Effectiveness of early in comparison to late(r) treatment in children with amblyopia or its risk factors: a systematic review.
OBJECTIVE
To evaluate the effectiveness of early in comparison to late(r) treatment in children with (1) amblyopia or (2) its risk factors, such as refractive errors and strabismus.


METHODS
Eight bibliographic databases were searched with no limitation to a specific year of publication or language. Studies including children and juveniles with amblyopia or its risk factors were considered for this review.


RESULTS
In total, five studies (three direct comparisons within one study; one indirect comparison between two studies) met the inclusion criteria. (1) Treatment of amblyopia: one comparison suggested that amblyopia treatment in preschool children is more effective than treatment later in life. However, a subgroup analysis of children who have never received any treatment indicated that patching may also have an effect after the "sensitive phase." The second comparison showed that a delay in treatment until the age of 5 did not seem to influence effectiveness. (2) Treatment of amblyogenic risk factors: two comparisons showed that hyperopia treatment and strabismus surgery (outcome: remaining amblyopia) is more effective under 2 years of age than later in life. However, the studies showed methodological weaknesses (for example, a high loss to follow-up, unmasked outcome assessments) limiting the validity of their findings. The current literature does not provide data evaluating quality of life or school performance.


CONCLUSIONS
Uncertainties remain about the age at which treatment for amblyopia or its risk factors is most effective. Beside methodological limitations, the design of the studies made it challenging to address this question sufficiently.
Schmucker
Christine
C
German Cochrane Center, Institute of Medical Biometry and Medical Informatics, Department of Medical Biometry and Statistics, University Hospital Freiburg, Freiburg, Germany. schmucker@cochrane.de
Kleijnen
Jos
J
Grosselfinger
Robert
R
Riemsma
Rob
R
Antes
Gerd
G
Lange
Stefan
S
Lagrèze
Wolf
W
D000367:Age Factors; D000550:Amblyopia / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006801:Humans; D007223:Infant; D012030:Refractive Errors / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D013285:Strabismus / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome