Patching for patients with amblyopia—especially children—has shown to be less effective than atropine treatment, but when combined atropine and patching therapy (CAPT) was applied, previous studies showed this treatment worked much better. In a new study, researchers delved further into these treatments to compare the efficacy of CAPT vs. patching alone in 108 children ages three to 12 years with severe amblyopia, with follow-up visits at three and six months.

At the six-month mark, amblyopic eye VA with CAPT improved more than with patching alone. “In addition, the subgroup analysis showed no significant interaction between interventions and baseline VA subgroups, which suggested that CAPT achieved more improvement in amblyopic eye VA than patching in the initial six-month treatment, even when baseline VA was as poor as 20/200 or lower,” the authors explained in their study. “We speculate that atropine, as cycloplegia that can prevent accommodation, could induce blurred vision in the fellow eye at near fixation to force participants to use the amblyopic eye more when the fellow eye was not covered.”

Patients consistent with patching time was similar in both groups, which indicated that the difference in VA change between the two groups was attributed to the effect of the atropine treatment.

“Participant adherence to the use of atropine was excellent in 75% of participants in the CAPT group. Moreover, there were seven participants in the patching group with an improvement in amblyopic eye VA of three lines or less and none in the CAPT group at six months. These findings suggest that the CAPT would be more helpful for children who have poor adherence with patching,” the authors concluded in their study. “However, although CAPT is an alternative to patching therapy alone, this trial cannot determine if children with poor adherence to patching would have greater improvement with one versus the other strategy.”

The authors noted a further study with a larger sample size for children ages seven to 12 years is needed.

Wang S, Wen W, Zhu W, et al. Effect of combined atropine and patching vs patching alone for treatment of severe amblyopia in children aged 3 to 12 years. JAMA Ophthalmology. Epub ahead of print.