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Bifocal use in hyperopic anisometropic amblyopia treated with atropine: a proof-of-concept randomized trial

Eye volume 37, pages 1840–1843 (2023)Cite this article

Subjects

Abstract

Objectives

To investigate the effect of bifocal wearing in the amblyopic eye when atropine is used in the sound eye for the treatment of hyperopic anisometropic amblyopia.

Methods

Children 4–8 years old were randomly assigned to bifocal + atropine (n = 16) or only atropine (control, n = 19) groups of treatment in a proof-of-concept study. Measurements included visual acuity (logMAR), prism and cover test, stereoacuity (Randot preschool or Randot circles), contrast sensitivity (MARS test), accommodation (Grand Seiko WAM5500 and dynamic retinoscopy), retinoscopic and subjective refraction, before starting treatment and at 6 months, except accommodation, which was remeasured at 9–11 months. Main outcome measure was change in logMAR lines of visual acuity, and secondary outcome measures were change in stereoacuity and contrast sensitivity in the amblyopic eye, at 6 months.

Results

Improvement in visual acuity of the amblyopic eye was significantly better (p = 0.04) in the atropine plus bifocal (3.3 ± 0.9 logMAR lines) than in the atropine only group (2.6 ± 0.8 logMAR lines), whereas change in stereoacuity and contrast sensitivity was not significantly different between the two groups. Differences in accommodative gain, which was impaired in the amblyopic compared to the sound eye, before treatment, decreased after treatment, in the atropine group (0.62 ± 0.16 vs 0.79 ± 0.2, p = 0.3), and atropine + bifocal group (0.69 ± 0.15 vs 0.82 ± 0.2, p = 0.4).

Conclusions

Use of bifocal lens add in the amblyopic eye of children with hyperopic anisometropic amblyopia, treated by atropine penalization, is beneficial in the follow-up period of 6 months.

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Fig. 1: Accommodative gain of the sound and amblyopic eye in each group of treatment.
Fig. 2: Improvement of visual acuity in the amblyopic eye at 6 months in the atropine (red) and atropine + bifocal (green) groups of treatment (p = 0.04, Mann–Whitney U test).
Fig. 3: Change in stereoacuity at 6 months in the atropine (red) and atropine + bifocal (green) groups of treatment (p = 0.6, Mann–Whitney U test).

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Data availability

Data available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Hospital Ramón y Cajal, Madrid, Spain

    Jaime Tejedor & Francisco J. Gutiérrez-Carmona

  2. Department of Neuroscience and Laboratory of Human Vision, Universidad Autónoma de Madrid, Madrid, Spain

    Jaime Tejedor

  3. Department of Surgery, Universidad Alfonso X el Sabio, Madrid, Spain

    Francisco J. Gutiérrez-Carmona

Authors
  1. Jaime Tejedor
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  2. Francisco J. Gutiérrez-Carmona
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Contributions

JT contributed to the conception and design of the study, data acquisition, statistical analysis, analysis and interpretation of results, and writing the draft and final version of the manuscript. FJGC contributed to the conception and design of the study, analysis and interpretation of results, writing the draft, revising it critically, and obtaining the final version of the manuscript.

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Correspondence to Jaime Tejedor.

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Tejedor, J., Gutiérrez-Carmona, F.J. Bifocal use in hyperopic anisometropic amblyopia treated with atropine: a proof-of-concept randomized trial. Eye 37, 1840–1843 (2023). https://doi.org/10.1038/s41433-022-02247-4

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