Risk of amblyopia recurrence after cessation of treatment.
BACKGROUND
Although amblyopia can be successfully treated with patching or atropine, there have been few prospective studies of amblyopia recurrence once treatment is discontinued.


METHODS
We enrolled 156 children with successfully treated anisometropic or strabismic amblyopia (145 completed follow-up), who were younger than 8 years of age and who received continuous amblyopia treatment for the previous 3 months (prescribed at least 2 hours of daily patching or prescribed at least one drop of atropine per week) and who had improved at least 3 logMAR levels during the period of continuous treatment. Patients were followed off treatment for 52 weeks to assess recurrence of amblyopia, defined as a 2 or more logMAR level reduction of visual acuity from enrollment, confirmed by a second examination. Recurrence was also considered to have occurred if treatment was restarted because of a nonreplicated 2 or more logMAR level reduction of visual acuity.


RESULTS
Recurrence occurred in 35 (24%) of 145 cases (95% confidence interval 17% to 32%) and was similar in patients who stopped patching (25%) and in patients who stopped atropine (21%). In patients treated with moderately intense patching (6 to 8 hours per day), recurrence was more common (11 of 26; 42%) when treatment was not reduced prior to cessation than when treatment was reduced to 2 hours per day prior to cessation (3 of 22; 14%, odds ratio 4.4, 95% confidence interval 1.0 to 18.7).


CONCLUSIONS
Approximately one fourth of successfully treated amblyopic children experience a recurrence within the first year off treatment. For patients treated with 6 or more hours of daily patching, our data suggest that the risk of recurrence is greater when patching is stopped abruptly rather than when it is reduced to 2 hours per day prior to cessation. A randomized clinical trial of no weaning versus weaning in successfully-treated amblyopia is warranted to confirm these observational findings.
Holmes
Jonathan M
JM
Jaeb Center for Health Research, Tampa, FL 33647, USA. holmes.jonathan@mayo.edu
Beck
Roy W
RW
Kraker
Raymond T
RT
Astle
William F
WF
Birch
Eileen E
EE
Cole
Stephen R
SR
Cotter
Susan A
SA
Donahue
Sean
S
Everett
Donald F
DF
Hertle
Richard W
RW
Keech
Ronald V
RV
Paysse
Evelyn
E
Quinn
Graham F
GF
Repka
Michael X
MX
Scheiman
Mitchell M
MM
D000550:Amblyopia / Q000209:etiology* / Q000628:therapy; D001285:Atropine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012683:Sensory Deprivation; D014792:Visual Acuity; D028761:Withholding Treatment
D009184:Mydriatics; D001285:Atropine