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JAMA Ophthalmol. 2014 Jul;132(7):799-805. doi: 10.1001/jamaophthalmol.2014.392.

Atropine vs patching for treatment of moderate amblyopia: follow-up at 15 years of age of a randomized clinical trial.

Collaborators (149)

Sala NA, Hodde RM, Zeto VL, Romeo JM, Astle WF, Ells AL, Millar CM, Sandusky HN, Sanders EN, Gillis CD, Tien DR, Garner SJ, McGuinness MB, Lees SM, Arnold RW, Armitage MD, Glaser SR, Coussens TL, Senderowitsch N, Graham LL, Glaser SR, Repka MX, Christoff A, Goodman CR, Cotter SA, Chu RH, Mesropian L, Roberts TL, Parker SM, Beauchamp CL, Stager DR, Felius J, Goodloe A, Levada AJ, Capobianco C, Walker TL, Marella KJ, Paysse EA, Coats DK, Dorenbach CJ, Kong L, Ruttum MS, Picard VR, Holmes JM, Hatt SR, Nielsen RA, Holmquist JA, Cruz OA, Davitt BV, Miyazaki EA, Whitfill CR, Wheeler AM, Zinn RJ, Rutstein RP, Marsh-Tootle WL, Hill MP, Roegner RB, Longmuir S, Olson RJ, Ottar-Pfeifer WI, Summers C, Holleschau AM, de Melo AI, Hogue KM, Droste PJ, Peters RJ, Hilbrands J, Weakley DR, Dias CL, Linsenbardt EK, Karr DJ, Rauch PK, Berg PH, Bubnov YM, Romo A, Ruben JB, Desai D, Kulp MT, Dallas FD, Silbert DI, Matta NS, Lambert SR, Brower JL, Robb RA, Donahue SP, Fraine LA, Crouch ER Jr, Ventura GG, Kraker RT, Beck RW, Cagnina-Morales CM, Chandler DL, Conner CL, Donahue Q, Fimbel BP, Hoepner JE, Koh CR, Lazar EL, Melia BM, Rojas DE, Shah JA, Everett DF, Birch EE, Cotter SA, Everett DF, Foster NC, Golden RP, Holmes JM, Jones SK, Kraker RT, Kulp MT, Lazar EL, Petersen DB, Pineles S, Repka MX, Ventura GG, Verderber LC, Wallace DK, Holmes JM, Bacal DA, Beck RW, Birch EE, Christiansen SP, Cotter SA, Crouch ER 3rd, Enyedi LB, Everett DF, Hoover DL, Huston PA, Jackson JL, Kraker RT, Kulp MT, Miller AM, Morrison DG, Petersen DB, Repka MX, Rogers DL, Rutstein RP, Sala NA, Ticho BH, Wallace DK, Diener-West M, Baker JD, Davis B, Everett DF, Phelps DL, Poff S, Saunders RA, Tychsen L.

Author information

Wilmer Ophthalmological Institute, The John Hopkins University, Baltimore, Maryland.
Pediatric Eye Disease Investigator Group Coordinating Center, Jaeb Center for Health Research, Tampa, Florida.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Casey Eye Institute, Portland, Oregon.
currently in private practice, Rockville, Maryland.
Southern California College of Optometry, Fullerton.
Pediatric Ophthalmology and Strabismus Associates, Providence, Rhode Island.



Initial treatment for amblyopia of the fellow eye with patching and atropine sulfate eyedrops improves visual acuity. Long-term data on the durability of treatment benefit are needed.


To report visual acuity at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia.


In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40 to 20/100) were randomly assigned to patching (minimum of 6 h/d) or atropine sulfate eyedrops, 1% (1 drop daily), for 6 months. Treatment after 6 months was at the discretion of the investigator. Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up.


Initial treatment with patching or atropine with subsequent treatment at investigator discretion.


Visual acuity at 15 years of age with the electronic Early Treatment Diabetic Retinopathy Study test in amblyopic and fellow eyes.


Mean visual acuity in the amblyopic eye measured in 147 participants at 15 years of age was 0.14 logMAR (approximately 20/25); 59.9% of amblyopic eyes had visual acuity of 20/25 or better and 33.3%, 20/20 or better. Mean interocular acuity difference (IOD) at 15 years of age was 0.21 logMAR (2.1 lines); 48.3% had an IOD of 2 or more lines and 71.4%, 1 or more lines. Treatment (other than spectacles) was prescribed for 9 participants (6.1%) aged 10 to 15 years. Mean IOD was similar at examinations at 10 and 15 years of age (2.0 and 2.1 logMAR lines, respectively; P = .39). Better visual acuity at the 15-year examination was achieved in those who were younger than 5 years at the time of entry into the randomized clinical trial (mean logMAR, 0.09) compared with those aged 5 to 6 years (mean logMAR, 0.18; P < .001). When we compared subgroups based on original treatment with atropine or patching, no significant differences were observed in visual acuity of amblyopic and fellow eyes at 15 years of age (P = .44 and P = .43, respectively).


At 15 years of age, most children treated for moderate amblyopia when younger than 7 years have good visual acuity, although mild residual amblyopia is common. The outcome is similar regardless of initial treatment with atropine or patching. The results indicate that improvement occurring with amblyopia treatment is maintained until at least 15 years of age.

TRIAL REGISTRATION: Identifier: NCT00000170.

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