Aug. 8, 2003 — Eye patches help kids with lazy eye. But kids hate wearing them. Soon they may have another option.

Lazy eye — amblyopia to doctors — isn’t really an eye problem. It happens when a child’s brain ignores input from one eye. The treatment: Cover the good eye with a patch, forcing the brain to accept images from the lazy eye.

Another strategy is to put vision-blurring eye drops — atropine — in the good eye. Studies looking back at the eye-drop strategy suggested it didn’t work as well. But a recent clinical trial led by Michael X. Repka, MD, of the Wilmer Eye Institute at Baltimore’s Johns Hopkins University, breathed new life into atropine treatment.

The study, in 1,419 kids younger than 7 years, showed that patching worked faster. But after six months, there was no statistically significant difference between the two groups.

In the August issue of Ophthalmology, Repka’s team reports that atropine works as well in kids whose vision in the lazy eye was 20/100 as it did in kids with lazy-eye vision of 20/40.

“Our findings are important because previous … studies suggested atropine might be less effective than patching, and that it was largely ineffective in children with poorer visual acuity,” Repka says in a news release. “These preliminary findings suggest the need for a future study, in which we will assess the effect of atropine at visual acuity levels worse than 20/100.”

Which Is the Best Treatment?

So which is better, patching or eye drops? Repka and colleagues say it’s a toss-up.

“In some cases, parent or even child preference may be the overriding factor in deciding which treatment to prescribe,” they conclude.

Not so fast, suggests an editorial accompanying the Repka study. Burton J. Kushner, MD, of the University of Wisconsin in Madison, takes a close look at the Repka team’s data.

He notes that 56% of the kids who wore a patch improved lazy-eye vision to 20/30 after only five weeks. Only 33% of the eye-drop kids got this much better this quickly.

“The difference between a patient being cured of amblyopia after six months of treatment, versus only five weeks, can mean a difference of four or five additional trips to the doctor’s office,” Kushner writes. “This translates into more time off work, more inconvenience, greater expense, a prolongation of the difficulties that may be encountered with the treatment, and more frustration for parent and child.”

Kushner also notes that in the end, 40% of patch kids improved to 20/25 vision — but only 28% of eye-drop kids did this well. Moreover, Kushner points out, there are still questions about whether the eye drops have long-lasting effects in the good eye.

“Patching definitely works much more quickly, results in a better final visual outcome, and is a more known quantity with respect to adverse effects on binocular vision and [both eyes working together],” Kushner writes. “Consequently, the choice seems clear to me.”