Controlled study comparing CAM treatment with occlusion therapy. A randomized trial of patching regimens for treatment of moderate amblyopia in children. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening. Evaluation of the CAM treatment for amblyopia: a controlled study. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. A pilot study of anisometropic amblyopia improved in adults and children by perceptual learning: an alternative treatment to patching. Objectively monitored patching regimens for treatment of amblyopia: randomised trial. A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. A randomized trial of near versus distance activities while patching for amblyopia in children aged 3 to less than 7 years. Treatment of anisometropic amblyopia with spectacles or in combination with translucent Bangerter filters.
nan To compare 2 hours vs 6 hours of daily patching as treatments for moderate amblyopia in children younger than 7 years.
                In a randomized multicenter (35 sites) clinical trial, 189 children younger than 7 years with amblyopia in the range of 20/40 to 20/80 were assigned to receive either 2 hours or 6 hours of daily patching combined with at least 1 hour per day of near visual activities during patching.Main Outcome Measure Visual acuity in the amblyopic eye after 4 months.
                Visual acuity in the amblyopic eye improved a similar amount in both groups. The improvement in the visual acuity of the amblyopic eye from baseline to 4 months averaged 2.40 lines in each group (P =.98). The 4-month visual acuity was at least 20/32 and/or improved from baseline by 3 or more lines in 62% of patients in each group (P>.99).
                When combined with prescribing 1 hour of near visual activities, 2 hours of daily patching produces an improvement in visual acuity that is of similar magnitude to the improvement produced by 6 hours of daily patching in treating moderate amblyopia in children aged 3 to 7 years. To compare full-time patching (all hours or all but 1 hour per day) to 6 hours of patching per day, as prescribed treatments for severe amblyopia in children younger than 7 years.
                Prospective, randomized multicenter clinical trial (32 sites).
                One hundred seventy-five children younger than 7 years with amblyopia in the range of 20/100 to 20/400.
                Randomization either to full-time patching or to 6 hours of patching per day, each combined with at least 1 hour of near-visual activities during patching.
                Visual acuity in the amblyopic eye after 4 months.
                Visual acuity in the amblyopic eye improved a similar amount in both groups. The improvement in the amblyopic eye acuity from baseline to 4 months averaged 4.8 lines in the 6-hour group and 4.7 lines in the full-time group (P = 0.45).
                Six hours of prescribed daily patching produces an improvement in visual acuity that is of similar magnitude to the improvement produced by prescribed full-time patching in treating severe amblyopia in children 3 to less than 7 years of age. To test the efficacy of treatment for unilateral visual loss detected by preschool vision screening and the extent to which effectiveness varies with initial severity.
                Randomised controlled trial of full treatment with glasses and patching, if required, compared with glasses only or no treatment. Masked assessment of best corrected acuity after one year of follow up.
                Eight UK eye departments.
                177 children aged 3-5 years with mild to moderate unilateral impairment of acuity (6/9 to 6/36) detected by screening.
                Children in the full and glasses treatment groups had incrementally better visual acuity at follow up than children who received no treatment, but the mean treatment effect between full and no treatment was equivalent to only one line on a Snellen chart (0.11 log units; 95% confidence interval 0.050 to 0.171; P < 0.0001). The effects of treatment depended on initial acuity: full treatment showed a substantial effect in the moderate acuity group (6/36 to 6/18 at recruitment) and no significant effect in the mild acuity group (6/9 to 6/12 at recruitment) (P = 0.006 for linear regression interaction term). For 64 children with moderate acuity loss the treatment effect was 0.20 log units, equivalent to one to two lines on a Snellen chart. When all children had received treatment, six months after the end of the trial, there was no significant difference in acuity between the groups.
                Treatment is worth while in children with the poorest acuity, but in children with mild (6/9 to 6/12) unilateral acuity loss there was little benefit. Delay in treatment until the age of 5 did not seem to influence effectiveness. Single letter and linear acuity (near and distance) and contrast sensitivity were measured in 15 amblyopes (ages 5 to 12) before, during, and after four weekly 7 min sessions of CAM treatment. Six of the children, however, played games over a homogeneous grey disc having the same space-averaged luminance as that of the striped stimuli. Experimental and controls results were indistinguishable. In a few subjects from both groups, contrast sensitivity and slight linear acuity improvement was observed. We conclude that these vision changes can be attributed to the short-term occlusion experienced by all subjects during treatment and that grating stimulation did not contribute to this improvement. To evaluate the effectiveness of treatment of amblyopia in children aged 7 to 17 years.
