Contact: Ellen Bank
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March 13, 2002
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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