Monitoring

Severe amblyopia, younger patient age, and more aggressive patching generally require closer follow-up than mild amblyopia, older patient age, and less aggressive patching.

Usually, providers see children with mild anisometropic and ametropic amblyopia treated with spectacles alone in follow-up after about 2-3 months, giving the patient enough time to obtain the spectacles, wear them, and achieve a treatment effect.[41]​ By contrast, infants with form-deprivation amblyopia, such as those who have undergone congenital cataract removal, are typically seen at 1 day, 1 week, and 1 month postoperatively to assess healing and monitor for complications. Thereafter, monthly or bimonthly visits allow for aggressive treatment of amblyopia and monitoring for changes in refraction in a rapidly growing young eye.

Once visual acuity in the amblyopic eye has stabilized over 2-3 visits or 4 months, treatment can usually be tapered.[1]​​ Amblyopia has a high risk of recurrence and thus children should be followed after cessation of treatment. In particular, patients treated for strabismic or anisometropic amblyopia usually require longer monitoring and further treatment. Adjust treatment as follows:​[1]​

  • Consider increasing penalization (patching or atropine) or trying an alternative therapy (including patching or atropine if not tried) if visual acuity remains unchanged after 3 months

  • Use an alternative treatment if severe skin irritation occurs with patching or side effects occur with atropine

  • Taper or terminate treatment if treatment has been unsuccessful due to underlying pathology

  • Temporarily stop treatment and monitor eye alignment and vision if strabismus or diplopia develop

  • Temporarily stop treatment, review diagnosis, and monitor if visual acuity decreases in the fellow eye by ≥2 lines (i.e., reverse amblyopia). Consider patching the originally amblyopic eye.

Many amblyopic children, especially those starting treatment at an older age, those with severe amblyopia, and those with form-deprivation amblyopia, will be left with a residual visual deficit despite compliance with treatment.[102][103]

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