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COMMENTARY
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 116

Commentary: Part time occlusion for amblyopia: The unsung hero!


Department of Pediatric Ophthalmology and Strabismology, Narayana Nethralaya, Narayana Health City, Bangalore, Karnataka, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Jyoti Matalia
Narayana Nethralaya 2, Narayana Health City, #258/A, Bommasandra Industrial Estate, Anekal Taluk, Hosur Road, Bangalore - 560 099, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1972_20

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How to cite this article:
Matalia J, Chandramouli A. Commentary: Part time occlusion for amblyopia: The unsung hero!. Indian J Ophthalmol 2021;69:116

How to cite this URL:
Matalia J, Chandramouli A. Commentary: Part time occlusion for amblyopia: The unsung hero!. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 28];69:116. Available from: https://www.ijo.in/text.asp?2021/69/1/116/303286



We appreciate the authors for their study “Efficacy of part time occlusion in amblyopia in Indian children.”[1]

We all know amblyopia is one of the causes of visual impairment in children. There have been various treatment options for amblyopia and occlusion therapy is one of the most commonly practised choice of treatment for any type of amblyopia. The PEDIG group has done an extensive research in this field and has laid the guidelines for amblyopia therapy which is currently being followed world over.[2],[3],[4] The study on efficacy of part time occlusion in amblyopia in Indian population is therefore pertinent as the studies done by PEDIG recruited only the western population. Though many pediatric ophthalmologists across India are practising part time occlusion therapy, there have been very few studies published. One such study was published by Singh et al.[5] in the year 2008 which had assessed the efficacy of part time occlusion for amblyopia in the Indian population and that too in the older children. Hence, in present-day pediatric ophthalmology practice in India this study is very relevant.

Part time occlusion or full time occlusion has been a long drawn debate. Numerous studies have been done to assess the effectiveness of these regimens of occlusion therapy in different age groups. The PEDIG undertook two concurrent randomized control trials of patching to address this matter and they prescribed 2 h/day versus 6 h/day for moderate amblyopia and 6 h/day versus full time for severe amblyopia in 3–6 year olds and found no obvious benefit in longer hours of patching.[6] A meta-analysis which compared the two concluded that both are equally effective and a minimum of 6 h of occlusion provides the maximum vision improvement.[7] The current study also shows that those who were started on full time occlusion therapy following failure of partial occlusion therapy did not show any improvement in vision.[1]

Despite the innumerable studies proving that part time occlusion is as effective or even better than full time occlusion therapy in mild to moderate amblyopia, many paediatric ophthalmologists continue to advocate full time occlusion therapy. Furthermore, considering the adverse effects of full time occlusion such as development of amblyopia in the patched eye and school going children being victimised by the peers, it's desirable to do part time occlusion depending upon the severity of amblyopia. We have been advising part time occlusion therapy for our patients with reasonably good results.

This study is one such study which emphasises the fact that part time occlusion is a dependable treatment choice for amblyopia as against full time occlusion. It is also one of the few to study the efficacy of occlusion therapy in the Indian population and also dismisses the belief that Indian children are not complaint with occlusion therapy.

To conclude, we can advocate part time occlusion therapy as a primary treatment modality over full time occlusion for mild to moderate amblyopia.



 
  References Top

1.
Kaur S, Bhatia I, Beke N, Jugran D, Raj S, Sukhija J. Efficacy of part-time occlusion in amblyopia in Indian children. Indian J Ophthalmol 2021;69:112-5.  Back to cited text no. 1
  [Full text]  
2.
Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol 2003;121:603-11.  Back to cited text no. 2
    
3.
Pediatric Eye Disease Investigator Group. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology 2003;110:2075-87.  Back to cited text no. 3
    
4.
Pediatric Eye Disease Investigator Group. A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. Ophthalmology 2006;113:904-12.  Back to cited text no. 4
    
5.
Singh I, Sachdev N, Brar GS, Kaushik S. Part-time occlusion therapy for amblyopia in older children. Indian J Ophthalmol 2008;56:459-63.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Repka MX, Holmes JM. Lessons from the amblyopia treatment studies. Ophthalmology 2012;119:657-8.  Back to cited text no. 6
    
7.
Yazdani N, Sadeghi R, Momeni-Moghaddam H, Zarifmahmoudi L, Ehsaei A, Barrett BT. Part-time versus full-time occlusion therapy for treatment of amblyopia: A meta-analysis. J Curr Ophthalmol 2017;29:76-84.  Back to cited text no. 7
    




 

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