Simultaneous versus sequential refractive correction and occlusion therapy in treatment of amblyopia

Background: Amblyopia is a neurodevelopmental disorder of vision with various treatment modalities available for treatment. This study was conducted to compare visual outcomes and stereoacuity in sequential and simultaneous refractive correction and patching in treatment of amblyopia. Materials and methods: A prospective randomized interventional study was conducted in age group 3-14 years with unilateral mild-to-moderate amblyopia in two groups (total 70 patients, 35 each) over a period of 1 year. Group A patients underwent simultaneous treatment and Group B patients underwent sequential treatment. Follow-up data for distant and near best corrected visual acuity (BCVA) and stereopsis was taken at baseline, 1 week, 6 weeks, 9 weeks and 12 weeks. Results: At final follow-up, the mean distant BCVA in amblyopic eye was 0.35LogMAReq (SD - 0.14) and 0.33LogMAReq (SD - 0.15) in Group A and Group B, respectively, with no statistically significant difference between both groups (p = .58). At final follow-up, there was a significant improvement in mean near BCVA in amblyopic eye in both the groups (p, Group A < .01, Group B < .01) with no statistically significant difference between the two groups (p = .93). The mean stereoacuity at final follow-up was 512.3 arc secs and 165.74 arc secs in Group A and Group B, respectively. The median (IQR) stereoacuity at final follow-up was 200 (300) and 100 (137) for Group A and Group B, respectively. The difference between the two groups was statistically significant (p = .01) at 9 weeks and (p < .01) at 12 weeks. For intergroup comparison, while the difference in stereoacuity was not statistically different comparing anisometropia amblyopia subtype (p = .95), there was a statistically significant difference in stereoacuity at final follow-up for strabismic amblyopia (p = .04), with Group B having better stereoacuity. Conclusion: It is concluded that there is no significant difference between simultaneous and sequential group for BCVA, however sequential group yields better stereopsis as compared to simultaneous group.