TABLE 2.

Summary of Clinical Outcomes for Traditional Amblyopia Treatment Modalities

Amblyopia treatment modality	Clinical outcomes
Visual acuity outcomes in amblyopia patients using refractive correction	There is often an immediate improvement in visual acuity from improved image clarity, and glasses are generally well tolerated by children2
	Continued wear of refractive correction for 18 weeks has been shown to improve visual acuity in the amblyopic eye by ≥2 lines in children aged 3-7 y with untreated anisometropic amblyopia2,39
	A study in children aged 7-17 y found that approximately 25% of patients improved by ≥2 lines with optical correction alone2,40
	Despite positive findings with refractive correction, 1 study found that glasses alone resolved amblyopia in only 27% of patients39
Visual acuity outcomes and adherence in amblyopia patients using patching and atropine
Patching and atropine	-A meta-analysis of 23 randomized clinical trials with 3,279 patients showed that monocular treatments provide 0.4-0.7 lines of vision gain beyond use of glasses alone with extended treatment duration41 -May result in reduced visual acuity of the sound eye or reverse amblyopia that resolves following treatment cessation. These results are reported more often for atropine therapy compared with patching2,32
Patching	- Patching length has been optimized: o For severe amblyopia (20/100-20/400) in children aged >7 y, 6 h of daily patching improves visual acuity equivalent to patching for all but 1 waking hour2,42 o For moderate amblyopia in children, 2 h of daily patching improves visual acuity equivalent to 6 h2,39 o Improvement is stable through at least age 15 y2,43 -Even with optimal patching treatment, 79% of patients experience residual amblyopia29 -When compliance for patching was measured objectively using an occlusion dose monitor; mean adherence was as low as 44% in children aged 3-8 y in a clinical trial setting30 - Low adherence may be caused by a variety of psychosocial and nonpsychosocial factors38 o Psychosocial factors include relational dynamic perceptions, personal feelings of stigma, and responses of peers toward amblyopia treatment o Nonpsychosocial factors include discomfort, difficulty with tasks, and factors affecting daily and long-term duration of treatment (age at treatment, severity of amblyopia, type of amblyopia, and degree of binocularity)
Atropine	Atropine is used less frequently. This may be because of side effects such as transient reduction in visual acuity and photosensitivity, which may interfere with daily activities such as movement and educational activities. Systemic adverse effects include dryness of the mouth and skin, fever, delirium, and tachycardia2,31