New 'Lazy Eye' Treatment

Eye drops work just as well as eye patches and are less likely to be shunned by youngsters with lazy eye, the most common cause of visual impairment in children, a study shows.

Parents often have difficulty getting youngsters to wear eye patches because of discomfort and teasing. But the study found children and parents preferred atropine drops and were more likely to use them than patches.

"This may well become a new standard treatment for some forms of amblyopia," the medical name for lazy eye, said Dr. Paul A. Sieving, director of the National Eye Institute, which funded the study.

The study, chaired by Dr. Michael Repka of Johns Hopkins University, found the drops worked as well as patches in treating mild to moderate forms of the disorder in children aged 3 to 6. More severe forms, when vision is worse than 20/100, may require patches.

The condition causes poor vision in an otherwise healthy eye because the brain has learned to favor the other eye. Symptoms can include crossed eyes, farsightedness and nearsightedness. It affects as many as 3 percent of U.S. children and usually develops in infancy or early childhood, according to NEI.

Standard treatment has been eye patches worn over the unaffected eye, which stimulates better vision in the "lazy" eye. The same thing happens with atropine drops, which temporarily blur vision in the unaffected eye.

Atropine drops are used to treat eye inflammation and to dilate youngsters' pupils before an eye exam. The drug is less commonly used for lazy eye, and though some studies have shown it's effective, there's little data comparing it with eye patches, the researchers said.

The new study appears in the March issue of Archives of Ophthalmology.

Repka and colleagues compared the two treatments in 419 children at 47 locations nationwide. About half received one drop daily of atropine for six months and half wore patches for six to 12 or more hours daily. A six-month supply of atropine drops cost about $10, compared with about $100 for six months of patches.

Vision improved faster in the patch group, but results were essentially equal at six months. Treatment was successful in 79 percent of the patch children and 74 percent of the atropine group, a difference that was not clinically significant, the researchers said.

Although more atropine patients than patch patients had slightly reduced vision in the healthy eye at six months, this did not persist at subsequent follow-up exams. The children are being followed through April 2003 to see if there are any long-term advantages to either treatment.

In an Archives editorial, Dr. Burton Kushner of the University of Wisconsin said more research is needed to see if the quicker pace of vision improvement with patches might mean children would need less treatment with patches than with atropine. If so, parents and children might end up preferring patches to eye drops, he said.

Treatment, whether with drops or patches, works best and quickest if started in early childhood, said Dr. Brian N. Campolattaro of the New York Eye and Ear Infirmary. Some children may require a year or more of treatment, he said.

Campolattaro, who uses both atropine and patches in his patients, said the study confirms what may eye doctors have suspected - that atropine "is equally efficacious and should continue to be used very aggressively."