                At 49 clinical sites, 507 patients with amblyopic eye visual acuity ranging from 20/40 to 20/400 were provided with optimal optical correction and then randomized to a treatment group (2-6 hours per day of prescribed patching combined with near visual activities for all patients plus atropine sulfate for children aged 7 to 12 years) or an optical correction group (optical correction alone). Patients whose amblyopic eye acuity improved 10 or more letters (> or =2 lines) by 24 weeks were considered responders.
                In the 7- to 12-year-olds (n = 404), 53% of the treatment group were responders compared with 25% of the optical correction group (P<.001). In the 13- to 17-year-olds (n = 103), the responder rates were 25% and 23%, respectively, overall (adjusted P = .22) but 47% and 20%, respectively, among patients not previously treated with patching and/or atropine for amblyopia (adjusted P = .03). Most patients, including responders, were left with a residual visual acuity deficit.
                Amblyopia improves with optical correction alone in about one fourth of patients aged 7 to 17 years, although most patients who are initially treated with optical correction alone will require additional treatment for amblyopia. For patients aged 7 to 12 years, prescribing 2 to 6 hours per day of patching with near visual activities and atropine can improve visual acuity even if the amblyopia has been previously treated. For patients 13 to 17 years, prescribing patching 2 to 6 hours per day with near visual activities may improve visual acuity when amblyopia has not been previously treated but appears to be of little benefit if amblyopia was previously treated with patching. We do not yet know whether visual acuity improvement will be sustained once treatment is discontinued; therefore, conclusions regarding the long-term benefit of treatment and the development of treatment recommendations for amblyopia in children 7 years and older await the results of a follow-up study we are conducting on the patients who responded to treatment. To compare the effects of perceptual learning or patching on improving visual acuity and contrast sensitivity in patients with anisometropic amblyopia.
                Patients with anisometropic amblyopia received either patching or perceptual learning treatment. Corrected amblyopic logMAR visual acuity and contrast sensitivity function were measured at four-weekly intervals until visual acuity stabilized or amblyopia resolved. Improvements in visual acuity, contrast sensitivity and resolution of amblyopia were compared between the two groups.
                The mean visual acuities of the amblyopic eyes improved by 0.34 logMAR (95% CI: 0.22-0.47 logMAR) with patching and 0.25 logMAR (95% CI: 0.16-0.35 logMAR) with perceptual learning (p=0.125). Resolution of amblyopia was achieved in 10 of 26 patients (38%) in the perceptual learning group and 17 of 27 patients (63%) in the patching group (p=0.809). Amblyopia improved by two or more lines in 20 of 26 (76%) patients in the perceptual learning group and 26 of 27 (96%) patients in the patching group (p=0.0001). The mean time for patching was 37.3 weeks (522.2 h) and the average number of training sessions in the perceptual learning group was 48 (29.5 h) (p=0.0001).
                Visual acuity can be improved with perceptual learning and patching in older children and adult patients with anisometropic amblyopia. The improvements in visual acuity achieved with patching were one line better than those achieved with perceptual learning. Perceptual learning might provide an alternative treatment in patients with anisometropic amblyopia. To compare visual outcome in response to two prescribed rates of occlusion (six hours a day and 12 hours a day).
                Unmasked randomised trial.
                Research clinics in two London hospitals.
                97 children with a confirmed diagnosis of amblyopia associated with strabismus, anisometropia, or both.
                18 week period of wearing glasses (refractive adaptation) followed by occlusion prescribed ("patching") for six or 12 hours a day.
                Visual acuity measured by logMAR letter recognition; objectively monitored rate of occlusion (hours a day).
                The mean age of children at study entry was 5.6 (SD 1.5) years. Ninety were eligible for occlusion but 10 dropped out in this phase, leaving 80 children who were randomised to a prescribed dose rate of six (n=40) or 12 (n=40) hours a day. The mean change in visual acuity of the amblyopic eye was not significantly different (P=0.64) between the two groups (0.26 (95% confidence interval 0.21 to 0.31) log units in six hour group; 0.24 (0.19 to 0.29) log units in 12 hour group). The mean dose rates (hours a day) actually received, however, were also not significantly different (4.2 (3.7 to 4.7) in six hour group v 6.2 (5.1 to 7.3) in 12 hour group; P=0.06). The visual outcome was similar for those children who received three to six hours a day or more than six to 12 hours a day, but significantly better than that in children who received less than three hours a day. Children aged under 4 required significantly less occlusion than older children. Visual outcome was not influenced by type of amblyopia.
