Patching vs Atropine to Treat Amblyopia in Children Aged 7 to 12 Years: A Randomized Trial
Open accessAbstract
OBJECTIVE: To compare patching with atropine eyedrops in the treatment of moderate amblyopia (visual acuity, 20/40-20/100) in children aged 7 to 12 years. METHODS: In a randomized, multicenter clinical trial, 193 children with amblyopia were assigned to receive weekend atropine or patching of the sound eye 2 hours per day. Main Outcome Measure Masked assessment of visual acuity in the amblyopic eye using the electronic Early Treatment Diabetic Retinopathy Study testing protocol at 17 weeks. RESULTS: At 17 weeks, visual acuity had improved from baseline by an average of 7.6 letters in the atropine group and 8.6 letters in the patching group. The mean difference between groups (patching - atropine) adjusted for baseline acuity was 1.2 letters (ends of complementary 1-sided 95% confidence intervals for noninferiority, -0.7, 3.1 letters). This difference met the prespecified definition for equivalence (confidence interval <5 letters). Visual acuity in the amblyopic eye was 20/25 or better in 15 participants in the atropine group (17%) and 20 in the patching group (24%; difference, 7%; 95% confidence interval, -3% to 17%). CONCLUSIONS: Treatment with atropine or patching led to similar degrees of improvement among 7- to 12-year-olds with moderate amblyopia. About 1 in 5 achieved visual acuity of 20/25 or better in the amblyopic eye. CLINICAL RELEVANCE: Atropine and patching achieve similar results among older children with unilateral amblyopia. TRIAL REGISTRATION: (clinicaltrials.gov) Identifier: NCT00315328.
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In typically developing individuals, effectiveness of amblyopia treatment diminishes after age 7 years, although there are substantial individual differences after that period.
“In typically developing individuals, effectiveness of treatment diminishes after the age of 7 years, although there are substantial individual differences in response to treatment after that period (Scheiman et al., 2008).”
From Brain adaptation and alternative developmental trajectories (2015) · cites this paper as Scheiman et al., 2008
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Fortenbacher, D. L., Bartolini, A., Dornbos, B., & Tran, T. A. (2018) · Advances in Ophthalmology and Optometry · doi:10.1016/j.yaoo.2018.04.002 · Cited by 14 · see citing works
Chen, Y., Chen, X., Chen, J., Zheng, J., Xu, J., & Yu, X. (2015) · Current Eye Research · doi:10.3109/02713683.2015.1011280 · Cited by 14 · see citing works
Alotaibi, A. G., Fawazi, S. M., Alenazi, B. R., & Abu‐Amero, K. K. (2012) · Saudi Medical Journal · doi:10.15537/1658-3175.5527 · Cited by 13 · see citing works
Designing clinical trials for amblyopia
Holmes, J. M. (2015) · Vision Research · doi:10.1016/j.visres.2015.01.029 · Cited by 13 · see citing works
Roberts, T. L., Manny, R. E., & Anderson, H. A. (2019) · Investigative Ophthalmology & Visual Science · doi:10.1167/iovs.18-25256 · Cited by 12 · see citing works
Childhood amblyopia: A systematic review of recent management options
Alrasheed, S. H., & Aldakhil, S. (2024) · Saudi Journal of Ophthalmology · doi:10.4103/sjopt.sjopt_212_23 · Cited by 12 · see citing works
“[63] compared the effectiveness of 2 h of patching versus weekend atropine treatment for children (ages 7–12) with anisometropic and/ or strabismic amblyopia over 17 weeks.”
