Interventions for unilateral refractive amblyopia.
BACKGROUND
Unilateral refractive amblyopia is a common cause of reduced visual acuity in childhood, but optimal treatment is not well defined. This review examined the treatment effect from spectacles and conventional occlusion.


OBJECTIVE
Evaluation of the evidence of the effectiveness of spectacles and or occlusion in the treatment of unilateral refractive amblyopia.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. Relevant conference proceedings were manually searched. There were no date or language restrictions. The searches were last run on 7 July 2008.


METHODS
Randomised controlled trials of treatment for unilateral refractive amblyopia by spectacles, with or without occlusion were eligible. We included studies with participants of any age.


METHODS
Two authors independently assessed abstracts identified by the searches. We obtained full text copies and contacted study authors where necessary. Eight trials were eligible for inclusion. Data were extracted from seven. No meta-analysis was performed.


RESULTS
For all studies mean acuity (standard deviation (SD)) in the amblyopic eye post treatment is reported.Comparison: Spectacles only versus no treatment (Clarke 2003). Mean (SD) visual acuity: spectacles group 0.31 (0.17); no treatment group 0.42 (0.19). Mean difference (MD) between groups -0.11 (borderline statistical significance: 95% confidence interval (CI) -0.22 to 0.00).Comparison: Spectacles plus occlusion versus no treatment (Clarke 2003). Mean (SD) visual acuity: full treatment 0.22 (0.13); no treatment 0.42 (0.19). Mean difference between the groups -0.20 (statistically significant: 95% CI -0.30 to -0.10).Comparison: Spectacles plus occlusion versus spectacles only: Clarke 2003 MD -0.09 (borderline statistical significance 95% CI, -0.18 to 0.00); PEDIG 2005b; MD -0.15 (not statistically significant 95% CI -0.32 to 0.02); PEDIG 2006a; MD 0.01 (not statistically significant 95% CI -0.08 to 0.10).Comparison: Occlusion regimes. PEDIG 2003a: 2 hours versus 6 hours for moderate amblyopia: MD 0.01 (not statistically significant: 95% CI -0.06 to 0.08); PEDIG 2003b: 6 hours versus full-time for severe amblyopia: MD 0.03 (not statistically significant: 95% CI -0.08 to 0.14). Stewart 2007a: 6 hours versus full-time occlusion: MD -0.12 (not statistically significant: 95% CI -0.27 to 0.03)


CONCLUSIONS
In some cases of unilateral refractive amblyopia it appears that there is a treatment benefit from refractive correction alone. Where amblyopia persists there is some evidence that adding occlusion further improves vision. It remains unclear which treatment regimes are optimal for individual patients. The nature of any dose/response effect from occlusion still needs to be clarified.
Shotton
Kate
K
Department of Ophthalmology, Royal Victoria Infirmary, Claremont Wing, Queen Victoria Road, Newcastle upon Tyne, UK, NE1 4LP. kate.shotton@nuth.nhs.uk
Powell
Christine
C
Voros
Gerasimos
G
Hatt
Sarah R
SR
D000293:Adolescent; D000550:Amblyopia / Q000628:therapy*; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005139:Eyeglasses; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012030:Refractive Errors / Q000628:therapy; D014792:Visual Acuity