J Korean Ophthalmol Soc.  2008 Jun;49(6):958-966. 10.3341/jkos.2008.49.6.958.

The Prospective Comparison of the Efficacy of Intermittent Atropine Penalization and Part-time Occlusion Therapy

Affiliations
  • 1Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Medical Research Institute, Cheongju, Korea. mychoi@chungbuk.ac.kr

Abstract

PURPOSE: The objective of this study was to compare prospectively the efficacy between intermittent atropine penalization and part-time occlusion therapy for amblyopia in patients younger than 10 years old.
METHODS
The patients with newly diagnosed amblyopia were randomly assigned to either atropine penalization (Group A) or occlusion therapy (Group O). One drop of atropine was instilled into the sound eyes of patients in group A twice per week, while each patient in group O underwent daily patching for 6 hours in their sound eyes. The minimum follow-up time was 3 months after treatment. Best corrected visual acuity and compliance were compared for both groups.
RESULTS
A total of 43 patients were enrolled in this study, with 18 assigned to group A and 25 to group O. The follow-up period was not significantly different between group A and group O (6.3 and 7.0 months, respectively; p=0.437). The final corrected visual acuity (LogMAR) scores of amblyopic eyes in both groups showed significant improvement in the visual acuity of amblyopic eyes compared with that at baseline (0.28 in group A and 0.19 in group O). Group A had a higher level of compliance than group O (97.0 and 91.5%, respectively; p=0.007). There was no difference in the groups with regard to visual acuity in amblyopic eyes,which showed similar improvement (3.5:3.4 lines, respectively; p=0.867).
CONCLUSIONS
This study shows that for treating amblyopia in children younger than 10 years old, intermittent atropine penalization seems to be as effective as part-time occlusion.

Keyword

Amblyopia; Atropine penalization; Occlusion

MeSH Terms

Amblyopia
Atropine
Child
Compliance
Eye
Follow-Up Studies
Humans
Prospective Studies
Visual Acuity
Atropine

Figure

  • Figure 1. Graph showing the cumulative number of patients with 2 lines or more of visual improvement during follow-up in each group.


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J Korean Ophthalmol Soc. 2015;56(2):254-262.    doi: 10.3341/jkos.2015.56.2.254.

