Atropine penalization versus occlusion therapies for unilateral amblyopia after the critical period of visual development: a systematic review
Atropine penalization versus occlusion therapies for unilateral amblyopia after the critical period of visual development: a systematic review
Introduction:
Amblyopia therapy appears to be most effective when carried out on children under the age of 7 years, however, randomised control trials (RCTs) have previously shown occlusion therapy and / or atropine penalisation therapy may improve visual acuity in an older age group. Which of the two therapies is most effective with fewer adverse effects in an older age group is not agreed on.
Methods:
We systematically searched the literature for RCTs comparing atropine penalisation therapy and occlusion therapy in terms of their visual acuity outcomes and adverse events. We performed a meta-analysis on the visual acuity data and discuss the reported adverse effects and implications for clinical practice.
Results:
Two RCTs were identified, both of which conclude there is no detectable difference between the two therapies for the age groups they studied. We calculated the mean difference between atropine penalisation and occlusion therapies as -0.01 logMAR (95% confidence interval, -0.07 to 0.03 logMAR) in favour of occlusion therapy; no statistical difference between the two groups is detected (P=0.45). Neither study detected a marked difference in terms of reported adverse effects from the two interventions.
Conclusions:
We conclude there is no difference in visual acuity outcomes between atropine penalisation and occlusion therapy after 17 to 24 weeks treatment for 7 to 12-year olds. Further evidence to determine the efficacy of amblyopia therapy for a population older than this is required before studies compare atropine penalisation and occlusion therapy in this group. Atropine penalisation therapy may cause more frequent minor adverse effects such as light sensitivity but, in a clinical setting, this needs to be balanced with the potential practical benefits of twice weekly eye drops versus daily occlusion.
Amblyopia, Atropine penalization therapy, Occlusion therapy, Pediatric ophthalmology, Visual development
323-332
Osborne, Daniel
921c0d16-57f6-4608-836d-df11e41d4bc5
Greenhalgh, Kathryn M.
13067f98-9a16-4870-9cae-d7b74c832532
Ranger, Megan
ec142d15-ec0b-4eb9-89c2-a71f36f02d39
Self, James E.
0f6efc58-ae24-4667-b8d6-6fafa849e389
December 2018
Osborne, Daniel
921c0d16-57f6-4608-836d-df11e41d4bc5
Greenhalgh, Kathryn M.
13067f98-9a16-4870-9cae-d7b74c832532
Ranger, Megan
ec142d15-ec0b-4eb9-89c2-a71f36f02d39
Self, James E.
0f6efc58-ae24-4667-b8d6-6fafa849e389
Osborne, Daniel, Greenhalgh, Kathryn M., Ranger, Megan and Self, James E.
(2018)
Atropine penalization versus occlusion therapies for unilateral amblyopia after the critical period of visual development: a systematic review.
Ophthalmology and Therapy, 7 (2), .
(doi:10.1007/s40123-018-0151-9).
Abstract
Introduction:
Amblyopia therapy appears to be most effective when carried out on children under the age of 7 years, however, randomised control trials (RCTs) have previously shown occlusion therapy and / or atropine penalisation therapy may improve visual acuity in an older age group. Which of the two therapies is most effective with fewer adverse effects in an older age group is not agreed on.
Methods:
We systematically searched the literature for RCTs comparing atropine penalisation therapy and occlusion therapy in terms of their visual acuity outcomes and adverse events. We performed a meta-analysis on the visual acuity data and discuss the reported adverse effects and implications for clinical practice.
Results:
Two RCTs were identified, both of which conclude there is no detectable difference between the two therapies for the age groups they studied. We calculated the mean difference between atropine penalisation and occlusion therapies as -0.01 logMAR (95% confidence interval, -0.07 to 0.03 logMAR) in favour of occlusion therapy; no statistical difference between the two groups is detected (P=0.45). Neither study detected a marked difference in terms of reported adverse effects from the two interventions.
Conclusions:
We conclude there is no difference in visual acuity outcomes between atropine penalisation and occlusion therapy after 17 to 24 weeks treatment for 7 to 12-year olds. Further evidence to determine the efficacy of amblyopia therapy for a population older than this is required before studies compare atropine penalisation and occlusion therapy in this group. Atropine penalisation therapy may cause more frequent minor adverse effects such as light sensitivity but, in a clinical setting, this needs to be balanced with the potential practical benefits of twice weekly eye drops versus daily occlusion.
Text
ManuscriptFINAL01.10.18
- Accepted Manuscript
Text
Osborne 2018 Article Atropine Penalization Versus Occl
- Version of Record
Text
Osborne2018_Article_AtropinePenalizationVersusOccl
- Version of Record
More information
Accepted/In Press date: 12 September 2018
e-pub ahead of print date: 16 October 2018
Published date: December 2018
Keywords:
Amblyopia, Atropine penalization therapy, Occlusion therapy, Pediatric ophthalmology, Visual development
Identifiers
Local EPrints ID: 425280
URI: http://eprints.soton.ac.uk/id/eprint/425280
ISSN: 2193-8245
PURE UUID: a67a717d-968e-445c-a0f1-3b7651978bc9
Catalogue record
Date deposited: 12 Oct 2018 16:30
Last modified: 16 Mar 2024 07:10
Export record
Altmetrics
Contributors
Author:
Daniel Osborne
Author:
Kathryn M. Greenhalgh
Author:
Megan Ranger
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
