Drops Work as Well as Patch for Lazy Eye

Study finds they're easier, cheaper, and kids will comply

WEDNESDAY, March 13, 2002 (HealthDayNews) -- "Lazy eye," the most common visual problem in children, is usually treated by covering one eye with a patch that kids find annoying and embarrassing.

However, a new study says the condition can be treated just as effectively -- and much more easily -- with eye drops containing atropine.

The finding, which appears in the March issue of the Archives of Ophthalmology, "offers eye-care providers another option," says Donald Everett, program director for collaborative clinical research at the National Eye Institute, which sponsored the 47-site study. "Atropine can be used safely and effectively to treat amblyopia, and we think compliance will be greatly improved."

"I think that there's been a lot of reluctance in the past to use atropine for treating children. It was considered a second-line treatment, and patching was the first-line treatment," says Dr. Scott Lambert, a professor of ophthalmology at Emory University and an investigator in the study. "This would indicate that the drops are probably almost on a par with patching for certain patients with amblyopia. It gives parents two different options."

Amblyopia, which affects as many as 3 percent of American children, is a condition of poor vision in one eye because the brain has learned to favor the healthy eye. If left untreated, the condition can lead to permanent vision loss in the affected eye.

Up to now, the standard treatment has been to have the young child -- preferably starting at age 7 or younger -- wear an adhesive patch over the lazy eye. This forces the eye with amblyopia to work harder.

Atropine drops essentially do the same thing: By temporarily blurring vision in the good eye, the lazy eye is forced to work more. The drops have been around for a long time, but in the absence of any rigorous studies attesting to their effectiveness, they have rarely been used.

In this, the Amblyopia Treatment Study, 215 children were randomized to wear a patch at least six hours a day, and 204 were assigned to receive atropine eye drops once a day. At the end of six months, 79 percent of those with the patch were treated successfully and 74 percent of those who had received atropine were treated successfully, a difference that is clinically insignificant.

The drops have additional benefits over the patch. Most importantly, they are likely to lead to better compliance. Children can and do pull their eye patches off when parents are not watching. The eye drops are administered once a day, and need no additional supervision.

"It's a whole lot easier to put drops in once a day than have to worry about monitoring a child with a patch," Lambert says. "The problem is that the child's eye is dilated so it's more light sensitive."

Drops also weren't enough for about a quarter of the children; they also had to wear special glasses.

Surprisingly, the drops are less expensive than a patch -- coming in at about $10 for six months versus $100 for the eye patch. The special glasses that a portion of the children have to wear add another $50 to the cost.

Finally, with the patch, a child is forced to rely completely on an eye that doesn't see well. Atropine causes blurry vision in that eye, but the child can still see out of it. This factor should also help compliance.

Until now, "there has not been a good, well-documented study to show that atropine had the same effect as patching," says Dr. Stuart R. Dankner, a spokesman for the American Academy of Ophthalmology and a pediatric ophthalmologist in Baltimore. "A majority of ophthalmologists were reluctant to use atropine because it's potentially a longer-time therapy just like patching, and if that amount of time is going to be invested you want to know you're going to get a good result in terms of improving vision in the weaker eye."

Researchers will continue to follow the children in the study until April 2003 to see if there are any long-term advantages to either treatment method.

What To Do: To learn more about amblyopia, check out Prevent Blindness America or the American Academy of Family Physicians.

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