A prospective pilot study of treatment outcomes for amblyopia associated with myopic anisometropia

To determine the efficacy of refractive correction alone and patching treatment with near activities on amblyopia associated with myopic anisometropia in children aged 4 to less than 14 years. The associations of visual acuity (VA) improvement with age,degree of anisometropia, patching compliance, presence of strabismus, and presence of eccentric fixation were also investigated.

Seventeen amblyopic children were recruited(range of VA in the amblyopic eye, 20/80 to 20/400). Visual acuity was assessed at 4, 8, 12, and 16 weeks while participants wore spectacles and/or contact lenses for full refractive correction. Patching treatment was initiate dat the 16-week visit. The primary outcome was VA after 16 weeks of refractive correction alone and final VA after 16 weeks of patching.

The mean (SD) baseline VA in the amblyopiceye was 0.96 (0.27) logMAR, which improved to a mean(SD) of 0.84 (0.24) logMAR with refractive correction and to a mean (SD) of 0.71 (0.30) logMAR after the addition of patching (P.001). Comparing the final VA with the baseline VA, we found that VA improvement averaged 2.59 lines. The final VA in the amblyopic eye was associated with the baseline VA in the amblyopic eye(P.001), the magnitude of anisometropia (P.001),and the level of patching compliance (P=.04). The improvement in VA with patching was inversely associated with participants' age (P=.03) and presence of eccentric fixation (P=.02).

Both refractive correction and patching significantly improved the VA of the amblyopic eye associated with myopic anisometropia, with 88% of participants' eyes improving 2 lines or more. Further improvement in VA was observed when patching plus near activities was added to refractive correction and patients were followed for 16 more weeks. We recommend that clinicians treat myopic anisometropic amblyopia with refractive correction and patching plus near activities.