BackgroundEvaluation of the Aniseikonia Inspector Version 3 in School‐Aged Children
Kehler, L. A. F., Fraine, L. A., & Lu, P. (2014) · Optometry and Vision Science · doi:10.1097/opx.0000000000000245 · Cited by 12 · see citing works
Practical use and prescription of ocular medications in children and infants
Webber, A. L., & Sharwood, P. L. (2021) · Clinical and Experimental Optometry · doi:10.1080/08164622.2021.1877533 · Cited by 12 · see citing works
Jia, Y., Liu, J., Ye, Q., Zhang, S., Feng, L., Xu, Z., Zhuang, Y., He, Y., Zhou, Y., Chen, X., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.1013136 · Cited by 12 · see citing works
A computer-based anaglyphic system for the treatment of amblyopia
Rastegarpour, A., & Rastegarpour, A. (2011) · Clinical ophthalmology · doi:10.2147/opth.s25074 · Cited by 12 · see citing works
Home-based screening tools for amblyopia: a systematic review
Sii, S. S. Z., Chean, C. S., Kuht, H. J., Bunce, C., Thomas, M. G., & Rufai, S. R. (2023) · Eye · doi:10.1038/s41433-023-02412-3 · Cited by 11 · see citing works
Occlusion therapy improves phase-alignment of the cortical response in amblyopia
Kelly, J. P., Tarczy‐Hornoch, K., Herlihy, E. P., & Weiss, A. H. (2014) · Vision Research · doi:10.1016/j.visres.2014.11.014 · Cited by 11 · see citing works
Vega, L. L., Coco-Martín, M. B., Molina‐Martín, A., Cuadrado-Asensio, R., Vallelado-Álvarez, A. I., Sánchez-Tocino, H., Mayo-Íscar, A., Hernández-Rodríguez, C. J., Arenillas, J. F., & Pinero, D. P. (2024) · Scientific Reports · doi:10.1038/s41598-024-79565-y · Cited by 10 · see citing works
Milla, M., Molina‐Martín, A., & Pinero, D. P. (2022) · Children · doi:10.3390/children9071012 · Cited by 10 · see citing works
Carlton, J. (2011) · British and Irish Orthoptic Journal · doi:10.22599/bioj.35 · Cited by 10 · see citing works
Jia, Y., Ye, Q., Liu, J., Feng, L., Xu, Z., He, Y., Zhou, Y., Chen, X., Yao, Y. X., Thompson, B. S., et al. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e28857 · Cited by 9 · see citing works
“Amblyopia subtype differences that have been reported previously may have been influenced by smaller sample sizes or an interaction between amblyopia subtype and amblyopia treatment response, an effect that has been reported by some studies [50] but not others [51 – 54].”
ResultClinical Aniseikonia in Anisometropia and Amblyopia
South, J., Gao, T. Y., Collins, A., Lee, A. C.-L., Turuwhenua, J., & Black, J. M. (2020) · British and Irish Orthoptic Journal · doi:10.22599/bioj.154 · Cited by 9 · see citing works
Proportion of Refractive Errors in a Polish Immigrant Population in Chicago
Allison, C. L. (2010) · Optometry and Vision Science · doi:10.1097/opx.0b013e3181e61beb · Cited by 8 · see citing works
Paediatric Eye Services: How Much of the Workload Is Amblyopia-Related?
Stewart, C. E., Shah, S. P., Wren, S. M. E., & Roberts, C. J. (2016) · Strabismus · doi:10.1080/09273972.2016.1205102 · Cited by 8 · see citing works
Orssaud, C. (2014) · Journal Français d Ophtalmologie · doi:10.1016/j.jfo.2014.01.004 · Cited by 8 · see citing works
- Authors
- Pediatric Eye Disease Investigator Group
- Affiliations
- University of Ottawa (CA)
- Corresponding author
- Pediatric Eye Disease Investigator Group
- Venue
- Archives of Ophthalmology
- Publisher
- American Medical Association (AMA)
- Published
- 2008-12-08
- Volume
- 126
- Issue
- 12
- Pages
- 1634
- ISSN
- 0003-9950 (ISSN-L)
- PMC
- PMC2846774
- OpenAlex
- W97765374
- Cited by
- 182
- References
- 7
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 16 · 2021: 12 · 2020: 10 · 2019: 10 · 2018: 13 · 2017: 7 · 2016: 11 · 2015: 11 · 2014: 9 · 2013: 10 · 2012: 6
- FWCI
- 8.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Eye Institute (EY011751, U10EY011751, UG1EY011751)
- Topics
- Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Keywords
- amblyopia, occlusion therapy, patching, atropine, atropine eye drops, visual acuity, children, unilateral amblyopia, non-inferiority, treatment equivalence
- MeSH terms
- Amblyopia, Atropine, Child, Female, Humans, Male, Mydriatics, Ophthalmic Solutions, Sensory Deprivation, Visual Acuity, Vision, Binocular, Treatment Outcome
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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