Non-Interactive Amblyopia Treatment Modalities in Children: A Systematic Review and Meta-Analysis

Abstract Background: This review aimed to identify the most effective and safest amblyopia interventions in an integrative manner.Methods: Eligible studies were identified from Cochrane library (CENTRAL), Pubmed central, Google Scholar, ScienceDirect and Scopus database up to 09/2018. Data pooling was performed for trials with a little heterogeneity (P>0.05, I2 <50%) using the fixed-effect models. The mean difference (MD) and risk ratio (RR) at 95% confidence interval (CI) for visual acuity improvement, success of the treatment, reverse amblyopia and adherence rate were pooled.Results: Eight trials consisting of 1253 participants were included. Regardless of child’s age, cause and severity of amblyopia, six hours patching and full-time patching were equally effective (Pooled MD, 0.00; 95% CI, -0.54 to 0.55). Likewise, studies independently reported that two hours and six hours patching were equally effective for moderate amblyopia. The therapeutic outcome of patching was statistically comparable to atropine (pooled MD, 0.25 lines; 95% CI, 0.01 to 0.48). The weighted adherence rates for atropine was encouraging as compared to patching (pooled RR, 0.9; 95% CI, 0.84 to 0.96). However, significant reverse amblyopia and poor adherence was recognized in full-time patching and atropine. The risk of developing reverse amblyopia was lower by 19% for patching groups as compared to atropine (pooled RR, 0.19; 95% CI: 0.06 to 0.57). Conclusion: Overall, considering six hours patching or atropine penalization as a first line treatment is a fair decision from effectiveness perspective but it should be under proactive monitoring to optimize the noted adherence and adverse effects issues.