atropine, may be a good alternative to patching for treatment of lazy eye

SAN FRANCISCO – An eyedrop, atropine, may be a good alternative to patching for treatment of lazy eye, or amblyopia, in children between the ages of three and seven. This is the conclusion of a study appearing in Ophthalmology, the clinical journal of the American Academy of Ophthalmology, the Eye M.D. Association.

In this study, conducted at 47 clinical sites across the country, 1,419 children younger than seven years of age with visual acuity between 20/40 and 20/100 were randomly assigned to receive either patching, also called occlusion, or atropine. Their progress was followed for six months.

Though initially the improvement in visual acuity in the lazy eye was slightly greater in the group with patches, by six months there was no significant difference in outcome between those treated with patching of the strong eye and those treated with one-percent atropine drops in the strong eye. Both treatments were well tolerated, but atropine was the favored treatment indicated by a patient questionnaire completed after the first five weeks of treatment.

"Our findings are important because previous retrospective case studies suggested atropine might be less effective than patching, and that it was largely ineffective in children with poorer visual acuity," said Michael X. Repka, MD, lead investigator of the study and a professor of ophthalmology at the Wilmer Eye Institute, Johns Hopkins University. "However, our study found atropine was just as effective when visual acuity in the poor eye was 20/100, as it was when acuity was 20/40. These preliminary findings suggest the need for a future study, in which we will assess the effect of atropine at visual acuity levels worse than 20/100."

The study also found that patients with acuity levels of 20/80 to 20/100 improved faster when a greater number of hours of patching was prescribed, but after six months this improvement was not significantly greater than that occurring with fewer hours of prescribed patching or with daily atropine.

Academy spokesperson Stuart Dankner, MD, a pediatric ophthalmologist in Baltimore and an assistant professor of ophthalmology at Johns Hopkins University and the University of Maryland, School of Medicine, said, "This study offers an option to ophthalmologists who treat children with amblyopia. The use of patching or atropine may be effective for children with mild to moderate degrees of amblyopia. Atropine may be especially useful in children who are noncompliant with patching. However, atropine often takes a longer period of time to accomplish significant visual improvement."