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J Pediatr Ophthalmol Strabismus. 2010 Sep-Oct;47(5):270-6; quiz 277-8. doi: 10.3928/01913913-20091118-05. Epub 2009 Nov 23.

Atropine treatment of amblyopia: is a swap in fixation necessary?

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Department of Clinical Vision Sciences, La Trobe University, Melbourne, Australia.



To investigate the impact of fixation on vision outcomes in patients with amblyopia undergoing atropine treatment and the validity of the "cyclo-swap test" (CST) as a method of predicting atropine efficacy.


Sixteen children with amblyopia were included. The initial examination included a vision assessment and CST, in which fixation was assessed at 1/3 m, 6 m, and at distances less than 1/3 m. Children were treated for 10 weeks and reviewed at 5-week intervals with cessation of atropine 4 days prior. Vision and fixation were assessed at the follow-up visits. Children demonstrating no fixation swap initially were additionally observed after 1 week of atropine treatment under maximum cycloplegia.


Eight children demonstrated a fixation swap (FS group) to the amblyopic eye during the CST at either 1/3 or 6 m, and 8 demonstrated no fixation swap (NFS group). By the end of the 10-week treatment period, both groups demonstrated a mean visual acuity improvement of between 2 and 3 lines (FS = 0.22 log units; NFS = 0.27 log units). Six of the 8 children in the NFS group demonstrated improvement in vision, all of whom also demonstrated a fixation swap at some stage.


Vision improvement in patients using atropine is likely to be attributable to a fixation swap that occurs during the treatment phase. The CST performed at 1/3 and 6 m has little value in predicting improvements in vision; however, when performed at distances of less than 1/3 m, it may provide valuable clinical information about atropine efficacy.

[Indexed for MEDLINE]

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