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18-08-2011 | General practice | Article

Start young to reap most benefit from childhood amblyopia therapy

Abstract

Free abstract

MedWire News: Amblyopia treatment may be more effective in children younger than 7 years than in children up to the age of 13 years US researchers suggest.

A reduced treatment efficacy in older children may be due to declining central nervous system plasticity with increasing age or poor treatment compliance among old compared with young children, say Jonathan Holmes (Mayo Clinic, Rochester, Minnesota) and colleagues.

The team performed a four-study meta-analysis in which response to amblyopia treatment, defined as improvement in baseline visual acuity, was analyzed among 996 children aged 3-12 years.

All participants had moderate or severe unilateral amblyopia with a baseline visual acuity ranging from 20/40 to 20/400. Treatment consisted of patching of the lazy eye, atropine eye drop use, and/or Bangerter filter, and lasted 17-24 weeks.

As reported in the Archives of Ophthalmology, Holmes and team observed a significantly smaller improvement in visual acuity among children aged 7 to less than 13 years compared with those aged 3 to less than 7 years.

A lower treatment response was noted among children aged 3-4 years compared with those aged 5-7 years; however, this only occurred among participants with severe amblyopia (visual acuity 20/125 to 20/400).

"Despite the reduced treatment response in older children (ie, 7-12 years of age) compared with younger children, there was still an improvement in the mean visual acuity with treatment, and some individuals responded dramatically," remark the researchers.

Indeed, lines of visual acuity improved 1.65- to 4.16-fold among all children.

Holmes and colleagues conclude that occlusion dose monitors may be useful in future studies aiming to determine if age-related compliance is the underlying reason for the better treatment response seen among young children compared with older children.

By Lauretta Ihonor

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