Common childhood eye disorder is best treated by patching earlier, a new study published in The Lancet shows

Irene Gottlob, MD

Most children with a ‘lazy eye’ benefit from earlier patching, new research by University of Leicester and Cooper Medical School of Rowan University experts show.

Amblyopia (or lazy eye), the most common childhood visual disease, is typically treated by wearing glasses to correct the patient’s vision for a lengthy period of time before patching the eye with better vision to stimulate the weaker eye.

But a new study has found that patching sooner without a long period of glasses wearing helps to correct the disorder more effectively in most children, leading to improved vision and treatment satisfaction.

The research was carried out under the collaboration of the European Pediatric Amblyopia Treatment Study for Children (EuPatch), set up by the University of Leicester. Its findings have now been published in the Lancet and could prove vital for updating clinical guidelines around the world.

The study has been jointly led by senior author clinical lead Irene Gottlob, MD, previously Professor and Chair of Ophthalmology at University of Leicester, along with Frank Proudlock, Associate Professor and Michael Hisaund, research orthoptist at the University of Leicester. Dr. Gottlob is currently Professor of Neurology at  Cooper Medical School of Rowan University and attending physician with Cooper and Inspira Neurosciences in Camden, New Jersey.

“These results are important because an extended period of glasses wearing before patching is commonly used today by many countries,” Dr.  Gottlob said.

“Amblyopia affects 1-5% of children and currently treatment outcomes are poor. We hope that the results of this study could pave the way for personalized treatment care for children with amblyopia, tailoring the type of treatment to the child.”

Amblyopia is usually caused by either strabismus, where the two eyes look in different directions, or anisometropia, where the light focusing mechanisms are different between the two eyes. It typically leads to much poorer vision in one eye and if left untreated can generate lifelong visual problems.

The study divided 334 children aged between three and eight years in a randomized controlled trial across hospitals in the UK, Greece, Austria, Germany and Switzerland, who required treatment for ‘lazy eye’ into two groups. One group received patching treatment for 24 weeks after a lengthy period of 18 weeks wearing glasses. The other group received patching treatment for 24 weeks after only three weeks wearing glasses.

It found that for most children with amblyopia, patching earlier was more effective than patching following an extended period of wearing glasses.

However, one group of younger children, with less severe amblyopia, did benefit from a lengthier period of 18 weeks glasses wearing before patching as they were most likely to improve during this time.

Dr Proudlock said: “We measured the improvement in vision as the main outcome, but we also found, using questionnaires, that families preferred to start patching without a period of prolonged glass wear. The numbers of hours of patching needed was equal in both groups. Since younger children with less severe visual loss responded better to initial treatment with glasses, our study introduced an important advancement in personalized medicine.”

He added that further research was needed to improve personalized care for amblyopia.

The study was funded by Action Medical Research, the NIHR Clinical Research Network who supported the UK sites through the NIHR portfolio adoption scheme and the Ulverscroft Foundation.


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