From the Guidelines
Amblyopia treatment should begin as early as possible, ideally before age 7, with the primary approach involving correction of underlying refractive errors with glasses, followed by patching or atropine eye drops to force use of the weaker eye. The most recent and highest quality study 1 suggests that treatment of moderate amblyopia with 2 hours of daily patching or weekend atropine can improve visual acuity in most children. Key findings from this study include:
- VA ≥20/30 and/or improved by ≥3 lines in 79% of occlusion group and 74% of atropine group
- VA improved in both groups: 3.7 lines in occlusion group; 3.6 lines in atropine group
- Mean difference = 0.01 lines (95% CI, −0.02 to 0.04) Another study 1 highlights the importance of treating refractive error alone to improve visual acuity in children with anisometropic, strabismic, or combined amblyopia. For patching therapy, covering the stronger eye for 2-6 hours daily, with the duration depending on amblyopia severity, is recommended 1. Alternatively, atropine 1% eye drops can be applied to the stronger eye once daily to blur vision and encourage use of the amblyopic eye. Treatment typically continues for months, with regular follow-up appointments every 6-12 weeks to monitor progress 1. Vision therapy exercises may supplement these treatments to improve binocular function. Consistent adherence to the prescribed regimen is crucial for successful outcomes.
From the FDA Drug Label
Atropine Sulfate Ophthalmic Solution, 1% is indicated for: ... 1.3 Penalization of the healthy eye in the treatment of amblyopia In individuals from three (3) months of age or greater, 1 drop topically to the cul-de-sac of the conjunctiva, forty minutes prior to the intended maximal dilation time. Atropine Sulfate Ophthalmic Solution, 1% is a muscarinic antagonist indicated for: ... Penalization of the healthy eye in the treatment of amblyopia (1.3)
Amblyopia Treatment: Atropine sulfate ophthalmic solution is indicated for the treatment of amblyopia by penalization of the healthy eye. The recommended dosage is 1 drop topically to the cul-de-sac of the conjunctiva, forty minutes prior to the intended maximal dilation time, in individuals from three months of age or greater 2, 2.
From the Research
Amblyopia Treatment Overview
- Amblyopia is the leading cause of monocular vision loss in children, and early recognition and treatment are crucial to prevent vision loss 3
- The U.S. Preventive Services Task Force recommends vision screening for all children at least once between three and five years of age to detect the presence of amblyopia or its risk factors 3
Treatment Options
- Treatments for amblyopia include patching, atropine eye drops, and optical penalization of the nonamblyopic eye 3
- In children with moderate amblyopia, patching for two hours per day is as effective as six hours, and daily atropine is as effective as daily patching 3
- Atropine penalization therapy and occlusion therapy have shown similar visual acuity outcomes in children aged 7-12 years, with no significant difference in adverse effects 4
Age and Treatment Efficacy
- Children younger than seven years receive the most benefit from treatment, but older children may still benefit 3
- Recent evidence suggests that cortical plasticity can be induced in older children, extending the "treatment window" beyond the critical period 5
- Treatment efficiency declines with age, but an attempt at treatment should be offered to all amblyopic children regardless of age, including those in later childhood 6
Novel Treatment Approaches
- Novel approaches targeted to the restoration of binocular functions, such as perceptual learning, video gaming, and dichoptic training, have shown small effects on visual acuity but require further investigation 6
- New pharmacological agents are being studied to extend the "treatment window" beyond the critical period and improve treatment outcomes 5
Asymmetric Bilateral Amblyopia
- Primary occlusion therapy in asymmetric, bilateral amblyopia patients has shown similar visual acuity outcomes to secondary occlusion therapy, with no significant difference in improvement 7
- VA improvement was observed in both eyes, with a reduction in interocular difference, irrespective of occlusion status 7