Blue filter amblyopia treatment protocol for strabismic amblyopia: a prospective comparative study of 50 cases

Previous studies of monochromatic visual evoked potentials confirm the strong suppression of (the cortical representation of) paracentral retinal areas of functionally amblyopic eyes, by a flat response to a blue stimulus. A clinical trial stimulating these areas with blue light was encouraging, and justified a prospective comparison of this treatment with conventional classic treatment.

In 50 strabismic children with amblyopia, the blue filter treatment protocol (flash stimulation with, and the wearing of, a blue filter during occlusion of the better eye for one hour daily) was compared with the classical treatment (full time total occlusion by patch) in a prospective matched and randomized study. Patients 3 to 7 years old without previous treatment and a visual acuity up to 0.3 were admitted to the study. Visual acuity and fixation behavior were used as the parameters of comparison. Visual Evoked Potentials by monochromatic flashes were also studied. Results of treatment were compared after 6 months.

The visual acuity outcome for the blue filter treatment was "statistically significantly" better (p=0.005). The greatest improvement was seen in the subgroup of children with eccentric fixation (p=0.01). Fixation behavior also showed a better outcome from the blue filter treatment (p=0.05) favoring especially children between 3 and 5 years. In children of this age with a visual acuity better than 0.1 we found a very "statistically significant" difference between the two treatments (p=0.004). In children 3 to 5 years old with poorer visual acuity we also found a "statistically significant" difference in the two treatments (p=0.04). The interocular difference of amplitude on the Visual Evoked Potentials also demonstrated more improvement in children treated with the blue filter. This treatment improved especially the cortical response to blue flash stimulation, correlating to paracentral retinal areas.

The blue filter treatment protocol provided better results for treating amblyopia than the conventional classic occlusion treatment method. We propose that stimulation of these paracentral retinal areas triggers a better disinhibition of a functionally amblyopic eye.