A Cochrane review [Abstract] 1 included 3 studies with a total of 525 amblyopic eyes. Pooling was not done due to differences in the studies. In one study (n=419), improvement in vision was initially faster in the patching group, but at 6 months, the difference in visual acuity between the two treatment groups was small and clinically inconsequential (MD 0.034 logMAR, 95% CI 0.005 to 0.064). The six-month visual acuity was 0.2 logMAR or better in the amblyopic eye in 63.5% of the patching group and 53.1% of the atropine group (RR 1.20, 95% CI 1.01 to 1.41). At 24 months, additional visual acuity improvement in the amblyopic eye was seen in both treatment groups. Visual acuity improved from baseline to a mean of 3.7 lines in the patching group and 3.6 lines in the atropine group. There continued to be no meaningful difference between groups in mean visual acuity score (MD 0.01 logMAR; 95% CI −0.02 to 0.04).
The second study (n=70) reported atropine to be more effective than occlusion. At 6 months, visual acuity improved 1.8 lines in the patching group and 3.4 lines in the atropine penalization group, and was in favor of atropine (MD -0.16 logMAR, 95% CI -0.23 to -0.09). The third study (n=36) had inherent methodological flaws and limited inference could be drawn. No difference in ocular alignment, stereo acuity and sound eye visual acuity between occlusion and atropine penalization was found. Although both treatments were well tolerated, compliance was better in atropine.
Comment: The quality of evidence is downgraded by study quality and by inconsistency (heterogeneity in interventions and outcomes).
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