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Lee, Chae, and Choi: Comparison of Part-time Occlusion Therapy and Intermittent Atropine Penalization Therapy for Amblyopic Children of School Age
Original Article

J Korean Ophthalmol Soc 2010;51(2):259-265.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.259

Comparison of Part-time Occlusion Therapy and Intermittent Atropine Penalization Therapy for Amblyopic Children of School Age

Kyoungsook Lee, MD1, Ju Byung Chae, MD2, Mi Young Choi, MD, PhD1

1Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Medical Research Institute, Cheongju, Korea

2Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea

Address reprint requests to Mi Young Choi, MD, PhD Department of Ophthalmology, College of Medicine, Chungbuk National University Hospital #410 Sung Bong-ro, Heungduk-gu, Cheongju 361-711, Korea Tel:82-43-269-6335, Fax: 82-43-264-5263, E-mail: mychoi@chungbuk.ac.kr

Received 23 February 2009       Accepted 19 October 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the outcome of part-time occlusion therapy and intermittent atropine penalization therapy in amblyopic school-age patients.

Methods

In the present study, the authors retrospectively analyzed school-age amblyopic patients treated with part-time occlusion therapy (Group 1) and intermittent atropine penalization therapy (Group 2) as primary treatments. Age, visual acuity (logMAR) and interocular acuity differences at the beginning of treatment, cause of amblyopia, depth of amblyopia, and compliance for treatment were analyzed. Visual acuity and the lines of improvement from baseline visual acuity in the amblyopic eye were compared between the two groups with high compliance.

Results

The number of patients was 43 in Group 1 and 23 in Group 2. Age and the baseline visual acuity were not significantly different between Group 1 and Group 2. Group 2 had a higher level of compliance than did Group 1 (91.7; 63.4%), but there was no statistical difference between the groups (p=0.064). The visual acuity (logMAR, 0.27:0.05, p=0.020) and the lines of improvement of the amblyopic eye at the final follow-up (2.7:4.2 lines, p=0.010) were better in Group 1 than in Group 2 with high compliance.

Conclusions

In amblyopic school-age children, part-time occlusion therapy could be conducted as primary treatment in cases with high compliance. Intermittent atropine penalization therapy can be attempted if there is low compliance in occlusion therapy.

Keywords: Amblyopia, Atropine, Compliance, Occlusion, School age

References

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Table 1.
The comparison of baseline characteristics of atropine penalization and occlusion group
Atropine (n=23) Occlusion (n=43) p-value
Age (mean± SD, years) [range] 7.7±1.3 [6.0–10.6] 7.8±1.6 [6.1–13.5] 0.869*
   <7 (No.) 7 18 0.448†
   7≤ <9 (No.) 11 17
   9≤ (No.) 5 8
Initial visual acuity (logMAR± SD)
   Amblyopic eye 0.53±0.53 0.41±0.32 0.361*
   Better eye 0.05±0.07 0.03±0.05 0.147*
Interocular acuity difference (Line on logMAR) 5.48±3.54 5.30±2.78 0.825*
Depth of amblyopia (No.) 0.254†
   Mild 9 13
   Moderate 7 22
   Severe 7 8
Cause of amblyopia (No.) 0.466†
   Strabismus 8 9
   Anisometropia 13 30
   Combined 2 4
Duration of treatment (mean± SD, months) 7.9±4.6 7.2±5.6 0.578*

* t-test

† chi-square test.

Table 2.
Visual acuity of amblyopic eye stratified by gender and cause of amblyopia
 Visual acuity of amblyopic eye (logMAR, mean± SD)
 p-value*
Atropine (n=23) Occlusion (n=43)
Gender (No.)
   Male 0.74±0.53 (9) 0.47±0.31 (23) 0.253
   Female 0.40±0.51 (14) 0.35±0.33 (20) 0.697
Cause of amblyopia (No.)
   Strabismus 0.68±0.58 (8) 0.28±0.17 (9) 0.237
   Anisometropia 0.35±0.31 (13) 0.44±0.35 (30) 0.203
   Combined 1.15±1.20 (2) 0.58±0.34 (4) 0.816

* Wilcoxon rank sum test.

