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July 2010 - Volume
8, Issue 6
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From
the Editor
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Editorial
Abdulrazak Abyad (Chief Editor)
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Original
Contributon and Clinical Investigation
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<--
Jordan -->
Rhinitis
During Pregnancy : Risk Factors And Management
Mahmoud Mashagbeh,
Ahmad Sbaihat, Hind Harahsheh MD
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<--
Saudi Arabia -->
Qat
Chewing and Autoimmune Hepatitis True Association
or Coincidence
Hind I Fallatah, Hisham
O Akba
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<--
Saudi Arabia -->
Hypertensive
patients attending military family medicine clinics
in Tabuk, Saudi Arabia
Abdul-Aziz F. Alkabbaa |
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Review Articles
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<--
Pakistan -->
Irritable
Bowel Syndrome (IBS): Clinical approach in Family
Practice
Firdous
Jahan |
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Education
and Training
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<--
International -->
Global
Competencies in family medicine
Bill Cayly, Lesley Pocock, Victor Inem,
Mohsen Rezaeian |
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Clinical
Research and Methods
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<--
Jordan -->
Atropine
Penalization versus Occlusion Therapy in Amblyopia
Mohammad Abdo Ja'ara |
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Case Report |
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<--
Jordan -->
Necrotizing
fascitis induced by self-injection of kerosene
Hani M.Kafaween,
Haitham Rbehat, Majida Sweis, Khitam Nimer Hawil |
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Chief
Editor -
Abdulrazak
Abyad
MD, MPH, MBA, AGSF, AFCHSE
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Phone: (961) 6-443684
Fax: (961) 6-443685
Email:
aabyad@cyberia.net.lb
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Publisher
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Pocock
medi+WORLD International
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Sherbrooke 3789
AUSTRALIA
Phone: +61 (3) 9005 9847
Fax: +61 (3) 9012 5857
Email:
lesleypocock@mediworld.com.au
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expressed are those of the authors and do not
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| July 2010 - Volume
8, Issue 6 |
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Atropine
Penalization versus Occlusion Therapy in Amblyopia
.........................................................................................................................
Mohammad
Abdo Ja'ara, MD
Paediatric Ophthalmologist,
King Hussein Medical Center
Jordan
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ABSTRACT
Objectives: To evaluate the efficacy
of atropine penalization in the treatment
of amblyopia in comparison with conventional
patching.
Methods: A prospective randomized
study that was conducted at King Hussein
Medical Center of the Royal Medical Services
during the period between January 2007
and January 2009. One hundred patients
were enrolled in the study. Patients were
divided into two groups of 50 subjects
each. The first group was treated by atropine
penalization and the second by conventional
patching. Inclusion criteria included
age between 6 and 12 years, visual acuity
between 6/12 and 6/60 and anisometropia
as the only explanation for poor vision.
Snellen's visual was tested 1 month, 3
months, 6 months and one year after treatment.
Results: Mean age of patients was
8.9 years with a male to female ratio
of 0.9:1. For the group treated by atropine
penalization, visual acuity improved by
1.1 Snellen's lines after 1 month, 1.8
lines after 3 months and 2.3 lines after
6 months and 1 year. Patching showed faster
recovery after 1 month with improvement
of vision by 1.9 Snellen's lines after
1 month. The results were almost the same
after 6 months and 1 year with improvement
of 2.2 and 2.3 lines respectively.
Conclusion: Atropine penalization
is as effective as patching in the treatment
of anisometropic amblyopia though the
speed of recovery is slower.
Keywords: penalization, patching,
anisometropia and amblyopia.
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Amblyopia is a decrease of
visual acuity with no apparent cause detected
on ocular examination (1).It is the most common
cause of monocular visual impairment in children
and young adults (2). Amblyopia is generally
classified in order of frequency into strabismic,
anisometropic and visual deprivation. Anisometropic
amblyopia accounts for 20% of causes of amblyopia
(3).
Anisometropic amblyopia can occur with any refractive
error though is more common in hypermetropia
than myopia (4). Treatment modalities include
occlusion of the sound eye in order to stimulate
vision in the amblyopic eye. Methods of occlusion
include conventional patching and atropine penalization
(5). In this study we aimed to evaluate the
efficacy of atropine penalization in the treatment
of amblyopia in comparison with conventional
patching.
A prospective randomized study that was conducted
at King Hussein Medical Center of the Royal
Medical Services during the period between January
2007 and January 2009. One hundred patients
were enrolled in the study. Patients were divided
into two groups of 50 subjects each. The first
group was treated by atropine penalization and
the second by conventional patching. Inclusion
criteria included age between 6 and 12 years,
visual acuity between 6/12 and 6/60 and anisometropia
as the only explanation for poor vision. Snellen's
visual was tested 1 month, 3 months, 6 months
and one year after treatment.
