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D. K. Wallace, D. L. Chandler, R. W. Beck, Pediatric Eye Disease Investigator Group; Treatment of Bilateral Refractive Amblyopia in Children 3-9 Years Old. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1109.
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To determine the amount and time course of binocular visual acuity improvement with treatment of bilateral refractive amblyopia in children age 3 to 9 years old.
The study enrolled 113 children (mean age = 5.1 years) with previously untreated bilateral refractive amblyopia, defined as 20/40 to 20/320 best corrected acuity in each eye and binocularly and ≥ +4.00 D hypermetropia and/or ≥ 2.00 D astigmatism in each eye. Optimal spectacle correction was provided and children were followed prospectively for one year with visits at 5, 13, 26 and 52 weeks. Treatment with patching and/or atropine was at investigator discretion.
During the year of follow up, 96 patients (85%) received spectacle correction alone and 17 patients (15%) received treatment with patching or atropine in addition to spectacle correction. For the 100 patients who had acuity tested at one year, binocular best corrected visual acuity (VA) improved from a mean of 0.50 logMAR (20/63) at baseline to 0.11 logMAR (20/25) at one year (mean improvement 3.9 lines, 95% confidence interval 3.5 to 4.2). The cumulative probability of binocular acuity of 20/25 or better was 20% at 5 weeks, 45% at 13 weeks, 58% at 26 weeks, and 73% at 52 weeks (95% CI = 65% to 81%). Mean improvement at one year for the 83 children with baseline binocular best corrected VA of 20/40 to 20/80 was 3.4 lines (95% CI = 3.2 to 3.7) and for the 17 children with baseline binocular VA of 20/100 to 20/320 was 6.1 lines (95% CI = 4.9 to 7.3). Of the 94 children who had stereoacuity tested at the one year examination, stereoacuity improved a mean of 1.9 levels on the Randot Preschool Test (95% CI = 1.4 to 2.3) with 56 children (60%) improving two levels or more after one year.
Treatment of bilateral refractive amblyopia, primarily with spectacle correction alone, improves binocular visual acuity in children age 3 to 9 years old, with most achieving 20/25 acuity or better within one year.
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