Teenagers may benefit from amblyopia treatment

Baltimore-Treating amblyopia in older children and teenagers, that is, those over 7 years of age and up to 18 years, may produce positive results. The Pediatric Eye Disease Investigator Group (PEDIG) recently reported that conventional treatments can work in teenagers; however, the magnitude of the benefit varies greatly among individuals, according to Michael X. Repka, MD.

However, as he pointed out, there are older patients and adults with amblyopia who do have an injury or impairment to the sound eye and have had improvements in visual acuity. He cited a recent study in the British Journal of Ophthalmology (El Mallah MK, Chakravarthy U, Hart PM. Br J Ophthalmol 2000;84:944-945) that reported on patients with age-related macular degeneration in the sound eye who had "remarkable improvements" in visual acuity in the previously amblyopic eye.

Response rate in two subgroups

PEDIG then set out to determine the response rate to conventional amblyopia treatment in two subgroups of patients by age-7 to 12 and 13 to 18 years-at the onset of therapy. The investigators also wanted to determine the frequency of recurrence of amblyopia. Children who were 7 to 18 could participate in the study if there was no myopia, no more than 1 month of therapy during the previous 6 months, and there had to be a difference of 3 or more lines of visual acuity or one octave between the affected eye and the fellow eye.

All patients were randomly assigned to spectacles only or spectacles plus therapy that included occlusion for 2 hours daily. Children up to 13 years also received daily atropine in the sound eye. In this group, if children were wearing spectacles but could not read at a grade-appropriate level, they were given reading glasses for use in school with the advisory that the spectacle use be minimized at other times. Children were also instructed to perform a near visual task for 1 hour while wearing the patch, such as doing homework, workbooks, working on a computer, or playing video games, Dr. Repka explained.