Common childhood eye disorder is best treated by patching earlier, new study shows

Most children with a ‘lazy eye’ benefit from earlier patching, new research by University of Leicester experts show.

Amblyopia (or lazy eye), the most common childhood visual disease, is typically treated by wearing glasses to correct the patient’s vision for a lengthy period of time before patching the eye with better vision in order to stimulate the weaker eye.

But a new study has found that patching sooner without a long period of glasses wearing helps to correct the disorder more effectively in most children, leading to improved vision and treatment satisfaction.

The research was carried out under the collaboration of the European Paediatric Amblyopia Treatment Study for Children (EuPatch), set up by the University of Leicester. Its findings have now been published in the Lancet and could prove vital for updating clinical guidelines around the world.

The study has been jointly led by Frank Proudlock, Associate Professor at the University’s Ulverscroft Eye Unit, Michael Hisaund, research orthoptist at the Ulverscroft Eye Unit, NIHR Clinical Research Network and University Hospitals of Leicester NHS Trust, and clinical lead Irene Gottlob, Emeritus Professor at Leicester, who is currently working at the Cooper Neurological Institute and the Rowan University in New Jersey USA.  

“These results are important because an extended period of glasses wearing before patching is commonly used today by many countries,” Professor Irene Gottlob said.

“Amblyopia affects 1-5% of children and currently treatment outcomes are poor. We hope that the results of this study could pave the way for personalised treatment care for children with amblyopia, tailoring the type of treatment to the child.”

Amblyopia is usually caused by either strabismus, where the two eyes look in different directions, or anisometropia, where the light focussing mechanisms are different between the two eyes. It typically leads to much poorer vision in one eye and if left untreated can generate lifelong visual problems.

The study divided 334 children aged between three and eight years in a randomised controlled trial across hospitals in the UK, Greece, Austria, Germany and Switzerland, who required treatment for ‘lazy eye’ into two groups. One group received patching treatment for 24 weeks after a lengthy period of 18 weeks glasses wearing. The other group received patching treatment for 24 weeks after only three weeks wearing glasses.

It found that for most children with amblyopia, patching earlier was more effective than patching following an extended period of wearing glasses.

However, one group of younger children, with less severe amblyopia, did benefit from a lengthier period of 18 weeks glasses wearing before patching as they were most likely to improve during this time.

Dr Proudlock said: “We measured the improvement in vision as the main outcome but we also found, using questionnaires, that families preferred to start patching without a period of prolonged glass wear. The numbers of hours of patching needed was equal in both groups. Since younger children with less severe visual loss responded better to initial treatment with glasses, our study introduced an important advancement in personalised medicine.”

He added that further research was needed to improve personalised care for amblyopia.