A Randomized Trial of Near Versus Distance Activities While Patching for Amblyopia in Children Aged 3 to Less Than 7 Years
Received 15 April 2008; received in revised form 14 May 2008; accepted 25 June 2008. published online 12 September 2008.
Purpose
To determine whether performing near activities while patching for amblyopia enhances improvement in visual acuity.
Design
Randomized clinical trial.
Participants
A total of 425 children, aged 3 to <7 years, with amblyopia (20/40–20/400) that was caused by anisometropia, strabismus, or both, and that persisted after treatment with spectacles.
Methods
Children were randomized to 2 hours of patching per day with near activities or 2 hours of patching per day with distance activities. Instruction sheets describing common near and distance activities were given to the parents. Study visits were scheduled at 2, 5, 8, and 17 weeks. In weeks without a visit, weekly telephone calls were made to the parent to monitor and encourage compliance during the first 8 weeks.
Main Outcome Measure
Masked assessment of visual acuity by isolated crowded HOTV optotypes at 8 weeks.
Results
At 8 weeks, improvement in amblyopic eye visual acuity averaged 2.6 lines in the distance activities group and 2.5 lines in the near activities group (mean difference in acuity between groups, adjusted for baseline acuity, 0.0 lines 95% confidence interval, −0.3 to 0.3). The 2 groups also appeared statistically similar at the 2-, 5-, and 17-week visits. At the 17-week examination, children with severe amblyopia improved a mean of 3.6 lines with 2 hours of daily patching.
Conclusions
Performing common near activities does not improve visual acuity outcome when treating anisometropic, strabismic, or combined amblyopia with 2 hours of daily patching. Children with severe amblyopia may respond to 2 hours of daily patching.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: September 11, 2008.
Manuscript no. 2008-468.
Financial Disclosure(s): No conflicting relationships exist.
Supported by National Eye Institute of National Institutes of Health, Department of Health and Human Services EY011751 (Pediatric Eye Disease Investigator Group).
Correspondence: Jonathan M. Holmes, BM, BCh, c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647. pedig@jaeb.org
Writing Committee: Lead authors: Jonathan M. Holmes, BM, BCh, Don W. Lyon, OD, Samara F. Strauber, MS.
Additional writing committee members: Eileen E. Birch, PhD, Roy W. Beck, MD, PhD, Yasmin S. Bradfield, MD, Rhonda Hodde, Deborah L. Klimek, MD, Dave H. Lee, MD, B. Michele Melia, ScM, Erin R. Nosel, OD, Michael X. Repka, MD, Diane L. Tucker, OD.
⁎ A list of the members of the Pediatric Eye Disease Investigator Group participating in the study is available in Appendix 1 at http://aaojournal.org.
ABSTRACT