                Substantial (six hours a day) and maximal (12 hours a day) prescribed occlusion results in similar visual outcome. On average, the occlusion dose received in the maximal group was only 50% more than in the substantial group and in both groups was much less than that prescribed. Younger children required the least occlusion.
                Clinical Trials NCT00274664. To compare 2 hours of daily patching (combined with 1 hour of concurrent near visual activities) with a control group of spectacle wear alone (if needed) for treatment of moderate to severe amblyopia in children 3 to 7 years old.
                Prospective randomized multicenter clinical trial (46 sites).
                One hundred eighty children 3 to 7 years old with best-corrected amblyopic-eye visual acuity (VA) of 20/40 to 20/400 associated with strabismus, anisometropia, or both who had worn optimal refractive correction (if needed) for at least 16 weeks or for 2 consecutive visits without improvement.
                Randomization either to 2 hours of daily patching with 1 hour of near visual activities or to spectacles alone (if needed). Patients were continued on the randomized treatment (or no treatment) until no further improvement was noted.
                Best-corrected VA in the amblyopic eye after 5 weeks.
                Improvement in VA of the amblyopic eye from baseline to 5 weeks averaged 1.1 lines in the patching group and 0.5 lines in the control group (P = 0.006), and improvement from baseline to best measured VA at any visit averaged 2.2 lines in the patching group and 1.3 lines in the control group (P<0.001).
                After a period of treatment with spectacles, 2 hours of daily patching combined with 1 hour of near visual activities modestly improves moderate to severe amblyopia in children 3 to 7 years old. To determine whether performing near activities while patching for amblyopia enhances improvement in visual acuity.
                Randomized clinical trial.
                A total of 425 children, aged 3 to <7 years, with amblyopia (20/40-20/400) that was caused by anisometropia, strabismus, or both, and that persisted after treatment with spectacles.
                Children were randomized to 2 hours of patching per day with near activities or 2 hours of patching per day with distance activities. Instruction sheets describing common near and distance activities were given to the parents. Study visits were scheduled at 2, 5, 8, and 17 weeks. In weeks without a visit, weekly telephone calls were made to the parent to monitor and encourage compliance during the first 8 weeks.
                Masked assessment of visual acuity by isolated crowded HOTV optotypes at 8 weeks.
                At 8 weeks, improvement in amblyopic eye visual acuity averaged 2.6 lines in the distance activities group and 2.5 lines in the near activities group (mean difference in acuity between groups, adjusted for baseline acuity, 0.0 lines 95% confidence interval, -0.3 to 0.3). The 2 groups also appeared statistically similar at the 2-, 5-, and 17-week visits. At the 17-week examination, children with severe amblyopia improved a mean of 3.6 lines with 2 hours of daily patching.
                Performing common near activities does not improve visual acuity outcome when treating anisometropic, strabismic, or combined amblyopia with 2 hours of daily patching. Children with severe amblyopia may respond to 2 hours of daily patching. To compare spectacle correction alone with spectacle correction with Bangerter filters to treat anisometropic amblyopia in children.
                Prospective, randomized clinical trial.
                Eighty children (mean age, 4.4 years) with untreated anisometropic amblyopia and a median best-corrected visual acuity (BCVA) in the amblyopic eye of 0.4 logarithm of the minimum angle of resolution (logMAR).
                Optimal refractive correction was provided, and the children were assigned to treatment with either spectacles or spectacles in combination with a Bangerter filter worn on the spectacle lens of the better eye. The BCVA, binocular function, and refractive errors were measured repeatedly over the course of 1 year.
                The time course to resolution of the amblyopia (interocular difference, < or =1 line).
                The difference in the mean time to the resolution of amblyopia was 3.9+/-3.2 months for the spectacles group versus 2.2+/-1.9 months for the filter group, and the difference reached significance (P<0.05). The BCVA in the amblyopic eye improved significantly (P<0.001 for both comparisons) in both groups. After 1 year, there was no significant difference in the BCVA between the groups. The binocular function improved in both groups; at 1 year there was no significant difference between the groups. The median spherical equivalent refractive error increased significantly during the study in the amblyopic eyes (P<0.05) and the fellow eyes (P<0.001). The median anisometropia decreased significantly from the first visit to the 1-year visit in both groups (P<0.001 for both comparisons).
                We found a more rapid visual acuity recovery with the Bangerter filters than with spectacles alone in eyes with anisometropic amblyopia. However, the 1-year visual acuity outcome was not statistically significantly different between the 2 treatments.