A randomized trial comparing Bangerter filters and patching for the treatment of moderate amblyopia in children.

Abstract

OBJECTIVE:

To determine whether visual acuity improvement with Bangerter filters is similar to improvement with patching as initial therapy for children with moderate amblyopia.

DESIGN:

Randomized, clinical trial.

PARTICIPANTS:

We enrolled 186 children, 3 to <10 years old, with moderate amblyopia (20/40-20/80).

METHODS:

Children were randomly assigned to receive either daily patching or to use a Bangerter filter on the spectacle lens in front of the fellow eye. Study visits were scheduled at 6, 12, 18, and 24 weeks.

MAIN OUTCOME MEASURES:

Visual acuity in amblyopic eyes at 24 weeks.

RESULTS:

At 24 weeks, amblyopic eye improvement averaged 1.9 lines in the Bangerter group and 2.3 lines in the patching group (difference in mean visual acuities between groups adjusted for baseline acuity = 0.38 line). The upper limit of a 1-sided 95% confidence interval was 0.76 line, which slightly exceeded a prespecified noninferiority limit of <0.75 line. Similar percentages of subjects in each group improved > or =3 lines (Bangerter group 38% vs patching group 35%; P = 0.61) or had > or =20/25 amblyopic eye acuity (36% vs 31%, respectively; P = 0.86). There was a lower treatment burden in the Bangerter group as measured with the Amblyopia Treatment Index. With Bangerter filters, neither a fixation switch to the amblyopic eye nor induced blurring in the fellow eye to worse than that of the amblyopic eye was required for visual acuity improvement.

CONCLUSIONS:

Because the average difference in visual acuity improvement between Bangerter filters and patching was less than half a line, and there was lower burden of treatment on the child and family, Bangerter filter treatment is a reasonable option to consider for initial treatment of moderate amblyopia.

• Authors: Pediatric Eye Disease Investigator Group Writing Committee, Robert P Rutstein, Graham E Quinn, Elizabeth L Lazar, Roy W Beck, Dean J Bonsall, Susan A Cotter, Eric R Crouch, Jonathan M Holmes, Darren L Hoover, David A Leske, Ingryd J Lorenzana, Michael X Repka, Donny W Suh
• Journal: Ophthalmology (Ophthalmology) Vol. 117 Issue 5 Pg. 998-1004.e6 (May 2010) ISSN: 1549-4713 [Electronic] United States
• PMID: 20163869 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Topics

• Amblyopia (physiopathology, therapy)
• Child
• Child, Preschool
• Eyeglasses
• Female
• Humans
• Male
• Occlusive Dressings
• Sensory Deprivation
• Treatment Outcome
• Visual Acuity (physiology)