AAO PPP Pediatric Ophthalmology/Strabismus Panel, Hoskins Center for Quality Eye Care
By the American Academy of Ophthalmology Preferred Practice Pattern Pediatric Ophthalmology/Strabismus Panel: Oscar A. Cruz, MD,
1 Michael X. Repka, MD, MBA, Consultant,
2 Amra Hercinovic, MPH, Methodologist,
3 Susan A. Cotter, OD, MS, Consultant,
4 Scott R. Lambert, MD,
5 Amy K. Hutchinson, MD,
6 Derek T. Sprunger, MD, MPH,
7 Christie L. Morse, MD,
8 David K. Wallace, MD, MPH, Chair
9 As of November 2015, the PPPs are initially published online-only in the
Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or
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1Anwar Shah Endowed Chair and Professor, Department of Ophthalmology and Department of Pediatrics, Saint Louis University Medical Center, Saint Louis, Missouri
2David L. Guyton, MD and Fednuniak Family Professor of Ophthalmology, Professor of Pediatrics, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
3Jaeb Center for Health Research, Tampa, Florida
4Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
5Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
6Professor of Ophthalmology, Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
7Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
8Concord Eye Center, Concord, New Hampshire
9Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
Please note that the Amblyopia PPP was updated in February 2024 by the PPP Pediatric Ophthalmology/Strabismus Panel. An additional reference (Wygnanski-Jaffe T, Kushner BJ, Moshkovitz A, et al. An eye-tracking-based dichoptic home treatment for amblyopia: A multicenter randomized clinical trial.
Ophthalmology. 2023;130:274-285) was added on P153 in the "Choice of Therapy" section and edits (bolded below) were made to the Binocular (Dichoptic) Digital Therapy section on P156:
"
Software and hardware development has continued and has been associated with improved outcomes. A randomized clinical trial of a digital dichoptic treatment using virtual reality headsets to deliver reduced contrast images to the nonamblyopic eye with masking of portions of the image visible to each eye, while viewing web-based content, found at 12 weeks that the mean amblyopic eye VA improved by 1.8 lines in the treatment group compared with 0.8 lines in the continued glasses group (P = 0.0011).
212 A randomized trial of movie viewing on a hand-held device using contrast reduction and complementary areas of image masking found improvement similar to that achieved with 2 hours of patching after 2 weeks of treatment.
213 Research with this technology is ongoing, which will be used to delineate use of binocular therapy for treatment of amblyopia.
208 Another randomized prospective clinical trial studied a digital therapeutic using a desk based computer platform, red-blue anaglyph glasses and an eye tracker found at 16 weeks the therapeutic (2.8 lines of improvement to be non-inferior to patching 2 hours per day (2.3 lines of improvement).* (I+, Good, Discretionary) (See Appendix 3.)"
*Wygnanski-Jaffe T, Kushner BJ, Moshkovitz A, et al. An eye-tracking-based dichoptic home treatment for amblyopia: A multicenter randomized clinical trial.
Ophthalmology. 2023;130:274-285
Highlighted Findings and Recommendations for Care
Treatment of refractive error alone can improve visual acuity (VA) in children who have anisometropic, strabismic, or combined amblyopia. Visual acuity of children who have bilateral refractive amblyopia also can substantially improve with refractive correction alone.
Most children who have moderate amblyopia (20/40 to 20/80) respond to initial treatment consisting of 2 hours of daily patching or weekend atropine.
Following treatment of amblyopia caused by strabismus, anisometropia, or both, continued monitoring is necessary and additional treatment, if needed, is associated with long-term durability of the VA improvement.
Suitable treatment options for amblyopia include optical correction, patching, pharmacological treatment, optical treatment, Bangerter (translucent) filters, and digital therapeutics, in addition to managing the underlying cause of amblyopia.
Amblyopia treatment may be effective in older children and adolescents, particularly if they have not previously been treated.
Literature Search
Amblyopia PPP - 2022 - Literature Search