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Table 6 Systematic reviews on treatment effectiveness

From: Vision screening in newborns and early childhood

Syste-matic review Objective Methods Main findings
Date of literature search Inclusion criteria
Jonas 2017 [6] To assess effectiveness of treatment of amblyopia, its risk factors, and refractive error June 2016 - Children aged 6 months to 5 years
- Studies conducted in countries categorized as “very high” on the United Nations Human Development Index
- Publication in English language
- Good or fair quality of studies
- 3 studies included, 2 conducted in the UK, 1 in the US.
- Comparison: 2 studies compared patching versus no patching (with continued eyeglasses in both groups if required); 1 study compared patching plus eyeglasses versus eyeglasses alone versus no intervention.
- Participants: mean age of 4 to 5.2 years and ranging from 3 to 8 years.
- Intervention: the duration of treatment was 5 and 12 weeks for the two studies comparing patching versus no patching with 52 weeks of follow-up in one of them, and one year of treatment for the third study comparing three arms, with 78 weeks of follow-up.
- Outcome measured: improvement in visual acuity.
- Findings: patching was associated with visual acuity improvement, although the effect was small.
- The review authors concluded that early treatment of amblyopia in children aged between 3 and 5 years improved vision, with greater benefits among children with more severe vision impairment at baseline.
- The strength of the evidence based on these three clinical trials (n = 417) was rated as moderate for improved visual acuity.
Taylor 2014 [20] To establish the most effective treatment for strabismic amblyopia:
- Impact of conventional occlusion therapy
- Role of partial occlusion and optical penalisation
January 2014 - RCTs for the treatment of strabismic amblyopia
- No age restriction
- No language or date restriction
- 3 studies included (of which 1 is included in Jonas 2017), conducted in the US. Of them, 2 studies assessed the effect of supplementing the occlusion therapy with near activities.
- Occlusion in addition to refractive correction with eyeglasses when needed, ‘appears to be more effective than refractive correction alone in the treatment of strabismic amblyopia’ and that ‘the benefit of combining near activities with occlusion is unproven’
Taylor 2012 [21] To evaluate the effectiveness of spectacles, occlusion or both for the treatment of unilateral and bilateral refractive amblyopia January 2012 - RCTs
- Treatment for unilateral and bilateral refractive amblyopia by spectacles, with or without occlusion
- No age restriction
- 8 studies included (of which 2 are included in Jonas 2017)
- No trials included children with bilateral amblyopia.
- Meta-analysis could not be performed due to heterogeneity with a lack of data for each outcome.
- Overall, review authors concluded that ‘in some cases of unilateral refractive amblyopia it appears that there is a treatment benefit from refractive correction alone’ and that ‘where amblyopia persists there is evidence that adding occlusion further improves vision’
Antonio-Santos 2014 [15] To assess the effectiveness of occlusion therapy for stimulus deprivation amblyopia October2013 - RCTs or quasi-RCTs
- Participants with unilateral stimulus deprivation amblyopia
- No age restriction
- No trial was found that fulfilled the inclusion criteria.
Tailor 2015 [19] To determine whether binocular versus standard occlusion or pharmacological blurring treatment for unilateral amblyopia in children between 3 and 8 years of age April 2015 - RCTs
- Participants between 3 and 8 years of age with unilateral amblyopia
- Any type of binocular viewing intervention
- No trial was found that fulfilled the inclusion criteria.
Korah 2014 [15] To assess strabismus surgery before versus after completion of amblyopia therapy on functional and anatomic outcomes July 2014 - RCTs
- Children < 7 years of age
- Comparison of strabismus surgery before completion of amblyopia therapy with strabismus surgery after completion of amblyopia therapy
- No trial was found that fulfilled the inclusion criteria.
PrevInfad [5]
To address treatment of vision impairment    - 19 included studies
- Comparisons:
• 7 studies compared different regimens of ocular occlusion with patches
• 5 studies compared blurring the vision with atropine versus ocular occlusion
• 1 study compared blurring the vision with atropine on a daily basis or during weekends
• 6 studies assessed other interventions
- Main conclusions:
• There is no evidence of any specific intervention being more effective
• More intensive occlusive treatment with patches were beneficial to older children and those with severe amblyopia
• In children with moderate amblyopia, blurring the eye with atropine twice weekly and patching were similarly effective, and the risk of local and systemic adverse effects caused by atropine are compensated by the psychosocial effects of patching
  1. Abbreviation: RCTS randomized controlled trials