 months (prescribed at least 2 hours of daily patching or prescribed at least one drop of atropine per week) and who had improved at least 3 logMAR levels during the period of continuous treatment. Patients were followed off treatment for 52 weeks to assess recurrence of amblyopia, defined as a 2 or more logMAR level reduction of visual acuity from enrollment, confirmed by a second examination. Recurrence was also considered to have occurred if treatment was restarted because of a nonreplicated 2 or more logMAR level reduction of visual acuity.

RESULTS:

Recurrence occurred in 35 (24%) of 145 cases (95% confidence interval 17% to 32%) and was similar in patients who stopped patching (25%) and in patients who stopped atropine (21%). In patients treated with moderately intense patching (6 to 8 hours per day), recurrence was more common (11 of 26; 42%) when treatment was not reduced prior to cessation than when treatment was reduced to 2 hours per day prior to cessation (3 of 22; 14%, odds ratio 4.4, 95% confidence interval 1.0 to 18.7).

CONCLUSIONS:

Approximately one fourth of successfully treated amblyopic children experience a recurrence within the first year off treatment. For patients treated with 6 or more hours of daily patching, our data suggest that the risk of recurrence is greater when patching is stopped abruptly rather than when it is reduced to 2 hours per day prior to cessation. A randomized clinical trial of no weaning versus weaning in successfully-treated amblyopia is warranted to confirm these observational findings.

• Authors: Jonathan M Holmes, Roy W Beck, Raymond T Kraker, William F Astle, Eileen E Birch, Stephen R Cole, Susan A Cotter, Sean Donahue, Donald F Everett, Richard W Hertle, Ronald V Keech, Evelyn Paysse, Graham F Quinn, Michael X Repka, Mitchell M Scheiman, Pediatric Eye Disease Investigator Group
• Journal: Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus (J AAPOS) Vol. 8 Issue 5 Pg. 420-8 (Oct 2004) ISSN: 1091-8531 [Print] United States
• PMID: 15492733 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Mydriatics
• Atropine

Topics

• Amblyopia (etiology, therapy)
• Atropine (therapeutic use)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Humans
• Male
• Mydriatics (therapeutic use)
• Prospective Studies
• Recurrence
• Risk Factors
• Sensory Deprivation
• Visual Acuity
• Withholding Treatment