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A randomized trial of increasing patching for amblyopia
1, David K Wallace, Elizabeth L Lazar
1Duke University Eye Center, Durham, North Carolina.
Insights
Increasing daily patching time for children with stable residual amblyopia from 2 to 6 hours significantly improves visual acuity (VA). This enhanced patching regimen offers a greater improvement in amblyopic eye VA over 10 weeks compared to continuing 2-hour patching.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Vision Science
Background:
- Residual amblyopia can persist in children despite refractive correction and patching.
- Strabismus and anisometropia are common causes of amblyopia.
- Optimizing treatment duration is crucial for amblyopia management.
Purpose of the Study:
- To evaluate the effectiveness of increasing daily patching time from 2 to 6 hours.
- To assess visual acuity (VA) improvement in children with stable residual amblyopia.
- To compare outcomes between extended and standard patching durations.
Main Methods:
- Prospective, randomized, multicenter clinical trial.
- 169 children aged 3 to <8 years with stable residual amblyopia.
- Random assignment to 2 hours or 6 hours of daily patching for 10 weeks.
Main Results:
- The 6-hour patching group showed an average improvement of 1.2 lines in amblyopic eye VA, compared to 0.5 lines in the 2-hour group.
- A statistically significant difference in mean VA improvement (0.6 lines) favored the 6-hour group (P = 0.002).
- 40% of children in the 6-hour group achieved a 2-line or more improvement versus 18% in the 2-hour group (P = 0.003).
Conclusions:
- Increasing daily patching to 6 hours is more effective than 2 hours for improving VA in stable residual amblyopia.
- Extended patching duration offers a significant benefit when VA plateaus with standard treatment.
- This strategy provides a valuable option for enhancing visual outcomes in pediatric amblyopia.
Objective:
After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia.
Design:
Prospective, randomized, multicenter clinical trial.
Participants:
A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks.
Intervention:
Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day.
Main Outcome Measures:
Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks.
Results:
Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50(-2)). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003).
Conclusions:
When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily.
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