Table 3.
Factors associated with compliance in occlusion group
High-compliance (n=29) Low-compliance (n=14) p-value
Age (mean± SD, years) 7.4±1.1 8.8±2.1 0.015†
Gender (No.) 0.509‡
  Male 14 9
  Female 15 5
VA* of amblyopic eye (logMAR) 0.35±0.27 0.56±0.37 0.037†
Cause of amblyopia (No.) 0.448‡
  Strabismus 5 4
  Anisometropia 22 8
  Combined 2 2

* Visual acuity

† Wilcoxon rank sum test

‡ chi-square test.

Table 4.
Results of treatment in the patients with high compliance
Atropine (n=21) Occlusion (n=29) p-value*
VA of amblyopic eye (mean± SD, logMAR)
    at base line 0.50±0.52 0.35±0.27 0.937
    at last 0.27±0.41 0.05±0.11 0.020
No. of lines of improvement from baseline (Line on logMAR) 2.7±1.4 4.2±2.1 0.010
Duration of treatment (mean ± SD, months) 8.6±4.3 7.5±5.4 0.193

* Wilcoxon rank sum test.

Table 5.
Outcome of visual acuity stratified by baseline characteristics in the patients with high compliance
 Visual acuity of amblyopic eye (logMAR, mean± SD)
 p-value*
Atropine (n=21) Occlusion (n=29)
Gender (No.)
   Male 0.41±0.51 (8) 0.07±0.15 (14) 0.111
   Female 0.18±0.33 (13) 0.03±0.05 (15) 0.119
Age (No.)
   <7 (No.) 0.33±0.39 (6) 0.05±0.13 (16) 0.144
   7≤ <9 (No.) 0.26±0.48 (11) 0.05±0.10 (10) 0.173
   9≤ (No.) 0.21±0.33 (4) 0.05±0.09 (3) 1.000
Cause of amblyopia (No.)
   Strabismus 0.37±0.57 (7) 0 (5) 0.136
   Anisometropia 0.15±0.24 (12) 0.06±0.12 (22) 0.267
   Combined 0.65±0.49 (2) 0.07±0.11 (2) 0.249
Depth of amblyopia (No.)
   Mild 0.02±0.03 (9) 0.04±0.09 (10) 1.000
   Moderate 0.37±0.57 (6) 0.03±0.04 (17) 0.125
   Severe 0.65±0.49 (6) 0.07±0.11 (2) 0.222

* Wilcoxon rank sum test.

Table 6.
Lines of improvement fro om baseline stratified by baseline characteristics in the patients with high compliance
No. of lines of improvement from baseline (Line on logMAR)
 p-value*
Atropine (n=21) Occlusion (n=29)
Gender (No.)
   Male 3.1±1.7 (8) 4.6±1.9 (14) 0.068
   Female 2.5±1.3 (13) 3.9±2.2 (15) 0.069
Age (No.)
   <7 (No.) 3.5±1.4 (6) 2.9±2.1 (16) 1.000
   7≤ <9 (No.) 2.4±1.5 (11) 3.4±2.0 (10) 0.282
   9≤ (No.) 2.5±1.3 (4) 3.6±1.5 (3) 0.157
Cause of amblyopia (No.)
   Strabismus 2.6±1.6 (7) 4.0±0.7 (5) 0.161
   Anisometropia 3.1±1.2 (12) 4.4±2.3 (22) 0.088
   Combined 1.0±1.4 (2) 3.5±2.1 (2) 0.474
Depth of amblyopia (No.)
   Mild 2.6±0.5 (9) 2.3±1.3 (10) 0.637
   Moderate 2.7±2.2 (6) 4.9±1.2 (17) 0.066
   Severe 2.3±1.8 (6) 8.0±1.3 (2) 0.108

* Wilcoxon rank sum test.

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