Eye Drops to Treat Childhood Eye Disorder
Works As Well as Patching the Eye
CINCINNATI -- Eye drops can be used to treat amblyopia (lazy eye), the most common cause of visual impairment in children, as effectively as the standard treatment of patching one eye, according to a new study conducted at 47 centers in the United States, including Cincinnati Children's Hospital Medical Center.
The finding, to be published in the March issue of Archives of Ophthalmology, may lead to better compliance with treatment and improved quality of life in children with this eye disorder, according to Constance West, M.D., director of Ophthalmology at Cincinnati Children's.
After six months of treatment, researchers found that the drug atropine, when placed in the unaffected eye once a day, works as well as eye patching and may encourage better compliance, which is an important factor in the success of therapy. Timely and successful treatment for amblyopia in childhood can prevent lifelong visual impairment.
Dr. West has been treating amblyopia in this manner for 11 years is one of only 3 percent of investigators who believed that atropine would be equivalent to patching.
Amblyopia is a condition of poor vision in an otherwise healthy eye in which the brain has learned to favor the unaffected eye. Although the eye with amblyopia looks normal, there is interference with normal visual processing that limits the development of a portion of the brain responsible for vision. The most common causes of amblyopia are misalignment of the eyes (crossed eyes) or significant differences between the two eyes in refractive error, such as farsightedness or nearsightedness.
Amblyopia usually begins in infancy or childhood. It is estimated that as many as 3 percent of children in the U.S. have some degree of vision impairment due to amblyopia.
Treatment is most effective when started in children less than 7 years old. Most eye care professionals treat amblyopia by placing an opaque adhesive patch, or "eye bandage," on the skin to cover the unaffected eye. This forces the child to use the eye with amblyopia, which stimulates vision and helps the part of the brain that manages vision to develop more completely.
Many children, however, do not like the appearance of the eye patch and the accompanying social and psychological stigma associated with it, so they do not wear it. In addition, patching forces a child to use an eye that has poor vision, often making compliance difficult for active children. The atropine eye drop works by temporarily blurring vision in the unaffected eye, thereby forcing the eye with amblyopia to be used. This strengthens the eye and improves vision. A parent simply places a drop in the child's eye once a day. With patching, a parent must monitor the child for at least six hours each day for many weeks or months.
In the Amblyopia Treatment Study, 215 children were randomly assigned to receive patching, and 204 were assigned to receive atropine eye drops. Researchers found that 79 percent of those receiving the eye patch were treated successfully, and that 74 percent of those receiving the atropine were treated successfully. This difference is clinically insignificant. Although researchers found that vision in the amblyopic eye improved faster in the patching group, the difference in the two groups at six months was small and not significant.
Since both patching and atropine work equally well, the choice of treatment can be made by the eye care professional in consultation with the parent. The children who were treated in this study will continue to be followed until April 2003, allowing researchers to learn whether there is any longer term advantage to treating amblyopia with either patching or atropine.
The study was funded by the National Eye Institute and coordinated by the Jaeb Center for Health Research in Tampa, Florida, and the Wilmer Eye Institute of Johns Hopkins University in Baltimore.
The study looked only at children with moderate amblyopia. Studies are underway at Cincinnati Children's to investigate the use of atropine in children with more severe amblyopia.
Contact Information
Jim Feuer
jim.feuer@chmcc.org
513-636-4656
