To patch right away or not? This is the question researchers sought to answer in a recent study investigating amblyopia treatment. The team reviewed treatment with glasses and patching when needed, in addition to glasses and patching simultaneously.
A total of 98 patients between the ages of three and 12 were included with a six-month follow-up period. Of the participants, 36 were categorized as simultaneous treatment (concurrent glasses and patching therapy at the first visit) and 62 were categorized as sequential treatment (glasses alone at the first visit followed by patching therapy at the second visit).
The investigators found that VA improved approximately four lines regardless of treatment type, with a similar improvement noted in interocular difference (IOD) as well. “The rate of improvement and length of treatment did not differ between groups despite a median delay of three months before the initiation of patching therapy for the sequential group patients,” the authors explained in their study.
Although VA and IOD outcomes were similar between treatment groups initially, stereopsis seemed to improve more in the sequential treatment group, with limitations. Despite a considerable difference in initial median stereopsis measures, the range of values in the two groups was nearly identical at the first visit, “confirming that stereopsis in both groups was similar at the onset of therapy, as was the percentage of patients with no measurable stereopsis,” the authors noted. However, they add, the pattern of stereopsis improvement appeared to differ between groups, with the sequential group experiencing stereopsis gains over the full course of treatment.
“Our study raises the possibility that a sequential approach to glasses wear and part-time patching may be preferred to optimize the development of stereopsis in the subset of children who do not have measurable stereopsis at presentation,” the authors explained in their study. “This period of uninterrupted spectacle correction could help stimulate binocular fusion and reduce suppression of the amblyopic eye, fostering binocularity and an appreciation of stereopsis.”
Chinn RN, Michalak SM, Shoshany TN, et al. Effect of sequential and simultaneous patching regiments in unilateral amblyopia. Am J Ophthalmol. July 12, 2021. [Epub ahead of print].