May 22, 2024
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Amblyopia, or lazy eye, is typically treated by wearing glasses for a lengthy period of time before patching the eye with better vision to stimulate the weaker eye. A new study suggests there is a better approach.
A new study's findings may transform worldwide treatment for the most common childhood visual disease, and the Philadelphia area can now call one of the lead researchers a local.
Amblyopia, or lazy eye, is reduced vision in one eye, rarely in both eyes, that occurs in early childhood when there is a disruption in the nerve pathways between the eye and the brain. Because of this breakdown, the brain eventually stops recognizing sight from one eye, making the stronger eye work harder. The weaker eye often wanders inward or outward, giving it the name lazy eye – although the person with the condition cannot control it.
Amblyopia affects 1% to 5% of the worldwide population. The global, treatment standard has been to have children wear glasses for four to six months and then patch the eye with better vision to strengthen the weaker eye. But "these guidelines were not really evidence-based," said Dr. Irene Gottlob, senior author of the study recently published in the journal The Lancet.
Gottlob was previously professor and chair of ophthalmology at the University of Leicester in England, where the research was conducted in collaboration with the European Pediatric Amblyopia Treatment Study for Children. Now, Gottlob is a professor of neurology at Cooper Medical School of Rowan University and an attending physician with Cooper and Inspira Neurosciences in Camden, New Jersey.
Gottlob and her team found that patching sooner – without a long period of glasses use – not only corrected amblyopia more effectively in most children but also led to better treatment satisfaction among families and children than the current mainstay of extended optical treatment. It was the first study to compare a group treated with extended glasses use to a group with earlier eye-patching. One group wore glasses for 18 weeks before 24 weeks of patching – currently the standard treatment for the disease – and the second group wore glasses for just three weeks before 24 weeks of patching.
The study involved 334 children, ages 3 to 8, with newly detected, untreated amblyopia in hospitals in the United Kingdom, Greece, Austria, Germany and Switzerland.
Though some younger children with less severe amblyopia benefitted from extended glasses wearing period before patching, the study indicated that for most children with amblyopia, patching earlier was more effective. The quality of life questionnaires also were more positive for the group that started patching earlier.
Gottlob said this might be partly because families "see improvement faster" with earlier patching. She said compliance improves, too.
"If the parents see each time they come for a visual check that the vision is better, then they are more motivated," Gottlob said.
She wants to extend her research into how to personalize care for children with amblyopia.
"It's not very specialized," Gottlob said about current treatment.
For instance, mild amblyopia may call for less patching, but more severe forms may necessitate more patching. Doctors also may prescribe once-a-day drops of atropine that temporarily blur vision in the stronger eye to make the weaker eye work harder. But developing more refined treatment protocols for specific groups may improve results, shorten treatment duration, cut health care costs and improve compliance, Gottlob said.
Diagnosing amblyopia as early as possible is important because the younger the children are, the better and faster they respond to treatment because the "brain has more plasticity," Gottlob said.
If left untreated, amblyopia can cause lifelong visual problems.
"The good thing is, it can be treated," Gottlob said. "There are other conditions that cannot be treated, so it's a good thing" that this disease can be addressed, she said.
The Mayo Clinic advises:
• See your child's doctor if you notice your child's eye wandering after the first few weeks of life.
• A vision check is especially important if there's a family history of crossed eyes, childhood cataracts or other eye conditions.
• For all children, a complete eye exam is recommended between ages 3 and 5.
