Amblyopia in children (aged 7 years or less)

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Amblyopia is decreased vision in one or both eyes due to abnormal development of vision in infancy or childhood. It affects up to 4% of children aged up to 7 years and can be amenable to treatment if detected early enough.

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Focus of the review

This systematic overview analyses the treatment options available for this common condition, focusing on the key visual developmental period, which is up to the age of 7 years. Commonly used interventions assessed include the use of glasses and penalisation, either with occlusion or atropine alone or in combination with near vision tasks. This overview looks at how effective these treatments are in terms of visual acuity, interocular acuity difference, binocularity, and stereopsis, as well as any adverse effects.

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Comments on evidence

The evidence base for amblyopia has improved in recent years and includes several randomised trials, longitudinal studies examining the effects of prolonged spectacle wear, and studies with objective monitoring of actual achieved patching treatment versus recommended patching treatment. These studies have informed clinical practice and are well known. However, for this overview, only RCTs are included and, as many of these are small trials with less than 200 participants, the quality of the evidence they provide is described as 'low' or 'very low' in many cases.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, May 2010, to January 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 14 full publications. Of the 14 full articles evaluated, two systematic reviews were updated, and three RCTs and two follow-up studies were added at this update.

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Substantive changes at this update

Glasses One systematic review updated.[13] Categorisation unchanged (likely to be beneficial).

Occlusion (patching) Two systematic reviews updated.[13][17] Three RCTs added[24][25][28] and two follow-up reports.[26][27] Categorisation unchanged (beneficial).

Penalisation Two systematic reviews updated.[13][17] Categorisation unchanged (likely to be beneficial).

Abstract

INTRODUCTION: Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7–8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medical treatments for amblyopia in children aged 7 years or less? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 70 studies. After deduplication and removal of conference abstracts, 51 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 37 studies and the further review of 14 full publications. Of the 14 full articles evaluated, two systematic reviews were updated and three RCTs and two follow-up studies were added at this update. We performed a GRADE evaluation for nine PICO combinations. CONCLUSIONS: In this systematic overview we categorised the efficacy for three interventions, based on information about the effectiveness and safety of glasses, occlusion, or penalisation with atropine.

Cite as

West S, Williams C. Amblyopia in children (aged 7 years or less). Systematic review 709. BMJ Clinical Evidence. . 2016 January. Accessed [date].

Latest citations

Interventions for strabismic amblyopia. ( 25 November 2015 )

Interventions for strabismic amblyopia. ( 25 November 2015 )