In the management of refractive amblyopia in a 4-year-old child, if best-corrected visual acuity improves to 6/9 in the amblyopic eye after 18 weeks of spectacle wear alone but does not reach 6/6, what is the next recommended step?
- A Continue spectacle correction alone as vision has improved and further improvement is expected
- B Add part-time occlusion of the fellow eye for 2-6 hours per day ✓
- C Switch to atropine penalisation of the fellow eye
- D Proceed to strabismus surgery to prevent further deterioration
Correct answer: B. Add part-time occlusion of the fellow eye for 2-6 hours per day
Explanation
If visual acuity improves with spectacle wear but plateaus at less than 6/6 (or shows a residual acuity difference of 2 or more lines between eyes) after an adequate period (typically 12-16 weeks), occlusion therapy of the fellow eye for 2-6 hours per day is added. This is supported by PEDIG studies showing that residual amblyopia benefits from occlusion. Atropine is an alternative for moderate amblyopia. Surgery is not indicated for purely refractive amblyopia.
Reference: Pediatric Ophthalmology and Strabismus, AAO BCSC, 2023-2024 ed.
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Written and medically reviewed by the StethoPrep medical team.