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  • Sequential vs. simultaneous treatment for amblyopia: Which is the better choice?

    Pediatric Ophth/Strabismus

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    Review of: Effect of sequential and simultaneous patching regimens in unilateral amblyopia

    Chinn R, Michalak S, Shoshany T, et al. American Journal of Ophthalmology, January 2022

    Investigators compared the preferred practice of treating amblyopia with glasses first and then part-time occlusion of the nonamblyopic fellow-eye if glasses are not effective (“sequential treatment”) with concurrent initiation of both full-time glasses use and part-time occlusion therapy (“simultaneous treatment”).

    Study design

    This was a US-based, retrospective, longitudinal, single-center nonrandomized clinical trial conducted between 2010 and 2014. Ninety-eight pediatric patients were included: 62 given sequential treatment and 36 given simultaneous treatment. The 2 main outcome measures were visual acuity (VA) and stereopsis, evaluated in a younger cohort (aged 3–6 years) and an older cohort (aged 7–12 years).

    Outcomes

    Improvements in VA were seen in both treatment groups at the 6-month follow-up visit. In patients without measurable stereopsis at baseline visit, especially in the younger cohort, the use of sequential treatment led to better/improved stereopsis outcomes than the use of simultaneous treatment (median change from baseline to 6 months: −1.29 log stereopsis vs. −0.26 log stereopsis, respectively).

    Limitations

    Limitations include the retrospective nature of the study and non-randomization of patients. In addition, out of a large database of 2311 patients, only 98 patients met eligibility criteria and were spread unevenly between the treatment groups. In addition, neither the VA nor the stereopsis outcome measures were uniformly measured.

    Clinical significance

    The authors suggest that patients with a new diagnosis of amblyopia start with wearing glasses full time in order to boost stereopsis recovery, as glasses can help promote binocular fusion without the need for patching. The most recent results from the Pediatric Eye Diseases Investigator Group (PEDIG) randomized trial, ATS22, are expected to be available in mid-2023 and will likely provide more information as to which treatment regimen is the most effective to treat amblyopia.