• By:

    Erica Oltra, MD

     

    Amblyopia

    Deciding how and when to stop amblyopia treatment generally depends on the patient’s age, final visual acuity, and either resolution of amblyopia or cessation of improvement in vision. The reported rates of recurrent amblyopia vary widely between studies, from 6% to 75%. Several recent large cohort studies have reported recurrence rates of approximately 25% at one year,1,2  though another study of older children (7-12 years) found a lower one-year recurrence rate of 7%.3  Recurrence occurs more frequently in the first several months after ending treatment, so close follow-up is recommended after stopping therapy and at least through the first year. Recurrence risk seems to be similar in those stopping patching and those stopping atropine.1 

    As expected, age and recurrence of amblyopia are inversely related, so those stopping therapy under the age of 10 require close monitoring for recurrence.2  One study found that the recurrence rate is higher in patients who abruptly stop patching 6 or more hours a day compared with those who stop patching just 2 hours a day.1 Therefore, patients being treated with 6 or more hours of daily patching should be weaned gradually from treatment. 

    Risk factors for recurrence include better visual acuity at the time of stopping treatment, a greater number of lines improved during treatment, and a history of recurrence.4 One study showed that older age at the time of diagnosis was a risk factor for recurrence, with patients diagnosed older than 7 years of age at nearly 8 times greater risk.5  Interestingly, orthotropia and high-grade stereoacuity are not protective against recurrence. 

    References

    1. The Pediatric Eye Disease Investigator Group. Risk of amblyopia recurrence after cessation of treatment.  J AAPOS.  2004;8:420-28.
    2. Bhola R, Keech RV, Kutschke P, et al. Recurrence of amblyopia after occlusion therapy.  Ophthalmology.  2006;113:2097-2100.
    3. The Pediatric Eye Disease Investigator Group. Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years.  Arch Ophthalmol.  2007;125:655-59. 
    4. The Pediatric Eye Disease Investigator Group. Factors associated with recurrence of amblyopia on cessation of patching.  Ophthalmology.  2007;114:1427-1432.
    5. Saxena R, Puranik S, Singh D, et al.  Factors predicting recurrence in successfully treated cases of anisometropic amblyopia.  Indian J Ophthalmol.  2013;61:630-33.