The Prospective Comparison of the Efficacy of Intermittent Atropine Penalization and Part-time Occlusion Therapy

Youn Hui Kim; Mi Young Choi

doi:10.3341/jkos.2008.49.6.958

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Kim and Choi: The Prospective Comparison of the Efficacy of Intermittent Atropine Penalization and Part-time Occlusion Therapy

Original Article

J Korean Ophthalmol Soc 2008;49(6):958-966.

Published online: 8 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.6.958

The Prospective Comparison of the Efficacy of Intermittent Atropine Penalization and Part-time Occlusion Therapy

Youn Hui Kim, M.D., Mi Young Choi, M.D.

Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Medical Research Institute, Cheongju, Korea

Address reprint requests to Mi Young Choi, M.D. Department of Ophthalmology, College of Medicine, Chungbuk National University Hospital #62 Kaeshin-dong, Heungduk-gu, Cheongju-si 361-711, Korea Tel: 82-43-269-6335, Fax: 82-43-264-5263, E-mail: mychoi@chungbuk.ac.kr

5 February 2008 Accepted 26 April 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The objective of this study was to compare prospectively the efficacy between intermittent atropine penalization and part-time occlusion therapy for amblyopia in patients younger than 10 years old.

Methods

The patients with newly diagnosed amblyopia were randomly assigned to either atropine penalization (Group A) or occlusion therapy (Group O). One drop of atropine was instilled into the sound eyes of patients in group A twice per week, while each patient in group O underwent daily patching for 6 hours in their sound eyes. The minimum follow-up time was 3 months after treatment. Best corrected visual acuity and compliance were compared for both groups.

Results

A total of 43 patients were enrolled in this study, with 18 assigned to group A and 25 to group O. The follow-up period was not significantly different between group A and group O (6.3 and 7.0 months, respectively; p=0.437). The final corrected visual acuity (LogMAR) scores of amblyopic eyes in both groups showed significant improvement in the visual acuity of amblyopic eyes compared with that at baseline (0.28 in group A and 0.19 in group O). Group A had a higher level of compliance than group O (97.0 and 91.5%, respectively; p=0.007). There was no difference in the groups with regard to visual acuity in amblyopic eyes, which showed similar improvement (3.5:3.4 lines, respectively; p=0.867).

Conclusions

This study shows that for treating amblyopia in children younger than 10 years old, intermittent atropine penalization seems to be as effective as part-time occlusion.

Keywords: Amblyopia, Atropine penalization, Occlusion

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Figure 1.

Graph showing the cumulative number of patients with 2 lines or more of visual improvement during follow-up in each group.

Table 1.

The comparison of baseline characteristics of atropine penalizaiton group and occlusion group

	Atropine penalization (n=18)	Occlusion (n=25)	p-value
Age (mean±SD, years)	5.9±1.7	5.1±1.4	0.094^*
<5 (No.(%))	5 (27.8)	12 (48.0)
5≤ <7 (No.(%))	6 (33.3)	10 (40.0)	0.107^†
≥7 <10 (No.(%))	7 (38.9)	3 (12.0)
Gender (No.(%))			0.977^†
Male	8 (44.4)	11 (44.0)
Female	10 (55.6)	14 (56.0)
Initial visual acuity (LogMAR±SD)
Amblyopic eye	0.63±0.47	0.55±0.43	0.550^*
Better eye	0.08±0.10	0.15±0.19	0.162^*
Depth of amblyopia (No.(%))			0.405^†
Severe	7 (38.9)	8 (32.0)
Moderate	9 (50.0)	10 (40.0)
Mild	2 (11.1)	7 (28.0)
Cause of amblyopia (No.(%))			0.458^†
Strabismus	9 (50.0)	8 (32.0)
Anisometropia	6 (33.3)	10 (40.0)
Combined	3 (16.7)	7 (28.0)
Binorcularity index (Score, mean±SD)	2.2±1.4	2.2±1.3	0.949^*
Compliance (%)	97.0	91.5	0.005^*
Duration of treatment^‡(mean±SD, months)	5.6±2.6	4.8±3.1	0.405^*
Follow-up^§ (mean±SD, months)	6.3±2.4	7.0±3.0	0.437^*

^* T-test

^† Pearson’s chi-square test

^‡ The sum of duration of treatment with atropine eye drop and/or patching

^§ Duration of treatment and follow-up after discontinuation.

Table 2.

Types of amblyopia in each group

	Atropine penalization (n=18)	Occlusion (n=25)	p-value
Strabismus			1.000^*
Esotropia	5	4
Exotropia	4	4
Anisometropia			0.701^†
Hypermetropia	5	7
Myopia	0	1
Astigmatism	1	2
Combined	3	7	0.312^*

^* Fisher’s Exact Test

^† Pearson’s chi-square test.

Table 3.

Treatment effect in each group

	Atropine penalization (n=18)	Occlusion (n=25)	p-value^*
Visual acuity of amblyopic eye (LogMAR, mean±SD)
at baseline	0.63±0.47	0.55±0.43	0.550
at last	0.29±0.44	0.19±0.21	0.327
P-value^†	0.000	0.018
No. of lines of improvement (mean±SD)	3.5±2.8	3.4±1.9	0.867

^* T-test between atropine penalization group and occlusion group

^† Paired t-test between baseline acuity and the last viual acuity.

Table 4.

Visual acuity outcomes stratified by baseline characteristics in each group

	No. of line of improvement		p-value^*
	Atropine penalization (n=18)	Occlusion (n=25)
Age (years)			0.331
<5	4.8	3.8
5≤ <7	5.1	3.3
≥7	1.2	2.0
Gender			0.746
Male	3.3	3.7
Female	3.4	3.4
Depth of amblyopia			0.938
Severe	3.9	4.3
Moderate	3.3	3.4
Mild	3.0	2.3
Cause of amblyopia			0.550
Strabismus	2.6	4.0
Anisometropia	6.2	2.0
Combined	0.8	4.7

^* ANOVA.

Table 5.

Demographic characteristics and visual acuity improvement in atropine penalization group

	Success (n=11)	Failure (n=7)	p-value
Age (mean±SD, years)	5.0±1.4	7.4±1.1	0.003^*
Baseline acuity of amblyopic eye (LogMAR±SD)	0.55±0.41	0.77±0.56	0.425^*
Compliance (%)	98.4	94.9	0.085^*
Cause of amblyopia (No.)			0.013^†
Strabismus	5	4
Anisomertopia	6	0
Combined	0	3

^* Mann-Whitney U test

^† Pearson’s chi-square test.

Table 6.

Demographic characteristics and visual acuity improvement in occlusion group

	Success (n=21)	Failure (n=4)	p-value
Age (mean±SD, years)	5.1±1.0	5.1±1.4	0.915^*
Baseline acuity of amblyopic eye (LogMAR±SD)	0.52±0.41	0.70±0.59	0.592^*
Compliance (%)	91.5	92.0	0.915^*
Cause of amblyopia (No.)			0.223^†
Strabismus	8	0
Anisomertopia	7	3
Combined	6	1

^* Mann-Whitney U test

^† Pearson’s chi-square test.

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