A 5-year-old child has severe amblyopia in the left eye with visual acuity of 6/60, and the right eye sees 6/6. Based on the randomised trials of prescribed patching regimens by the Pediatric Eye Disease Investigator Group (PEDIG), what is the MINIMUM prescribed daily patching duration that produced outcomes equivalent to full-time occlusion in severe amblyopia?

• A 1 hour per day
• B 2 hours per day
• C 6 hours per day ✓
• D 12 hours per day

Explanation

In PEDIG trials, severe amblyopia (acuity roughly 20/100 to 20/400) patched 6 hours daily achieved visual gains equal to full-time occlusion. Moderate amblyopia (roughly 20/40 to 20/80) needed only 2 hours daily for equivalence with 6 hours. Students who remember the moderate amblyopia result are drawn to 2 hours, but the 6 hour regimen applies specifically to severe amblyopia, which is the level stated in this stem. Full-time occlusion offers no added benefit and risks reverse amblyopia.

Reference: AAO Basic and Clinical Science Course, Section 6: Pediatric Ophthalmology and Strabismus, 2022 ed.

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Written and medically reviewed by the StethoPrep medical team.