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

Abstract Background: Recently, a number of clinical trials are conducting on amblyopia treatments. Discovering an intervention that provides optimal outcome with minimal subsidiary effect is an essential issue in medical arena. Therefore, 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 electronic database. Data pooling was performed for trials with a little statistical heterogeneity (P>0.05, I 2 <50%) using the fixed-effect models. The mean difference (MD) and risk ratio (RR) at 95% confidence interval (CI) for visual acuity improvement, the success of the treatment, reverse amblyopia, and adherence rate was pooled. Results : Eight trials consisted of 1253 participants were included . The pooled mean visual acuity improvement was similar for both six hours and full time patching (MD, 0.00; 95% CI, -0.54 to 0.55). In subgroup analysis, all spectrum of patching are equally effective in treating mild to moderate amblyopia but 6 hours to full-time patching regimen are effective for severe amblyopia. The therapeutic outcome of patching was statistically preferable to atropine (pooled MD, 0.25 lines; 95% CI, 0.01 to 0.48). Besides, the incidence of reverse amblyopia was lower in patching groups as compared to atropine (pooled RR, 0.19; 95% CI: 0.06 to 0.57). However, the treatment adherence for patching was lesser, (pooled RR, 0.9; 95% CI, 0.84 to 0.96). Conclusion: Patching, particulary six-hours patching as a first line treatment provides optimal visual acuity improvement that balances the effect of reverse amblyopia and poor adhrence as compared to atropine and other spectrum of patching regimen but it should be under proactive monitoring to optimize the adherence issues.