The efficacy of optical and pharmacological penalization

Ophthalmology. 1993 May;100(5):769-74; discussion 774-5. doi: 10.1016/s0161-6420(93)31577-0.


Purpose: Optical and pharmacological penalization of sound eyes are infrequently used alternatives to occlusion for treating amblyopia. The authors evaluated the efficacy of penalization as their primary treatment of amblyopia.

Methods: One hundred sixty-six patients underwent penalization treatment for strabismic or anisometropic amblyopia for a minimum of 3 months. Both atropine and optical penalization methods were used.

Results: Visual acuity improved in 67 (77%) of 87 patients treated with optical penalization. There was a significant improvement of the geometric mean visual acuity of the amblyopic eyes from 20/38 to 20/28 (P < 0.001). Visual acuity of 60 (76%) of 79 patients treated with pharmacological penalization improved. There was a significant improvement of mean visual acuity of the amblyopic eyes from 20/61 to 20/40 (P < 0.001). Neither therapy produced an instance of occlusion amblyopia. Thirteen patients discontinued therapy because of blur or discomfort.

Conclusion: This study demonstrates that penalization methods are effective methods for the treatment of amblyopia, with a low risk of occlusion amblyopia. Patient acceptance of these methods was excellent. Penalization should be considered more often for the primary treatment of amblyopia.

Publication types

  • Comparative Study

MeSH terms

  • Amblyopia / therapy*
  • Atropine / administration & dosage*
  • Child
  • Child, Preschool
  • Follow-Up Studies
  • Humans
  • Orthoptics*
  • Patient Satisfaction
  • Pupil / drug effects
  • Strabismus / therapy
  • Treatment Outcome
  • Visual Acuity


  • Atropine