A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years
Pediatric Eye Disease Investigator Group, Michael X Repka, Raymond T Kraker, Roy W Beck, Jonathan M Holmes, Susan A Cotter, Eileen E Birch, William F Astle, Danielle L Chandler, Joost Felius, Robert W Arnold, D Robbins Tien, Stephen R Glaser, Nicholas A Sala, Rhonda M Hodde, Stephen R Glaser, Jenifer A Aventuro Luck, Paige E Glaser, Jill E Mason, Kelly A Sirk, David Robbins Tien, Myra B McGuinness, Heidi C Christ, Brenda G Toro, Robert W Arnold, Mary Diane Armitage, William F Astle, Anna L Ells, Heather J Peddie, April D Ingram, Charlene D Gillis, Cheryl R Hayduk, Catriona I Kerr, Michael X Repka, Alex X Christoff, Carole R Goodman, Xiaonong Liu, Susan A Cotter, Carmen N Barnhardt, Raymond H Chu, Monique M Nguyen, Susan M Shin, Susan Parker, David R Stager Sr, Priscilla M Berry, Mary K Alters, Joost Felius, Alexia B Perez, Evelyn A Paysse, David K Coats, Jane D Kivlin, Mark S Ruttum, Veronica R Picard, Jonathan M Holmes, Jan M Sease, Rebecca A Nielsen, Julie A Holmquist, Rose M Kroening, Marna L Levisen, Debbie M Priebe, Julie A Spitzer, Andrew J Levada, Tabitha L Walker, Cheryl Schleif, Lisa A Marcil, Nicole G Rannazzisi, Robert P Rutstein, Wendy L Marsh-Tootle, Cathy H Baldwin, Patrick J Droste, Robert J Peters, Jan Hilbrands, Sandra K Rogers, C Gail Summers, Stephen P Christiansen, Ann M Holleschau, Sara J Downes, Kathy M Hogue, Jane D Lavoie, Kim S Merrill, Sean Donahue, Kamila M Kinder, Christine C Franklin, Sandy A Owings, Ron Biernacki, Neva Fukuda, David T Wheeler, Kimberley A Beaudet, Paula K Rauch, Oscar A Cruz, Bradley V Davitt, Emily A Miyazaki, Ronald V Keech, Richard J Olson, William E Scott, Wanda I Ottar Pfeifer, James B Ruben, Dipti Desai, Sue Ann Parrish, Charles R Whitfill, David A Johnson, Marjean T Kulp, Freda D Dallas, David R Weakley Jr, Clare L Dias, David I Silbert, Noelle S Matta, Alyson B Keene, Michelle M Lindsey, Earl R Crouch Jr, Gaylord G Ventura, Kristen D Ruark, Roy W Beck, Brian D Becker, Nicole M Boyle, Christina M Cagnina-Morales, Debbie Cagnina, Danielle L Chandler, Laura E Clark, Sharon R Constantine, Quayleen Donahue, Michelle D Drew, Mitchell Dupre, Kyle L Baccus Horsley, Heidi A Gillespie, Raymond T Kraker, Stephanie V Lee, Lee Anne Lester, Shelly T Mares, B Michele Melia, Pamela S Moke, Jim L Pyner, Nicole T Reese, Heidi J Strayer, Donald F Everett, Roy W Beck, Eileen E Birch, Steven P Christiansen, Susan A Cotter, Sean P Donahue, Donald F Everett, Jonathan M Holmes, Darren L Hoover, Pamela A Huston, Raymond T Kraker, Michael X Repka, Nicholas A Sala, Mitchell M Scheiman, David K Wallace, Roy W Beck, Eileen E Birch, Susan A Cotter, Sean P Donahue, Donald F Everett, Allison R Edwards, Stephen R Glaser, Richard W Hertle, Michael P Hill, Rhonda M Hodde, Jonathan M Holmes, Pamela A Huston, Deborah L Klimek, Don W Lyon, Noelle S Matta, Brian G Mohney, Pamela S Moke, Graham E Quinn, Michael X Repka, Robert P Rutstein, Nicholas A Sala, Mitchell M Scheiman, David K Wallace, David R Weakley Jr, William Barlow, Edward G Buckley, Barry Davis, Marie D Diener-West, Velma Dobson, John L Keltner, Hana Osman, Earl A Palmer, Dale L Phelps, Stephen W Poff, Richard A Saunders, Pediatric Eye Disease Investigator Group, Michael X Repka, Raymond T Kraker, Roy W Beck, Jonathan M Holmes, Susan A Cotter, Eileen E Birch, William F Astle, Danielle L Chandler, Joost Felius, Robert W Arnold, D Robbins Tien, Stephen R Glaser, Nicholas A Sala, Rhonda M Hodde, Stephen R Glaser, Jenifer A Aventuro Luck, Paige E Glaser, Jill E Mason, Kelly A Sirk, David Robbins Tien, Myra B McGuinness, Heidi C Christ, Brenda G Toro, Robert W Arnold, Mary Diane Armitage, William F Astle, Anna L Ells, Heather J Peddie, April D Ingram, Charlene D Gillis, Cheryl R Hayduk, Catriona I Kerr, Michael X Repka, Alex X Christoff, Carole R Goodman, Xiaonong Liu, Susan A Cotter, Carmen N Barnhardt, Raymond H Chu, Monique M Nguyen, Susan M Shin, Susan Parker, David R Stager