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17-11-2011 | Genetics | Article

Amblyopia treatment most effective in younger children

Abstract

Free abstract

MedWire News: Children younger than 7 years of age show a greater response to treatment for amblyopia than older children, although older patients can still have a marked response, the results of a US study indicate.

Previous studies have demonstrated that amblyopia treatment is effective in some older children. However, the question as to whether there is a relationship between age and size of treatment response remains unanswered, explain the study authors.

To investigate further, Jonathan Holmes, from the Jaeb Center for Health Research, in Tampa, Florida, and colleagues conducted a meta-analysis of four recently published randomized amblyopia treatment trials involving 996 children aged 3-13 years.

The participants, all of whom had unilateral amblyopia with 20/40 to 20/400 amblyopic eye visual acuity, were categorized into three groups: 3 to less than 5 years; 5 to less than 7 years; and 7 to less than 13 years.

Age was related to improvement in logMAR visual acuity with treatment, after adjustment for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol.

Initial analysis suggested that there was a decrease in treatment response with increasing age, which was particularly noticeable in children with more severe amblyopia, the team notes in the Archives of Ophthalmology.

They also observed that there was a significant interaction between age group and prior amblyopia treatment, indicating reduced improvement in amblyopic eye visual acuity in children 3 to less than 5 years of age with a history of prior amblyopia treatment than without (1.83 vs 2.74 logMAR lines)

For both moderate and severe amblyopia, children in the oldest age group had a significantly smaller treatment response than younger children. While there was no difference in treatment response between the two youngest age groups for moderate amblyopia, there was a trend for an improved response to treatment in the youngest age group compared with the middle age group for severe amblyopia.

The researchers conclude: "While there is improvement in visual acuity across all age ranges (from 3 to <13 years of age), children 7 to less than 13 years of age are least responsive to amblyopia treatment."

They add: "Nevertheless, it seems reasonable to offer treatment to even older teenagers (eg, through age 17 years) because we are currently unable to predict which patients will or will not respond."

By Liam Davenport

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