Treatment Approaches for Different Amblyopia Types: Choosing Between Patching and Penalization

Abstract

Purpose To evaluate which treatment method is better for the treatment of amblyopia, either patching or atropine penalization.

Methods This systematic review comprises randomized control trials (RCTs) that assess amblyopia treatment using atropine in comparison to patch therapy and which is more effective for different types of amblyopia. The articles were identified through searches on "PubMed," "Google Scholar," and "Science Direct," adhering to the APA format in study design. The selected studies specifically involved individuals with amblyopia caused by either strabismus or refractive error. Notably, participants with refractive error were instructed to wear their corrections during the therapy. Results There is no difference in visual acuity outcomes between atropine and patching therapy, but results are better if used in a combined form as Combined atropine and patching therapy (CAPT). One of the studies also shows that patching improves the stereoacuity too. Clinicians should keep in mind that patching will eliminate suppression and penalization will maintain bifoveal fixation and if clinician wants to go for combined therapy, it will strengthen fusion.

Conclusion Treatment of amblyopia with patching and atropine both have good outcomes. However, atropine penalization has better outcomes in cases where patch therapy failed, particularly in younger patients or those with poor pretreatment VA. Also, young patients with severe amblyopia could benefit from combined therapy. But patching therapy is more convenient for adults as they can remove the patch where it is needed to maintain bi- foveal fixation.