Mean age of patients was 8.9 years with a male
to female ratio of 0.9:1. For the group treated
by atropine penalization, visual acuity improved
by 1.1 Snellen's lines after 1 month, 1.8 lines
after 3 months and 2.3 lines after 6 months
and 1 year. Patching showed faster recovery
after 1 month with improvement of vision by
1.9 Snellen's lines after 1 month. The results
were almost the same after 6 months and 1 year
with improvement of 2.2 and 2.3 lines respectively
(Table 1).
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Period
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Atropine
group
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Patching
group
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1 month
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1.1
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1.9
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3 months
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1.8
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2.1
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6 months
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2.3
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2.2
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1 year
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2.3
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2.3
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Table 1: Improvement of visual acuity
after 1 month, 3 months, 6 months and 1 year
in both groups
The first step in treating amblyopia is proper
diagnosis that excludes any pathological cause
for poor vision (6). Amblyopia commonly affects
young children and early treatment is important
in order to prevent irreversible decrease
in vision. Detection and monitoring visual
acuity may be difficult in young children;
therefore we did not select patients younger
than 6 years in our study. In addition, we
did not include patients older than 12 years
as they respond poorly to treatment (7).
Standard treatment of amblyopia is stimulating
the amblyopic eye to focus. Refractive error
should be prescribed for strabismic and anisometropic
amblyopia, removal of media opacity in visual
deprivation amblyopia (8-11). As for refractive
errors, optimum correction should be given
in order to provide a clear image to fovea
and stimulate visual pathway (12). During
treatment, patients were encouraged to do
near activity for two hours daily (13).
The results of our studies showed that both
treatment options are effective in reversing
amblyopia. Conventional patching showed faster
recovery with 1.9 lines improvement in visual
acuity after 1 month compared to 1.1 lines
in the atropine group. The results were almost
the same after 6 months of treatment (2.2
lines and 2.3 lines). Extending the period
of treatment to 1 year did not show further
improvement.
In conclusion, atropine penalization is as
effective as patching in the treatment of
anisometropic amblyopia though the speed of
recovery is slower.
1. American Academy of Ophthalmology. San
Francisco, Calif: American Academy of Ophthalmology;
2002. Preferred Practice Pattern: Amblyopia.
2. Flynn JT, Woodruff G, Thompson JR, et al.
The therapy of amblyopia: an analysis comparing
the results of amblyopia therapy utilizing
two pooled data sets. Trans Am Ophthalmol
Soc. 1999; 97: 373-90.
3. Gregson R. Why are we so bad at treating
amblyopia. Eye. 2002; 16: 461-2.
4. Atilla H, Oral D, Coskun S, et al. Poor
correlation between "fix-follow-maintain"
monocular/binocular fixation pattern evaluation
and presence of functional amblyopia. Binocul
Vis Strabismus Q. 2001; 16: 85-90.
5. Foley-Nolan A, McCann A, O'Keefe M. Atropine
penalisation versus occlusion as the primary
treatment for amblyopia. Br J Ophthalmol.
1997; 81: 54-7.
6. Gräf M, Becker R, Kaufmann H. Lea
symbols: visual acuity assessment and detection
of amblyopia. Graefes Arch Clin Exp Ophthalmol.
2000; 238: 53-8.
7. Chen PL, Chen JT, Tai MC, et al. Anisometropic
amblyopia treated with spectacle correction
alone: possible factors predicting success
and time to start patching. Am J Ophthalmol.
2007; 143: 54-60.
8. Cleary M. Efficacy of occlusion for strabismic
amblyopia: can an optimal duration be identified.
Br J Ophthalmol. 2000; 84: 572-7.
9. Cotter SA, Edwars AR, Wallace DK, et al.
Treatment of anisometropic amblyopia in children
with refractive correction. Ophthalmology.
2006; 113: 895-903.
10. Cotter SA, Edwars AR, Arnold RW, et al.
Treatment of strabismic amblyopia with refractive
correction. Am J Ophthalmol. 2007; 143: 1060-3.
11. Kaye SB, Chen SI, Price G, et al. Combined
optical and atropine penalization for the
treatment of strabismic and anisometropic
amblyopia. J AAPOS. 2002; 6: 289-93.
12. Klimek DL, Cruz OA, Scott WE, et al. Isoametropic
amblyopia due to high hyperopia in children.
J AAPOS. 2004; 8:310-13.
13. Kutschke PJ, Scott WE, Keech RV. Anisometropic
amblyopia. Ophthalmology. 1991; 98:258-63.
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