Arch Ophthalmol. 2011;129:960-962.
- A meta-analysis of data of 996 children from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity.
- Strabismus, anisometropia, or both caused the amblyopia.
- The protocols were (1) patching 2 hours per day with near or distance activities for children ages 3 years to younger than 7 years; (2) treatment with atropine with or without a plano lens for children ages 3 years to younger than 7 years; (3) treatment with atropine or patching 2 hours per day for children ages 7 years to younger than 13 years; and (4) use of a Bangerter filter or patching 2 hours per day for children ages 3 years to younger than 10 years.
- The 4 trials were not designed to determine the maximal treatment effect.
- Primary outcome was assessed at 17 to 24 weeks after enrollment.
- Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol.
- Age was categorized (3 to < 5 years, 5 to < 7 years, and 7 to < 13 years) because there was a nonlinear relationship between age and improvement in amblyopic eye visual acuity.
- Results demonstrated that children ages 7 years to younger than 13 years were significantly less responsive to treatment than were younger age groups (children 3 to < 5 years old or children 5 to < 7 years old) for moderate and severe amblyopia (P < .04 for all 4 comparisons).
- There was an association between greater improvement in amblyopic eye visual acuity and a less hyperopic amblyopic eye spherical equivalent (P = .002).
- There was significant interaction between age group and prior amblyopia treatment (P = .02), indicating less improvement in amblyopic eye visual acuity with a history of amblyopia treatment than without in children ages 3 years to younger than 5 years (P = .02).
- There was no association between amblyopic visual acuity improvement with amblyopia type (P = .20), amblyopia study treatment (P = .14), and protocol (P = .28).
- There was no difference in treatment response between children 3 years old to younger than 5 years and children 5 years old to younger than 7 years for moderate amblyopia (P = .67), but there was a suggestion of greater responsiveness in children 3 years old to younger than 5 years vs children 5 years old to younger than 7 years for severe amblyopia (P = .09).
- Possible reasons for a reduced response to amblyopia treatment in older children are there may be declining plasticity of the central nervous system as children age and poorer compliance when older children are treated.
- There was improvement in visual acuity across all ages in the treatment of amblyopia; however, amblyopia is more responsive to treatment among children younger than 7 years.