Axial Length Dynamics and Safety of Occlusion Therapy in Pediatric Amblyopia: A Longitudinal Analysis

The purpose of this study was to evaluate the impact of occlusion therapy on the elongation of axial length in children with amblyopia using real-world big data.

A cohort of 2932 children aged 3 to 15 years undergoing occlusion therapy with varying patching durations was analyzed using longitudinal data from the Zhongshan Ophthalmic Center (May 1, 2019 to September 30, 2023). Retrospective analyses utilized multivariable linear regression to assess associations between patching duration and axial length elongation. Generalized estimating equations (GEEs) were used to evaluate interocular axial length differences. The analyses were adjusted for factors including revisit interval, age, sex, baseline best-corrected visual acuity (BCVA), initial axial length, spherical equivalent, amblyopia type, and concurrent treatments.

The mean annual axial length increase was 0.23 ± 0.22 mm. Patching had no significant overall effect on axial length elongation (β = -0.02, P = 0.12), even for long daily patching (≥5 hours/day). Subgroup analyses revealed reduced axial length elongation in patched eyes of school-age children (6-12 years) with shorter baseline axial lengths, suggesting age- and baseline-specific effects. GEE analysis showed no significant interocular differences except among preschool children (3-5 years), where the observed eyes exhibited slightly less axial length elongation compared with fellow eyes.

Occlusion therapy is safe for amblyopia management. Tailored regimens based on age and baseline ocular characteristics are recommended to optimize therapeutic outcomes.