Level 2: Mid-level evidence

Amblyopia in children is commonly treated by patching the unaffected eye to increase the use of the eye with impaired visual acuity, but compliance with patch wearing can be a problem. A recent Cochrane review suggests that treatment with atropine drops appears to be at least as effective as patching (Cochrane Database Syst Rev. 2009;4:CD006460). In three trials with 518 children aged 2-10 years (525 amblyopic eyes), visual acuity was measured in both amblyopic and sound eyes at baseline and at various timepoints during follow-up. Adverse effects and difficulties associated with treatment were assessed with questionnaires. Patching and atropine drops were both well tolerated. In the largest, highest-quality trial, atropine was associated with higher compliance rates (78% vs. 49%) and greater mean improvement in visual acuity at six months (3.4 lines vs. 1.8 lines, P <0.05). The other two trials showed no significant differences in acuity between groups, although both groups showed improvement at 24 months in one trial.