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Risk of amblyopia recurrence after cessation of treatment

Presented at 2004 JAAPOS Annual Meeting in Washington, DC.
https://doi.org/10.1016/j.jaapos.2004.07.007Get rights and content

Background:Although amblyopia can be successfully treated with patching or atropine, there have been few prospective studies of amblyopia recurrence once treatment is discontinued.Methods:We enrolled 156 children with successfully treated anisometropic or strabismic amblyopia (145 completed follow-up), who were younger than 8 years of age and who received continuous amblyopia treatment for the previous 3 months (prescribed at least 2 hours of daily patching or prescribed at least one drop of atropine per week) and who had improved at least 3 logMAR levels during the period of continuous treatment. Patients were followed off treatment for 52 weeks to assess recurrence of amblyopia, defined as a 2 or more logMAR level reduction of visual acuity from enrollment, confirmed by a second examination. Recurrence was also considered to have occurred if treatment was restarted because of a nonreplicated 2 or more logMAR level reduction of visual acuity. Results:Recurrence occurred in 35 (24%) of 145 cases (95% confidence interval 17% to 32%) and was similar in patients who stopped patching (25%) and in patients who stopped atropine (21%). In patients treated with moderately intense patching (6 to 8 hours per day), recurrence was more common (11 of 26; 42%) when treatment was not reduced prior to cessation than when treatment was reduced to 2 hours per day prior to cessation (3 of 22; 14%, odds ratio 4.4, 95% confidence interval 1.0 to 18.7). Conclusions:Approximately one fourth of successfully treated amblyopic children experience a recurrence within the first year off treatment. For patients treated with 6 or more hours of daily patching, our data suggest that the risk of recurrence is greater when patching is stopped abruptly rather than when it is reduced to 2 hours per day prior to cessation. A randomized clinical trial of no weaning versus weaning in successfully-treated amblyopia is warranted to confirm these observational findings.

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Patients and methods

Our study was supported through a cooperative agreement with the National Eye Institute of the National Institutes of Health and was conducted by the Pediatric Eye Disease Investigator Group at 30 clinical sites. The protocol and informed consent forms were approved by institutional review boards for each site, and the parent or guardian of each study patient gave written informed consent. Study oversight was provided by an independent data and safety monitoring committee appointed by the

Patient demographics

The average age of the 145 patients was 5.9 years; 49% were female and 86% were white. Ninety-two (63%) of the 145 patients had previously participated in a randomized amblyopia treatment trial.1, 2, 3 At the time of enrollment, 112 patients (77%) stopped patching treatment and 33 patients (23%) stopped atropine treatment. The mean visual acuity at enrollment was 0.13 logMAR in the amblyopic eye (equivalent to 20/25-) and 0.04 logMAR in the sound eye (equivalent to 20/20-). Table 2 lists

Discussion

In a prospective observational study of successfully treated amblyopic children less than 8 years of age, in whom treatment had been discontinued, we found an overall amblyopia recurrence risk of 24% (95% CI 17% to 32%) during 1 year of follow-up. Recurrence risk was similar among those patients who stopped patching and those who stopped atropine.

There have been few previous studies that have addressed the amblyopia recurrence risk at a specific time after cessation of treatment. The majority

Acknowledgments

Writing Committee: Lead authors: Jonathan M. Holmes, BM, BCh; Roy W. Beck, MD, PhD; Raymond T. Kraker, MSPH. Additional writing committee members (alphabetical): William F. Astle, MD; Eileen E. Birch, PhD; Stephen R. Cole, PhD; Susan A. Cotter, OD; Sean Donahue, MD.; Donald F. Everett, MA; Richard W. Hertle MD; Ronald V. Keech, MD; Evelyn Paysse, MD; Graham E. Quinn, MD, MSCE; Michael X. Repka, MD; Mitchell M. Scheiman, OD.

The pediatric eye disease investigator group

Clinical sites that

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Supported by a cooperative agreement from the National Eye Institute EY11751

Correspondence: Jonathan M. Holmes, BM, BCh, c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647; (e-mail: [email protected].)

*

The writing committee and a list of the members of the Pediatric Eye Disease Investigator Group (PEDIG) participating in the trial appear in the Acknowledgments.

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