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J AAPOS. 2015 Feb;19(1):42-8. doi: 10.1016/j.jaapos.2014.10.022.

A randomized trial of adding a plano lens to atropine for amblyopia.

Collaborators (181)

Hoover DL, Huston PA, Deifel CJ, Racan PM, Sayal JK, Soros KE, Tamkins SM, Ewert CE, Nunez M, Crespo R, Gomez I, Joshi P, Mesropian L, Olivares EM, Parra M, Salinas LE, Sala NA, Romeo JM, Hodde RM, Tanner CE, Zeto VL, Crouch ER Jr, Crouch ER 3rd, Ventura GG, Carlton CM, Lee KA, Schweinler BR, Beck D, Plum LW, Ticho BH, Clausius DA, Allen M, Giers SL, Horan LA, Glaser SR, Glaser SR, Pacheco MM, Graham LL, Miller MG, Senderowitsch N, Shabanowitz AC, Marsh-Tootle WL, Lee SD, Rutstein RP, Weise KK, Hill MP, Ray CO, Petersen DB, McMurtrey J, Droste PJ, Peters RJ, Hilbrands J, Mennega MK, Mooney JL, Miller AM, Jackson JL, Repka MX, Christoff A, Liu X, Goodman CR, Bremer DL, Rogers DL, Fellows RR, McMillin MC, Wagner AJ, Vanover LJ, Enyedi LB, Wallace DK, Young TL, Jones SK, Cotter SA, Barnhardt CN, Chen AM, Heyman CL, Patel RA, Parker SM, Waters AL, Dent RJ, Cheung JC, Cheung JC, Rice ML, Parypa TM, Goddard AE, Ferro JJ, Smith JB, Mellott ML, Kieser TL, Palitsch KA, Beauchamp CL, Stager DR, Goodloe A, Karr DJ, Summers AI, Rauch PK, Bubnoz YM, Romo A, Holmes JM, Nielsen RA, Hatt SR, Goldblum TA, Alfaro A, Escobedo CR, Morse CL, Fang CC, Christian ML, Johnson DA, Moulton KL, Drake K, Kraker RT, Beck RW, Boyle NM, Cagnina-Morales CM, Conner CL, Chandler DL, Dean TW, Donahue Q, Fimbel BP, Hoepner JE, Kaplon JD, Lazar EL, Melia B, Orlowski RV, 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, Melia B, Petersen DB, Pineles S, Repka MX, Suh DW, Ventura GG, Verderber LC, Wallace DK, Holmes JM, Astle WF, Bacal DA, Beck RW, Birch EE, Chen AM, Christian ML, Christiansen SP, Cotter SA, Crouch ER Jr, Crouch ER 3rd, Donahue SP, Enyedi LB, Everett DF, Hoover DL, Huston PA, Jackson JL, Kraker RT, Kulp MT, Lambert SR, Manny RE, 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 SW, Saunders RA, Tychsen L.



Some children have residual amblyopia after treatment with atropine eyedrops for amblyopia due to strabismus and/or anisometropia. We conducted a randomized clinical trial to evaluate the effectiveness of augmenting the effect of atropine by changing the lens over the fellow eye to plano in children with residual amblyopia.


A total of 73 children 3 to <8 years of age (mean, 5.8 years) with stable residual amblyopia (range, 20/32 to 20/160, mean 20/63(+1)) were enrolled after at least 12 weeks of atropine treatment of the fellow eye. Participants were randomly assigned to continuing weekend atropine alone or wearing a plano lens over the fellow eye (while continuing atropine). The primary outcome was assessed at 10 weeks, and participants were followed until improvement ceased.


At the 10-week primary outcome visit, amblyopic-eye visual acuity had improved an average of 1.1 lines with the plano lens and 0.6 lines with atropine only (difference adjusted for baseline visual acuity = + 0.5 line; 95% CI, -0.1 to +1.2). At the primary outcome or later visit when the best-measured visual acuity was observed, the mean amblyopic-eye improvement from baseline was 1.9 lines with the plano lens and 0.8 lines with atropine only.


When amblyopic-eye visual acuity stops improving with atropine treatment, there may be a small benefit to augmenting atropine therapy with a plano lens over the fellow eye. However, the effect was not statistically significant, and the large confidence interval raises the possibility of no benefit or a benefit larger than we observed. A larger study would be necessary to get a more precise estimate of the treatment effect.

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