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Alaska Blind Child Discovery

A cooperative, charitable research project to vision screen every preschool Alaskan

ATS-3 (Older Children)

OBJECTIVE: To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years. METHODS: At 49 clinical sites, 507 patients with amblyopic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then randomized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities (including study-provided GameBoy proximal video games) for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (> or =2 lines) by 24 weeks were considered responders. RESULTS: In the 7- to 12-year-olds (n = 404), 53% of the treatment group were responders compared with 25% of the optical correction group (P<.001). In the 13- to 17-year-olds (n = 103), the responder rates were 25% and 23%, respectively, overall (adjusted P = .22) but 47% and 20%, respectively, among patients not previously treated with patching and/or atropine for amblyopia (adjusted P = .03). Most patients, including responders, were left with a residual visual acuity deficit. CONCLUSIONS: Amblyopia improves with optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acuity when amblyopia has not been previously treated but appears to be of little benefit if amblyopia was previously treated with patching. We do not yet know whether visual acuity improvement will be sustained once treatment is discontinued; therefore, conclusions regarding the long-term benefit of treatment and the development of treatment recommendations for amblyopia in children 7 years and older await the results of a follow-up study we are conducting on the patients who responded to treatment.[1]
Pilot Study
PURPOSE: To determine whether amblyopia can be successfully treated in older children and adolescents. DESIGN: Prospective, single group treatment trial. METHODS: Sixty-six amblyopic patients aged 10 to <18 years with amblyopic eye acuity of 20/40 to 20/160 were treated with daily patching (> or =2 hours a day) combined with at least 1 hour of near activities. Visual acuity was measured before and after 2 months of prescribed treatment. RESULTS: Visual acuity improved 2 or more lines from baseline in 18 (27%) of the 66 patients (95% confidence interval, 17%-40%), and the improvement appeared similar in 10- to <14-year-olds and 14- to <18-year-olds. CONCLUSIONS: Amblyopia treatment can improve visual acuity in older children and adolescents. A randomized controlled trial is needed to determine if there is an upper age limit for which amblyopia treatment is successful.[2]
1. PEDIG, Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA, Crouch ER, Jr., Cruz OA, Davitt BV, et al: Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 2005, 123:437-447.
2. PEDIG: A prospective, pilot study of treatment of amblyopia in children 10 to <18 years old. Am J Ophthalmol 2004, 137:581-583.
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