Clinical trial of patching versus atropine penalization for the treatment of anisometropic amblyopia in older children

J AAPOS. 2008 Oct;12(5):493-7. doi: 10.1016/j.jaapos.2008.03.006. Epub 2008 Jun 5.


Purpose: To compare conventional patching therapy with atropine penalization in the treatment of anisometropic amblyopia.

Methods: Prospective, randomized, institution-based clinical trial of patching versus atropine penalization in patients aged 8-20 years. Patients received either conventional, full-time patching, or atropine penalization.

Results: Fifty-seven patients were enrolled, with visual acuity ranging from 6/12 to 6/60 in the amblyopic eye. Twenty-nine patients received conventional full-time patching; 28 received atropine penalization. At 6 months, visual acuity improved by 2.38 lines in the conventional patching group and 2.34 lines in the atropine group (p = 0.889). The speed of visual recovery was faster in the patching group (3.7 months) than in the atropine group (4.7 months; p = 0.013). There was significant improvement in near vision and contrast sensitivity in both groups, but improvement in the patching group was significantly better than in the atropine group. No patient had reduced visual acuity in the unaffected eye. Redness of eyes was observed more in the atropine group than in the patching group. Treatment tended to be better-accepted by parents and patients in the atropine group, but not significantly more.

Conclusions: In patients aged 8-20 years with anisometropic amblyopia, both patching and atropine therapy improved visual acuity. Although recovery was faster with patching, the 2 modalities of treatment appeared to be equally effective.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Amblyopia / physiopathology
  • Amblyopia / therapy*
  • Atropine / adverse effects
  • Atropine / therapeutic use*
  • Child
  • Contrast Sensitivity
  • Humans
  • Mydriatics / adverse effects
  • Mydriatics / therapeutic use*
  • Recovery of Function
  • Sensory Deprivation*
  • Time Factors
  • Treatment Outcome
  • Vision, Monocular
  • Visual Acuity


  • Mydriatics
  • Atropine