Some children with amblyopia may derive more benefit from high-intensity early eye patching than from an extended period of wearing eyeglasses prior to patching.
Study Design
The EuPatch randomized controlled trial, conducted at multiple European sites, sought to evaluate the efficacy of 2 different eye patching regimens—extended optical treatment (EOT) and early patching (EP)—in 342 children aged 3–8 years with newly diagnosed, previously untreated amblyopia. While both groups underwent 24 weeks of intensive patching (initially recommended at 10 hours per day, 6 days per week), the EOT group was required to wear their new glasses for 18 weeks prior to initiation of patching while the EP group only wore theirs for 3 weeks prior to patching. Patients were stratified by type (anisometropic, strabismic, or mixed) and severity of amblyopia. The primary outcome was successful treatment (defined as a ≤0.20 logMAR interocular difference in best-corrected visual acuity) after the first 12 weeks of patching.
Outcomes
The EP group had significantly higher rates of successful treatment than the EOT group (67% vs 54%, respectively). Children who were older, had more severe amblyopia, or had higher anisometropia benefitted most from the EP regimen. Interestingly, the attitude of parents and guardians toward patching, as measured by the Amblyopia Treatment Index questionnaire, was more positive in the EP group than in the EOT group. While the children’s attitudes toward patching, recorded with the Smiley Face Likert Scale, were less favorable than those of the adults, they were still relatively positive overall and did not differ between the 2 groups.
Limitations
Participants, parents, and assessors were not masked to treatment allocation, potentially introducing a level of bias. Approximately 9% of patients dropped out or did not complete treatment, though the overall results were statistically similar whether or not the missing data were included. Perhaps most significantly, the patching regimen prescribed was more intensive than many providers prescribe; therefore, it is uncertain whether these findings would be replicable with less time-intensive patching regimens.
Clinical Significance
Results of this study suggest that the early introduction of patching in children with amblyopia, rather than patching only after several months of glasses wear, may be beneficial, especially in older children or those with more severe disease. In such patients, it may be worth considering early initiation of patching, and clinicians could think about combining this early initiation with the introduction of glasses. However, further studies evaluating the same question, using differing intensities of patching regimens, would be helpful in determining clinical applicability.
Financial Disclosures: Dr. Robert Tauscher discloses no financial relationships.