A child aged 4 years has been diagnosed with anisometropic amblyopia (right eye 6/60, left eye 6/6). The right eye has +5.00 D hypermetropia, left eye +0.50 D. After 6 weeks of full spectacle correction, right VA is still 6/24. The next most appropriate step is:

• A Continue spectacle correction alone for 3 more months
• B Atropine penalization of the fellow eye weekly
• C Refer for surgical correction of the anisometropia
• D Part-time patching (2–6 hours/day) of the fellow (left) eye while wearing correct spectacles ✓

Explanation

Amblyopia treatment follows a stepwise approach: first correct the refractive error with appropriate spectacles and allow 6–18 weeks for refractive adaptation. If VA does not normalize, the next step is penalization of the better eye by patching (2–6 hours/day in moderate amblyopia per PEDIG MOTAS protocol) worn while doing near activities. Atropine penalization (1% atropine weekly in the fellow eye) is an alternative for moderate amblyopia but has less effect in dense amblyopia. Both are equivalent for moderate amblyopia.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.