What is the effectiveness of part-time occlusion or full-time occlusion in the management of amblyopia?

Clinical question: What is the effectiveness of part-time occlusion or full-time occlusion in the management of amblyopia?

Clinical scenario

A seven year child reports to A&B that she has difficulties looking at a book, school board or a television for the last 3 months. A clinical examination reveals a wound and movement of the skull to view something and there is squinting. A clinical diagnosis of covering the eye is made.  The child however is anxious to see with her two eyes.

Search strategy

New South Walls library using the PudMed interface

(Amblyopic, Full-time occlusion and part time occlusion) and adjectives such as evidence (high and low) Limit to (English and Human)

Search outcome

Out of the eight studies identified, three were conducted by the Paediatric Eye Disease Investigator.  The 3rd study was preceded by two studies that were conducted in 2003.  The first study (2003 A) involved daily patching for two or six hours and a minimum of one hour each day for optical stimulation tasks among children below the age of seven.  The preceding study (2003 B) equated fulltime patching and six hours patching as a management strategy for severe amblyopia in children under seven. The study concluded six hours patching is very useful just like the full time treatment in the management of severe amblyopia in children under seven. These two studies were classified as level II of proof. The 2008 PEDIG study indicated that performing near tasks during patch treatment for amblyopia acts as a catalyst for visual acuity when using two hours treatments as a management strategy. Experimental findings by Awan et al (2005) indicated that non compliance in the treatment procedures significantly influences the effectiveness of therapy. It suggested that non compliance with occlusion treatment causes unsatisfactory results.  On the other hand, hug (2004) shows evidence that fulltime patching outperformed part-time work in the children. Singh et al (2008) argues that part-time occlusion is similar to fulltime occlusion in the ability to treat mild-moderate cases of amblyopia in children.

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