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  • Sequential Versus Simultaneous Patching for Unilateral Amblyopia

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, January 2022

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    Which patching regimen is best for children with unilateral amblyopia? The Academy recommends spectacle wear as the first step, followed by part-time occlusion of the nonamblyopic fellow eye if glasses alone aren’t effective. In the approach known as simultaneous treatment, the child wears glasses full-time and uses occlusion on a part-time basis. Chinn et al. compared visual out­comes for the two regimens and found little difference between them.

    For this retrospective study, the researchers assessed children (ages 3-12 years) with unilateral amblyopia diagnosed at Boston Children’s Hos­pital during a five-year period. Other requirements were visual acuity (VA) of 20/40 to 20/200 (with interocular difference ≥3 lines) and a follow-up visit that occurred three to nine months after therapy was begun. Criteria for exclusion were deprivation amblyopia, any previous amblyopia treatment, and surgery for strabismus or cataract.

    Patients were grouped by type of regimen: “simultaneous treatment” (concurrent glasses/patching initially) or “sequential treatment” (glasses at first visit plus patching at second visit). Median age was similar for the two co­horts (5.26 and 5.10 years, respective­ly). Outcome measures were VA and stereopsis at the most recent follow-up visit.

    Of 2,311 patients in the Boston Amblyopia Study database, 98 met the inclusion criteria for this study; therapy was simultaneous for 36 and sequential for 62. VA improvement in amblyopic eyes was similar: The median change was +0.40 logMAR with each regimen (interquartile range [IQR]: 0.56-0.30 for simultaneous, 0.52-0.27 for sequential). For patients without stereopsis when therapy was initiated, outcomes for this parameter were better with sequential therapy (5.12 log stereopsis [IQR, 4.00-7.51]) than with simultaneous therapy (8.01 log stereopsis [IQR, 5.65-9.21]) (p = .046).

    In this study, both regimens were found to improve VA by approximately 4 lines. For patients whose stereopsis is not problematic when treatment is begun, sequential patching may be the better choice, said the authors. They affirmed that additional studies are needed to validate these findings. Of note, the Pediatric Eye Disease Investi­gator Group is recruiting participants for a randomized controlled study of the two regimens.

    The original article can be found here.