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Press Release
Study Shows Drops Help "Lazy Eye" in Children
March 13, 2002
Contact: Ellen Bank 843-792-2626
CHARLESTON, SC -- Dr. Richard Saunders, professor of ophthalmology at the Medical University of South Carolina in Charleston,
had a key role in the design of the study, the results of which are being released today (March 13, 2001).
Atropine eye drops given once a day to treat amblyopia, or lazy eye, the most common cause of visual impairment
in children, work as well as the standard treatment of patching one eye. This research finding may lead to better
compliance with treatment and improved quality of life in children with this eye disorder. These results appear
in the March issue of Archives of Ophthalmology.
Saunders has been a proponent of using atropine in selected patients for decades. He said he felt the treatment was
clearly superior for certain patients, but he was in a minority among pediatric ophthalmologists with this view. He
felt the design of the study was extremely important and described his role on the executive committee that designed
the study as "one of two atropine advocates, making sure eye drop therapy got a fair shake." MUSC was one of 47
clinical sites throughout North America participating in the study and had one patient enrolled.
Below is a summary of the study results provided by the National Eye Institute:
After six months of treatment, researchers found that the drug atropine, when placed in the unaffected
eye once a day, works as well as eye patching and may encourage better compliance is an important
factor in the success of amblyopia therapy.
Treatment should be started when the child is young, since amblyopia is more effectively treated
in children under seven years of age. Timely and successful treatment for amblyopia in childhood
can prevent lifelong visual impairment.
"These results are important because they provide an effective alternative treatment that helps
prevent permanent vision impairment for children with amblyopia," said Paul A. Sieving, M.D., Ph.D.,
director of the National Eye Institute, one of the Federal government's National Institutes of
Health and the agency that sponsored the study.
"Amblyopia is currently treated by wearing an eye patch over one eye for weeks to months. Children
usually do not like this treatment approach because of quality of life issues, such as irritation
of the skin and teasing by other children. This new study found that atropine eye drops had a higher
acceptance rate and better compliance by children and their parents than did patching. This may well
become a new standard treatment for some forms of amblyopia."
Amblyopia, or lazy eye, is a condition of poor vision in an otherwise healthy eye because the
brain has learned to favor the other eye. Although the eye with amblyopia looks normal, there
is interference with normal visual processing, which limits the development of a portion of the
brain responsible for vision. The most common causes of amblyopia are misalignment of the eyes
(crossed eyes) or significant differences in refractive error, such as farsightedness or
nearsightedness, between the two eyes. Amblyopia usually begins in infancy or childhood.
It is estimated that as many as three percent of children in the U.S. have some degree of
vision impairment due to amblyopia.
Treatment for amblyopia is most effective when started in young children less than seven
years old. Response to treatment in older children is much less effective. Most eye care
professionals treat amblyopia by placing an opaque adhesive patch, or "eye bandage," on the
skin to cover the unaffected eye. This forces the child to use the eye with amblyopia, which
stimulates vision in the eye with amblyopia and helps the part of the brain that manages
vision to develop more completely. However, many children do not like the appearance of the
eye patch and the accompanying social and psychological stigma and will not fully cooperate,
which can lead to treatment failure. Also, patching forces a child to use an eye that has
poor vision, often making compliance difficult for active children. Unless it is successfully
treated in early childhood, amblyopia usually persists into adulthood, and is the most common
cause of monocular (one eye) visual impairment among children and young and middle-aged adults.
Consequently, it is crucial for children to comply with treatment.
The atropine eye drop works by temporarily blurring vision in the unaffected eye, thereby
forcing the eye with amblyopia to be used. This strengthens it and improves vision. The
advantage of atropine treatment is that the parent simply places a drop in the child's eye
once a day. With patching, the parent must monitor the child wearing the patch for six or
more hours each day for many weeks or months.
In the Amblyopia Treatment Study, 215 children were randomly assigned to receive patching,
and 204 were assigned to receive atropine eye drops. Researchers found that 79 percent of
those receiving the eye patch were treated successfully, and that 74 percent of those receiving
the atropine were treated successfully. This difference is clinically insignificant. Although
researchers found that vision in the amblyopic eye improved faster in the patching group,
the difference in the two groups at six months was small and not significant.
"The daily burden to administer treatment for amblyopia falls on the parent," said study
chairman Michael Repka, M.D., professor of ophthalmology and pediatrics at the Wilmer Eye
Institute of Johns Hopkins University School of Medicine in Baltimore. "This study shows
that one drop a day of atropine works as well as patching the eye for some children with
amblyopia. Since both patching and atropine work equally well, the choice of treatment
can be made by the eye care professional in consultation with the parent." The children
who were treated in this study will continue to be followed until April 2003, allowing
researchers to learn whether there is any longer term advantage to treating amblyopia with
either patching or atropine.
The study was conducted by the Pediatric Eye Disease Investigator Group at 47 clinical
sites throughout North America. The study was funded by the National Eye Institute and
coordinated by the Jaeb Center for Health Research in Tampa, Florida and the Wilmer Eye
Institute of Johns Hopkins University in Baltimore.
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