Amblyopia

Check patient/caregiver understanding of the diagnosis, and provide written instructions and information to aid understanding, as appropriate (e.g., reading materials, weblinks, and video information).[41]American Academy of Ophthalmology. Pediatric ophthalmology/strabismus summary benchmarks - 2022. December 2022 [internet publication]. https://www.aao.org/education/summary-benchmark-detail/pediatric-ophthalmology-strabismus-summary-benchma ​

Compliance with amblyopia treatment is better if caregivers:[104]Tims C. Difficulties with patching. In: Taylor D, Hoyt CS, eds. Pediatric ophthalmology and strabismus, 3rd ed. Edinburgh, UK: Elsevier Saunders; 2005:1103-5.

• Understand why amblyopia treatment is needed

• Understand why it must be carried out when the child is young

• Receive encouragement and helpful tips from the physician.

Improved compliance is also associated with:[105]Loudon SE, Fronius M, Looman CW, et al. Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4393-400. https://iovs.arvojournals.org/article.aspx?articleid=2124121 http://www.ncbi.nlm.nih.gov/pubmed/17003431?tool=bestpractice.com

• Education aimed at children, such as providing them with a cartoon about treatment.

Poor compliance is associated with:[105]Loudon SE, Fronius M, Looman CW, et al. Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4393-400. https://iovs.arvojournals.org/article.aspx?articleid=2124121 http://www.ncbi.nlm.nih.gov/pubmed/17003431?tool=bestpractice.com

• Poor parental fluency in the national language

• Low level of parental education

• A child’s poor visual acuity at the start of treatment.

Online patient information may be helpful. AAPOS: amblyopia Opens in new window AAPOS: glasses for children Opens in new window Distraction, rewards, logbooks and star charts are helpful to encourage compliance for all forms of amblyopia treatment.[105]Loudon SE, Fronius M, Looman CW, et al. Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4393-400. https://iovs.arvojournals.org/article.aspx?articleid=2124121 http://www.ncbi.nlm.nih.gov/pubmed/17003431?tool=bestpractice.com Compliance is also likely to improve as the child's vision improves with treatment. The child with severe amblyopia may initially be quite fearful due to the profound visual impairment resulting from patching or blurring the better-seeing eye.

Spectacles

• Many strategies can be employed to improve the likelihood a child will wear spectacles appropriately. The spectacles should be comfortable, the frame should be as indestructible as possible as well as flexible, and the spectacle lens should be large enough to discourage peeking around the edge of the frame. An elastic band that fits behind the head can help keep the spectacles appropriately positioned. A sibling or parent wearing glasses may help. Also compliance may be improved by having some spectacles for the child's doll or stuffed animal to wear. Rarely, temporary use of elbow restraints may be necessary to keep the spectacles on the child's face.

Patching

• Similar strategies can be used to adapt a child to wearing a patch. A patch that is sticky enough to not be easily removed should be used, but not one that is so sticky as to irritate the skin. Cloth patches that fit over the spectacles can be used if the child refuses a sticky patch, but this may result in peeking around the edge of the patch. It is best to choose a time to patch when the child is not tired or irritable. Preschool or school teachers may be helpful in enforcing patching compliance, or other caregivers such as grandparents. If methods such as mittens and elbow restraints are deemed appropriate to use, they generally do not need to be used for long. The child adapts to wearing the patch, and vision in the amblyopic eye rapidly improves, making occlusion of the better-seeing eye less disabling.[104]Tims C. Difficulties with patching. In: Taylor D, Hoyt CS, eds. Pediatric ophthalmology and strabismus, 3rd ed. Edinburgh, UK: Elsevier Saunders; 2005:1103-5.

Atropine

• Atropine penalization is as successful as patching in the treatment of certain types of amblyopia. Installation of 1 drop of atropine on weekend days or every day is easier than patching for many families to manage. The atropine can be given when the child is asleep.

• The caregiver should stop the atropine drops and call the physician if the child develops adverse effects (e.g., flushing, rash, fever, thirst, agitation, or inappropriate behavior).

• Sunglasses and a hat outdoors are recommended in children receiving atropine eye drops.