Table 3.

Amblyopia treatment approaches: Historical versus current evidence-based approach

	Historical Dogma	Current Perspective
The mainstay of amblyopia treatment	Patching	Optimal refractive correction
Timing of refractive correction and occlusion (patching or atropine)	Simultaneous	Occlusion prescribed subsequent to gains from optical treatment effect
Patching dosage for moderate amblyopia	Generally, the more the better; usually ≥ 5–6 hours	Start with 2 hours; can increase dosage if needed
Patching dosage for severe amblyopia	Full-time or most waking hours	Start with 6 hours; 2 hours is effective in some cases
Atropine penalization use	Patching failures only	First-line treatment as alternative to patching or for patching failures
Atropine penalization guidelines
Amblyopia severity	Only for moderate amblyopia	Both moderate & severe cases
Age of child	Only in young children	Younger and older children
Age after which amblyopia can no longer be treated	Approximately 6–9 years of age	Upper age limit not established; albeit generally greater VA gains if <7 years of age
Recurrence of amblyopia after treatment cessation in 9 to <13- year-old children	High likelihood of regression	Vast majority (>90%) do not regress