Effect of Sequential and Simultaneous Patching Regimens in Unilateral Amblyopia

PURPOSE: Many clinicians treat unilateral amblyopia with glasses alone and initiate patching when needed; others start glasses and patching simultaneously. In this study, we reviewed the outcomes of the two approaches at our institution. DESIGN: Retrospective nonrandomized clinical trial. METHODS: Setting: Institutional practice. Patient population: All patients diagnosed with amblyopia at Boston Children's Hospital between 2010 and 2014. Inclusion criteria : Unilateral amblyopia (visual acuity (VA) 20/40 to 20/200 with interocular difference >= 3 lines,) age 3 to 12 years, with a 6-month follow-up visit. Exclusion criteria : Deprivation amblyopia, prior amblyopia treatment, treatment other than patching, surgery. Patients were categorized as "simultaneous treatment" (concurrent glasses and patching therapy at their first visit) or "sequential treatment" (glasses alone at first visit, followed by patching therapy at second visit.) Observation procedures : Patient demographics, VA, and stereopsis were compared. Outcome measures : VA and stereopsis at the last visit on treatment. RESULTS: We identified 98 patients who met inclusion criteria: 36 received simultaneous treatment and 62 sequential treatment. Median amblyopic eye VA improved similarly between the simultaneous (Delta 0.40; interquartile range [IQR], 0.56-0.30 logMAR) and sequential (Delta 0.40; IQR, 0.52-0.27 logMAR) groups. Patients without stereopsis at first visit had better stereopsis outcomes with sequential treatment (5.12 [IQR, 4.00-7.51] log stereopsis) compared with simultaneous treatment (8.01 [IQR, 5.65-9.21]) log stereopsis, P = 0.046). CONCLUSIONS: VA improved approximately 4 lines regardless of treatment type. For children without stereopsis at first presentation, sequential patching yielded better stereopsis outcomes. These findings require further validation and highlight the importance of evaluating stereopsis in future studies. (C) 2021 Elsevier Inc. All rights reserved.