Sr, Priscilla M Berry, Mary K Alters, Joost Felius, Alexia B Perez, Evelyn A Paysse, David K Coats, Jane D Kivlin, Mark S Ruttum, Veronica R Picard, Jonathan M Holmes, Jan M Sease, Rebecca A Nielsen, Julie A Holmquist, Rose M Kroening, Marna L Levisen, Debbie M Priebe, Julie A Spitzer, Andrew J Levada, Tabitha L Walker, Cheryl Schleif, Lisa A Marcil, Nicole G Rannazzisi, Robert P Rutstein, Wendy L Marsh-Tootle, Cathy H Baldwin, Patrick J Droste, Robert J Peters, Jan Hilbrands, Sandra K Rogers, C Gail Summers, Stephen P Christiansen, Ann M Holleschau, Sara J Downes, Kathy M Hogue, Jane D Lavoie, Kim S Merrill, Sean Donahue, Kamila M Kinder, Christine C Franklin, Sandy A Owings, Ron Biernacki, Neva Fukuda, David T Wheeler, Kimberley A Beaudet, Paula K Rauch, Oscar A Cruz, Bradley V Davitt, Emily A Miyazaki, Ronald V Keech, Richard J Olson, William E Scott, Wanda I Ottar Pfeifer, James B Ruben, Dipti Desai, Sue Ann Parrish, Charles R Whitfill, David A Johnson, Marjean T Kulp, Freda D Dallas, David R Weakley Jr, Clare L Dias, David I Silbert, Noelle S Matta, Alyson B Keene, Michelle M Lindsey, Earl R Crouch Jr, Gaylord G Ventura, Kristen D Ruark, Roy W Beck, Brian D Becker, Nicole M Boyle, Christina M Cagnina-Morales, Debbie Cagnina, Danielle L Chandler, Laura E Clark, Sharon R Constantine, Quayleen Donahue, Michelle D Drew, Mitchell Dupre, Kyle L Baccus Horsley, Heidi A Gillespie, Raymond T Kraker, Stephanie V Lee, Lee Anne Lester, Shelly T Mares, B Michele Melia, Pamela S Moke, Jim L Pyner, Nicole T Reese, Heidi J Strayer, Donald F Everett, Roy W Beck, Eileen E Birch, Steven P Christiansen, Susan A Cotter, Sean P Donahue, Donald F Everett, Jonathan M Holmes, Darren L Hoover, Pamela A Huston, Raymond T Kraker, Michael X Repka, Nicholas A Sala, Mitchell M Scheiman, David K Wallace, Roy W Beck, Eileen E Birch, Susan A Cotter, Sean P Donahue, Donald F Everett, Allison R Edwards, Stephen R Glaser, Richard W Hertle, Michael P Hill, Rhonda M Hodde, Jonathan M Holmes, Pamela A Huston, Deborah L Klimek, Don W Lyon, Noelle S Matta, Brian G Mohney, Pamela S Moke, Graham E Quinn, Michael X Repka, Robert P Rutstein, Nicholas A Sala, Mitchell M Scheiman, David K Wallace, David R Weakley Jr, William Barlow, Edward G Buckley, Barry Davis, Marie D Diener-West, Velma Dobson, John L Keltner, Hana Osman, Earl A Palmer, Dale L Phelps, Stephen W Poff, Richard A Saunders
Abstract
Objective: To determine the visual acuity outcome at age 10 years for children younger than 7 years when enrolled in a treatment trial for moderate amblyopia.
Methods: In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40-20/100) were randomized to patching or atropine eyedrops for 6 months. Two years after enrollment, a subgroup of 188 children entered long-term follow-up. Treatment after 6 months was at the discretion of the investigator; 89% of children were treated.
Main outcome measure: Visual acuity at age 10 years with the electronic Early Treatment Diabetic Retinopathy Study test.
Application to clinical practice: Patching and atropine eyedrops produce comparable improvement in visual acuity that is maintained through age 10 years.
Results: The mean amblyopic eye acuity, measured in 169 patients, at age 10 years was 0.17 logMAR (logarithm of the minimum angle of resolution) (approximately 20/32), and 46% of amblyopic eyes had an acuity of 20/25 or better. Age younger than 5 years at entry into the randomized trial was associated with a better visual acuity outcome (P < .001). Mean amblyopic and sound eye visual acuities at age 10 years were similar in the original treatment groups (P = .56 and P = .80, respectively).
Conclusions: At age 10 years, the improvement of the amblyopic eye is maintained, although residual amblyopia is common after treatment initiated at age 3 years to younger than 7 years. The outcome is similar regardless of initial treatment with atropine or patching.
Trial registration: ClinicalTrials.gov NCT00000170.
Source: PubMed