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Reference

References

1. Buffon M de. Dissertation sur la cause du strabims ou des yeux louches. Hist Acad R Sci. 1743; 231.
2. Scott WE, Stratton VB, Fabre J. Full‐ time occlusion therapy for amblyopia. Am Orthopt J. 1980; 30:125–30.
3. Simons K. Preschool vision screening: rationale, methodology and outcome. Surv Ophthalmol. 1996; 41:3–30.
Article
4. Oliver M, Neumann R, Chaiomovitch Y. . Compliance and results of treatment for amblyopia in children more than 8 years old. Am J Ophthalmol. 1986; 102:340–5.
Article
5. Searle A, Norman P, Harrad R, Vedhara K. Psychosocial and clinical determinants of compliance with occlusion therapy for amblyopic children. Eye. 2002; 16:150–5.
Article
6. Woodruff G, Hiscox F, Thompson JR, Smith LK. Factors affecting the outcome of children treated for amblyopia. Eye. 1994; 8:627–31.
Article
7. Beardsell R, Clarke S, Hill M. Outcome of occlusion treatment for amblyopia. J Pediatr Ophthalmol Strabismus. 1999; 36:19–24.
Article
8. Yeom HY, Han SH, Lee JB. Effects of soloitary part‐ time occlusion for the treatment of monocular amblyopia patients. J Korean Ophthalmol Soc. 2004; 45:1134–40.
9. Holmes JM, Kraker RT, Beck RW. . A randomized trial of prescribing patching regimens for treatment of severe amblyopia in children. Ophthalmology. 2003; 110:2075–87.
10. France TD, France LW. Optical penalization can improve vision after occlusion treatment. J AAPOS. 1999; 3:341–3.
Article
11. Binocular vision and ocular motility: Treatment of amblyopia, 6th ed. St Louis: Mosby. 2002; 545–452..
12. North RV, Kelly ME. Atropine occlusion in the treatment of strabismic amblyopia and its effect upon the non‐ amblyopic eye. Ophthalmic Physiol Opt. 1991; 11:113–7.
13. Yu DK, Choi MY. The efficacy of intermittent atropine penalization in amblyopic children who have failed patching therapy. J Korean Ophthalmol Soc. 2005; 46:1167–74.
14. The Pediatric Eye Disease Investigator Gorup. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2002; 120:268–78.
15. The Pediatric Eye Disease Investigator Group. A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors. Ophthalmology. 2003; 110:1632–8.
16. The Pediatric Eye Disease Investigator Group. Two‐ year follow‐ up of a 6‐ month randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2005; 123:149–57.
17. Simons K, Gotzler KC, Vitale S. Penalization versus part‐ time occlusion and binocular outcome in treatment of strabismic amblyopia. Ophthalmology. 1997; 104:2156–60.
18. Repka MX, Ray JM. The efficacy of optical and pharmacological penalization. Ophthalmology. 1993; 100:769–75.
Article
19. McCann A, O’keefe M. Atropine penalization versus occlusion as the primary treatment for amblyopia. Br J Ophthalmol. 1997; 81:54–7.
20. O’Connor PS, Mumma JV. Atropine toxicity. Am J Ophthalmol. 1985; 99:613–4.
21. Hoefnagel D. Toxic effects of atropine and homatropine eyedrops in children. N Engl J Med. 1961; 264:168–71.
Article
22. Mintz-Hittner HA, Fernandez KM.Successful amblyopia therapy initiated after age 7 years. Arch Ophthalmol. 2000; 118:1535–41.
23. Moon CS, Jin YH. Timing of amblyopia therapy in pure anisometropic amblyopia. J Korean Ophthalmol Soc. 1998; 39:185–92.
24. Repka MX, Beck RW, Holmes JM. . A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol. 2003; 121:603–11.
Article
25. Oh DE, Lim KH. Efficacy of occlusion therapy in amblyopia: type, depth & timing of amblyopia. J Korean Ophthalmol Soc. 2003; 44:2850–6.
26. Lithander J, Sjörstrand J.Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment. Br J Ophthalmol. 1991; 75:111–6.
Article
27. The Pediatric Eye Disease Investigator Gorup. Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology. 2006; 113:895–901.
28. Steele AL, Bradfield YS, Kushner BJ. . Successful treatment of anisometropic amblyopia with spectacles alone. J AAPOS. 2006; 10:37–43.
Article
29. Chen PL, Chen JT, Tai MC. . Anisometropic amblyopia treated with spectacle correction alone: possible factors predicting success and time to start patching. Am J Ophthalmol. 2007; 143:54–60.
Article
30. Simons K, Stein L, Sener EC. . Full‐ time atropine, intermittent atropine, and optical penalization and binocular outcome in treatment of strabismic amblyopia. Ophthalmology. 1997; 104:2143–55.
31. Scott WE, Dickey CF. Stability of visual acuity in amblyopic patients after visual maturity. Graefes Arch Clin Exp Ophthalmol. 1988; 226:154–7.
Article
32. Kim HY, Chang BL. Clinical evaluation of exotropia Combined with amblyopia in children. J Korean Ophthalmol Soc. 1996; 37:662–8.
33. Timmerman GJ. The results of penalization therapy. Doc Ophthalmol. 1977; 42:385–90.
Article
34. Brodstein RS, Brodstein DE, Olson RJ. . The treatment of myopia with atropine and bifocals. A long‐ term prospective study. Ophthalmology. 1984; 91:1373–9.
Article
35. Brenner RL. Further observations on use of atropine in the treatment of myopia. Ann Ophthalmol. 1985; 17:137–40.
36. Park SH, Yoon IN, Rah SH. The effect of atropinization of refractive accommodative esotropia patients with amblyopia. J Korean Ophthalmol Soc. 2003; 44:2292–8.
37. Ahn HB, Yoo KW, Rho SH. The cycloplegic effect of atropine. J Korean Ophthalmol Soc. 1995; 36:2029–34.
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