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Evidence-Based Amblyopia Treatment: Results of PEDIG Studies

Correspondence: Requests for reprints should be addressed to: David K. Wallace, M.D., M.P.H., Duke University Eye Center, DUMC 3802, Durham, NC 27710; e-mail: David.Wallace{at}duke.edu

Retrospective studies without control groups are sometimes useful for suggesting treatment effects and generating hypotheses, but they suffer from bias and confounding. In response to the need for better evidence for treatment, the Pediatric Eye Disease Investigator Group (PEDIG) has conducted several randomized amblyopia treatment trials over the past several years. Results have shown that spectacles alone are a powerful treatment for amblyopia; patching is superior to spectacles alone; initiating fewer hours of prescribed patching seems to be as effective as traditional treatment; patching is effective in older children, particularly if they have not previously been treated; atropine is as effective as patching after six months; and weekend atropine is equally effective as daily atropine. All studies have limitations, but randomized clinical trials limit bias and confounding and thus provide the highest level of evidence of treatment effect.

Key words: amblyopia, randomized clinical trials, patching, atropine