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B.C. Hainline, D.T. Sprunger; Reverse Amblyopia With Atropine Therapy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5709.
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Purpose: To compare the effectiveness of patching, atropine and combined therapy for the treatment of amblyopia in a community based ophthalmologist’s practice and to determine risk factors for the development of reverse amblyopia with these treatment modalities. Methods: A retrospective chart review of 133 consecutive patients in one community based ophthalmologist’s practice treated for amblyopia from 1998–2003. All patients started on atropine, patching, or combination (atropine and patching) therapy during that time period for amblyopia and had a recorded baseline visual acuity were included in the study. The following data was obtained: patient name, age, sex, type of amblyopia, normal and amblyopic eye visual acuity at the time therapy was initiated, at 6 months, and at 1 yr followup visits, refractive error in each eye, hours of patching per day, and days of atropine per week. Patients that developed reverse amblyopia, amblyopic eye acuity of at least 3 LogMar lines greater than sound eye acuity, during the treatment period were examined for length of time to reverse acuity on therapy, presence or absence of return to baseline acuity, time to return to baseline acuity, whether or not patching or atropine was used to treat reversed amblyopia. Results:Baseline visual acuity in the amblyopic eye in this study was 0.62 LogMar (20/80) and visual acuity in the sound eye for all patients was 0.12 (20/25) and was similar between the three groups. Improvement in vision after 6 months and 1 year after amblyopia therapy was similar between all three groups: 0.26 and 0.30 in the atropine group, 0.32 and 0.34 in the patching group, and 0.24 and 0.32 in the combined group. Change in sound eye vision after 6 months and 1 year after amblyopia therapy was different between all three groups: decrease of 0.09 and 0.06 in the atropine group, improvement 0.03 and 0.01 in the patching group, and decrease of 0.03 and no change in the combined group. Eight (6%) patients demonstrated reverse amblyopia. No patient undergoing patching alone developed reverse amblyopia. Reversed amblyopes were an average of 3.5 years old, 1.5 years younger than the average age of the study population, 7/8 had strabismic amblyopia, 6/8 were on daily atropine, and had average refractive errors of 4.77 in the amblyopic eye and 5.06 in the sound eye. Conclusions:In this community based ophthalmologist’s practice, atropine, patching, and combination therapy appear to be equally effective modalities to treat amblyopia. Highly hyperopic patients under 4 years of age with dense strabismic amblyopia and on daily atropine appear to be most at risk for development of reverse amblyopia.
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