Many factors have impact on treatment efficacy for amblyopia

Chicago-While treatment for amblyopia is effective, there is no consensus as to what treatment works best. There are a number of factors that have an impact on treatment efficacy, according to Bruce Furr, CO. He discussed these factors Sunday at the American Academy of Ophthalmology annual meeting.

“There is no consensus on the efficacy of which treatment method works best for amblyopia or what defines success,” he said.

Evidence regarding the type of amblyopia and the effect on visual outcome is mixed; two studies showed that outcomes differed depending on the amblyopia type, with pure anisometropic amblyopes faring better than those with strabismus and combined types. Patient compliance seems to be a critical determinant of the visual acuity outcome. An analysis of age at presentation does not seem to affect the final visual acuity outcome, according to Furr, who is from the Ida Lucy Iacobucci Orthoptic Clinic, University of Michigan Kellogg Eye Center, Ann Arbor.

Refractive error status has a strong correlation with the initial visual acuity and outcome in these patients, and that the higher the refractive error, the more aggressive the treatment should be. The combining of visual activities with treatment does not seem to produce a useful visual effect. Finally, abrupt discontinuation of treatment produces greater regression than weaning patients off of occlusion therapy.

“Amblyopia treatment seems to work,” Furr said. “A significant number of patients treated with any of the methods improved, whether the improvement is based on the lines of vision gained or the percentage of vision gained relative to the initial difference between the two eyes.”

Most clinicians prefer the use of patching therapy and then atropine after patching.

“Vision improvement can occur with any type of treatment for any type of functional amblyopia regardless of the age of the patient,” Furr said. “We must treat amblyopia when we see it, employ our best methods, and hope for active treatment compliance to achieve the best result for the most patients.”