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  • AAO OTAC Pediatric Ophthalmology/Strabismus Panel, Hoskins Center for Quality Eye Care
    Pediatric Ophth/Strabismus


    A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel.

    David G. Morrison, MD;1 Gena Heidary, MD, PhD;2 Melinda Y. Chang, MD;3 Gil Binenbaum, MD, MSCE;4 Kara M. Cavuoto, MD;5 Jennifer A. Galvin, MD; 6 Rupal H. Trivedi, MD, MSCR,7 Stephen J. Kim, MD;8 and Stacy L. Pineles,MD9 

    Ophthalmology, Vol. 130, issue 11, P1221-1227, © 2023 by the American Academy of Ophthalmology. Click here for full access to the OTA.

    Purpose: To review the published literature on the use of levodopa/carbidopa to augment the treatment of amblyopia. 

    Methods: Literature searches for English language studies were last conducted in October 2022 in the PubMed database with no date restrictions. The combined searches yielded 55 articles, of which 23 were reviewed in full text. Twelve of these were considered appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Nine studies were rated level I and 3 studies were rated level II; there were no level III studies.

    Results: The duration of treatment was limited to 3 to 16 weeks because of concern about long-term adverse effects such as tardive dyskinesia. This complication was not reported in any of the study participants. The dose of levodopa ranged from 1.5 to 8.3 mg/kg/day, generally divided into 3 daily doses. The carbidopa dose was approximately 25% of the levodopa dose in all treatments. Evidence from these studies indicates that augmenting traditional patch occlusion therapy with the oral administration of levodopa/carbidopa can improve the vision of amblyopic children, but the effect was small (0.17–0.3 logMAR units) and only statistically significant when compared with patching alone in 2 of the 12 studies cited. Regression of vision was reported in the majority of studies (9 of 12 reported; range, 0–0.17 logMAR unit regression) after discontinuation of therapy. Short-term side effects of the medications were not consistently reported but were most frequently mild and included headache and nausea.

    Conclusions: The best available evidence is currently insufficient to show that augmenting amblyopia therapy using up to 16 weeks of levodopa/carbidopa will result in meaningful improvement in visual acuity. Given the potential for significant side effects such as tardive dyskinesia with long-term therapy, levodopa/carbidopa does not appear to be a viable option for amblyopia therapy.

    1Hess Pediatric Ophthalmology, Saint Petersburg, FL 
    2Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts 
    3Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 
    4Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania  
    5Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 
    6Eye Physicians & Surgeons, PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT   
    7Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina
    8Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, TN 

    Jules Stein Eye Institute, Los Angeles, California