The Effect of Amblyopia Therapy on Ocular Alignment

Michael Repka

Jonathan Holmes

B Melia

Roy Beck

Matthew Gearinger

Susanna Tamkins

David Wheeler

^{From the Johns Hopkins University School of Medicine, Baltimore, Maryland}

^{From the Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota}

^{From the Jaeb Center for Health Research, Tampa, Florida}

^{From the University of Rochester Eye Institute, Rochester, New York}

^{From the Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida}

^{From the Casey Eye Institute, Oregon Health and Science University, Portland, Oregon}

^{Corresponding author.}

Reprint requests: Michael X. Repka, MD, c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647 (e-mail: ude.imhj@akperm).

^{A list of Pediatric Eye Disease Investigator Group sites participating in this study appears in Arch Ophthalmol 2005;123:156.}

Abstract

Purpose: We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment. Methods: A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up. Results: At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8Δ), and 105 (29%) had a heterotropia >8Δ. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8Δ. Microtropia at enrollment progressed to a deviation greater than 8Δ with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8Δ at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period. Conclusions: Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases.

Abstract

Footnotes

Presented at the annual meeting of the American Association for Pediatric Ophthalmology and Strabismus, Orlando, Florida, March, 2005

Supported in part by a cooperative agreement from the National Eye Institute, EY11751. Dr. Gearinger is supported in part by a Research to Prevent Blindness Challenge Grant.

Footnotes

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