Effect of Sequential and Simultaneous Patching Regimens in Unilateral Amblyopia.

Abstract

PURPOSE\nMany clinicians treat unilateral amblyopia with glasses alone and initiate patching when needed; others start glasses and patching simultaneously. In this study, we reviewed the outcomes of the two approaches at our institution.\n\n\nDESIGN\nRetrospective non-randomized clinical trial METHODS: Setting: Institutional practice.\n\n\nPATIENT POPULATION\nAll patients diagnosed with amblyopia at Boston Children s Hospital between 2010 and 2014.\n\n\nINCLUSION CRITERIA\nUnilateral amblyopia visual acuity (VA): 20/40-20/200 with interocular difference ≥ 3 lines, age 3-12 years, with a 6-month visit.\n\n\nEXCLUSION CRITERIA\nDeprivation amblyopia, prior amblyopia treatment, treatment other than patching, surgery. Patients were categorized as simultaneous treatment (concurrent glasses and patching therapy at their first visit) or sequential treatment (glasses alone at first visit followed by patching therapy at second visit.) Observation Procedures: Patient demographics, VA, and stereopsis were compared.\n\n\nOUTCOME MEASURES\nVA and stereopsis at the last visit on treatment.\n\n\nRESULTS\nWe identified 98 patients who met inclusion criteria: 36 received simultaneous treatment and 62 sequential treatment. Median amblyopic eye VA improved similarly between the simultaneous (∆0.40 (0.56, 0.30 logMAR) and sequential (∆0.40 (0.52, 0.27 logMAR) groups. Patients without stereopsis at first visit had better stereopsis outcomes with sequential treatment (5.12 (4.00, 7.51) log stereopsis) compared to simultaneous treatment (8.01 (5.65, 9.21) log stereopsis, p ≤ 0.046).\n\n\nCONCLUSIONS\nVA improved approximately 4 lines regardless of treatment type. For children without stereopsis at first presentation, sequential patching yielded better stereopsis outcomes. These findings require further validation and highlight the importance of evaluating stereopsis in future studies.