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Amblyopia in children (aged 7 years or less)
Stephanie West1, Cathy Williams
1Southampton General Hospital, Southampton, UK.
Insights
This systematic overview evaluated medical treatments for amblyopia, a vision disorder in children. It categorized the efficacy of glasses, occlusion, and atropine penalization for improving visual acuity.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Evidence-Based Medicine
Background:
- Amblyopia, or 'lazy eye,' is reduced visual acuity in children under 7, often linked to strabismus or unequal refractive errors.
- Affecting 2-4% of young children, amblyopia requires timely intervention during critical visual development periods.
- Early detection and treatment are crucial for preventing long-term visual impairment.
Purpose of the Study:
- To systematically review the clinical effectiveness and safety of medical treatments for amblyopia in children aged 7 years or less.
- To provide an evidence-based overview of interventions including glasses, occlusion therapy, and atropine penalization.
- To answer the clinical question regarding the effects of medical treatments for early-onset amblyopia.
Main Methods:
- A systematic overview of medical literature was conducted, searching major databases up to January 2014.
- Included studies were screened for relevance, with 14 full publications evaluated for inclusion.
- GRADE methodology was used to assess the quality of evidence for nine PICO (Population, Intervention, Comparison, Outcome) combinations.
Main Results:
- The review identified and evaluated existing systematic reviews and added new randomized controlled trials (RCTs) and follow-up studies.
- Data from 70 retrieved studies were screened, with 14 full articles undergoing detailed appraisal.
- The efficacy of three primary interventions was assessed based on the available evidence.
Conclusions:
- The study categorized the efficacy of glasses, occlusion, and atropine penalization for treating amblyopia in young children.
- Evidence on the effectiveness and safety of these interventions was synthesized to inform clinical practice.
- This overview provides a categorized assessment of key medical treatments for pediatric amblyopia.
Introduction:
Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7-8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years.
Methods And Outcomes:
We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for amblyopia in children aged 7 years or less? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
Results:
At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 14 full publications. Of the 14 full articles evaluated, two systematic reviews were updated and three RCTs and two follow-up studies were added at this update. We performed a GRADE evaluation for nine PICO combinations.
Conclusions:
In this systematic overview we categorised the efficacy for three interventions, based on information about the effectiveness and safety of glasses, occlusion, or penalisation with atropine.
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