A 4-year-old child is diagnosed with amblyopia secondary to a 4-dioptre unilateral hypermetropia. Spectacle correction is prescribed. If after 16 weeks of spectacle wear alone VA has improved from 6/60 to 6/18, the NEXT step is:
- A Strabismus surgery
- B Referral for laser refractive surgery
- C Optical penalisation of the better eye with atropine 1% eye drops or patching ✓
- D Continue spectacles only without any additional treatment
Correct answer: C. Optical penalisation of the better eye with atropine 1% eye drops or patching
Explanation
After optimal spectacle correction for refractive amblyopia, if VA does not reach 6/6 or continues to lag behind the fellow eye, patching (occlusion therapy) of the sound eye or atropine penalisation is the next step. The PEDIG studies showed patching 2 hours/day and atropine are similarly effective for moderate amblyopia. Since this child has reached 6/18 (improved but still below normal) after 16 weeks of glasses alone, active amblyopia therapy is now indicated. Surgery is reserved for strabismic cases after full amblyopia treatment.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.