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A randomized trial comparing Bangerter filters and patching for the treatment of moderate amblyopia in children
1, Robert P Rutstein, Graham E Quinn
1Jaeb Center for Health Research, Tampa, FL 33647, USA
Insights
Bangerter filters offer a comparable alternative to patching for treating moderate amblyopia in children, with a lower treatment burden. This visual acuity improvement study found Bangerter filters to be a reasonable initial therapy option.
Area of Science:
- Ophthalmology
- Pediatric Optometry
Background:
- Amblyopia, or "lazy eye," is a common cause of reduced vision in children.
- Current standard treatment involves patching the stronger eye to encourage use of the amblyopic eye.
Purpose of the Study:
- To compare the effectiveness of Bangerter filters versus patching for improving visual acuity in children with moderate amblyopia.
- To assess the treatment burden associated with each therapy.
Main Methods:
- A randomized clinical trial involving 186 children aged 3-9 years with moderate amblyopia (20/40-20/80).
- Participants were randomized to receive either daily patching or Bangerter filters applied to the fellow eye's spectacle lens.
- Visual acuity was measured at 24 weeks.
Main Results:
- Average visual acuity improvement was 1.9 lines with Bangerter filters and 2.3 lines with patching.
- Similar proportions of children achieved significant visual acuity gains (> or =3 lines or > or =20/25) in both groups.
- The Bangerter filter group experienced a lower treatment burden.
Conclusions:
- Bangerter filters provide a comparable visual acuity improvement to patching for moderate amblyopia.
- Given the reduced treatment burden, Bangerter filters are a viable option for initial amblyopia therapy.
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.
