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JAMA Ophthalmology Journal Club Slides: Treatment of Moderate Amblyopia

JAMA Ophthalmology Journal Club Slides: Treatment of Moderate Amblyopia.

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JAMA Ophthalmology Journal Club Slides: Treatment of Moderate Amblyopia

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  1. JAMA Ophthalmology Journal Club Slides:Treatment of Moderate Amblyopia Repka MX, Kraker RT, Holmes JM, et al; Pediatric Eye Disease Investigator Group. Atropine vs patching for treatment of moderate amblyopia: follow-up at 15 years of age of a randomized clinical trial. JAMA Ophthalmol. Published online May 1, 2014. doi:10.1001/jamaophthalmol.2014.392.

  2. Introduction • For treatment of amblyopia, refractive correction, patching, atropine sulfate eyedrops, and Bangerter filters to the fellow eye have been shown to improve the vision of the amblyopic eye.Regression after cessation of treatment for amblyopia occurs in some patients, thereby reducing the lifetime benefit of therapy. • Objective: • To report visual acuity (VA) at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia.

  3. Methods • Design: Long-term follow-up of children (aged 3 to <7 years) with moderate amblyopia (VA, 20/40 to 20/100) randomly assigned to patching or atropine eyedrops. • Participants: Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up. • Data Analysis: VAs in the amblyopic eye and fellow eye were compared between randomized treatment groups as continuous variables in analysis-of-covariance models adjusted for baseline VA. A logistic regression model was used to compare the proportions of eyes in each treatment group with VA of 20/25 or better in the amblyopic eye. • Limitation: Possible selection bias as more children with slightly better VA were enrolled in this phase.

  4. Results • The 15-year examination was completed by 152 of the 188 participants (80.9%). • Mean age was 5.1 years (range, 2.6-7.0 years) at enrollment. • Mean age was 15.3 years (range, 14.8-17.1 years) at outcome. • 41.5% were female. • Mean VA of the Amblyopic Eyes • 0.53 logMAR (approximately 20/63) at entry into the randomized clinical trial. • 0.14 logMAR (approximately 20/25) at 15-year examination. • 59.9% of amblyopic eyes had VA of 20/25 or better. • 33.3% had VA of 20/20 or better.

  5. Results • VA in Amblyopic Eye by Treatment Group • Original treatment with atropine: 0.13 logMAR. • Original treatment with patching: 0.14 logMAR. • Difference between the treatment groups adjusted for baseline VA was +0.02 logMAR (95% CI, −0.03 to +0.07; P = .44). • The amblyopic eye VA was 20/25 or better in 61% of participants originally prescribed patching and 58% of participants originally prescribed atropine (P = .27).

  6. Results • Multivariate Analyses of Baseline Characteristics • Cause of amblyopia (strabismus, anisometropia, or combination) • No effect (P = 0.33). • VA at baseline • Better baseline VA in the amblyopic eye was associated with better VA at age 15 years (P < .001). • Age at baseline • Younger age at baseline was associated with better VA at age 15 years (P < .001). • 0.09 logMAR (approximately 20/25) in participants younger than 5 years at randomization. • 0.18 logMAR (approximately 20/32) in participants aged 5 to 6 years.

  7. Results Amblyopic Eye Visual Acuity Over Time by Age at Randomization

  8. Results • Interocular VA Difference • VA measured with an electronic modification of the testing protocol developed for the Early Treatment Diabetic Retinopathy Study (e-ETDRS). • Mean interocular VA difference at 10 and 15 years of age: • 2.0 logMAR lines at age 10 years. • 2.1 logMAR lines at age 15 years. • P = .39.

  9. Comment • At 15 years of age, most children treated for moderate amblyopia when younger than 7 years have good VA (59.9% of amblyopic eyes had VA of 20/25 or better). • Mild residual amblyopia is common. • The outcome is similar regardless of initial treatment with atropine or patching. • The improvement occurring with amblyopia treatment is maintained until at least age 15 years.

  10. Contact Information • If you have questions, please contact the corresponding author: • Michael X. Repka, MD, MBA, Wilmer Ophthalmological Institute, The Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287-9028 (pedigats15yr@jaeb.org). Funding/Support • This study was supported through cooperative agreements EY011751 and EY018810 from the National Eye Institute of the National Institutes of Health, Department of Health and Human Services. Conflict of Interest Disclosures • None reported.

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