Reverse amblyopia with atropine treatment

Bryan C. Hainline, Derek T. Sprunger, David A. Plager, Daniel E. Neely, Matthew G. Guess

Research output: Contribution to journalArticle

7 Scopus citations


Introduction: Occlusion, pharmacologic penalization and combined therapy have been documented in controlled studies to effectively treat amblyopia with few complications. However, there remain concerns about the effectiveness and complications when, as in this case, there are not standardized treatment protocols. Methods: A retrospective chart review of 133 consecutive patients in one community based ophthalmology practice treated for amblyopia was performed. Treatments evaluated were occlusion only, atropine penalization, and combination of occlusion and atropine. Reverse amblyopia was defined as having occurred when the visual acuity of the sound eye was 3 LogMar units worse than visual acuity of the amblyopic eye after treatment. Results: Improvement in vision after 6 months and 1 year of amblyopia therapy was similar among all three groups: 0.26 Log mar lines and 0.30 in the atropine group, 0.32 and 0.34 in the occlusion group, and 0.24 and 0.32 in the combined group. Eight (6%) patients demonstrated reverse amblyopia. The mean age of those who developed reverse amblyopia was 3.5 years, 1.5 years younger than the mean age of the study population (p<0.01), 7/8 had strabismic amblyopia, 6/8 were on daily atropine and had a mean refractive error of +4.77 diopters in the amblyopic eye and +5.06 diopters in the sound eye. Reverse amblyopia did not occur with occlusion only therapy. Conclusions: In this community based ophthalmology practice, atropine, patching, and combination therapy appeared to be equally effective modalities to treat amblyopia. Highly hyperopic patients UNDER 4 YEARS OF AGE with dense, strabismic amblyopia and ON DAILY ATROPINE appeared to be most at risk for development of reverse amblyopia.

Original languageEnglish (US)
Pages (from-to)25-31
Number of pages7
JournalBinocular Vision and Strabismus Quarterly
Issue number1
StatePublished - Mar 1 2009

ASJC Scopus subject areas

  • Ophthalmology

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    Hainline, B. C., Sprunger, D. T., Plager, D. A., Neely, D. E., & Guess, M. G. (2009). Reverse amblyopia with atropine treatment. Binocular Vision and Strabismus Quarterly, 24(1), 25-31.