Abstract :
Purpoe
To ae the coure of the repone to atropine treatment of moderate amblyopia and to ae factor predictive of the treatment repone in children 3 year old to younger than 7 year old.
Deign
Multicenter, randomized clinical trial comparing atropine and patching (one of the amblyopia treatment tudie).
Method
A total of 195 children 3 year old to younger than 7 year of age with amblyopia in the range of 20/40 to 20/100 from the atropine treatment arm of thi trial were enrolled and included in thi analyi. At baeline, daily topical atropine wa precribed for the ound eye. During follow-up, a plano pectacle len wa precribed for the ound eye for patient whoe amblyopia had not been uccefully treated with atropine alone. Follow-up examination were performed at 5 week, 16 week, and 6 month. The primary outcome meaure wa viual acuity in the amblyopic eye at 6 month.
Reult
Mean viual acuity improved from baeline by 1.3 line after 5 week of treatment, by 2.4 line after 16 week, and by 2.8 line at 6 month. Viual acuity of 20/30 or better and/or 3 or more line of improvement from baeline wa achieved by 75% of the patient. Improvement occurred over the entire range of baeline acuitie (20/40 to 20/100) and wa not related to patient age (P = .36). Among the 134 patient improving 3 or more line from baeline, 7% achieved their maximum improvement by 5 week and 46% by 16 week. Among the 55 patient who did not repond adequately to atropine alone and were precribed a plano len for the ound eye, the mean improvement before the ue of the plano len wa 1.0 line, compared with 1.6 line after precribing the plano len (P = .11). None of the demographic or clinical factor aeed wa predictive of the repone to treatment. A hift in fixation preference at/near from the atropinized ound eye to the amblyopic eye wa not required for the amblyopic eye to improve; amblyopic eye acuity improved 3 or more line in 29 (60%) of the 48 patient who were found to be uing the atropinized ound eye on fixation preference teting. A 2 or more line decreae in ound eye viual acuity occurred more frequently when a plano len wa precribed in addition to atropine (7 of 43, 16%) compared with treatment with atropine alone (4 of 123, 3%; P = .01).
Concluion
A beneficial effect of atropine i preent throughout the age range of 3 year old to younger than 7 year old, and with an acuity range of 20/40 to 20/100. A hift in near fixation to the amblyopic eye i not eential for atropine to be effective in all cae. ound eye acuity hould be monitored when a plano pectacle len i precribed for the ound eye to augment the treatment effect of atropine.
