ATROPINE TREATMENT FOR AMBLYOPIA

(11/04)

Atropine drops are being recommended to treat your child's amblyopia. These have been used for over a century, but have never had the same acceptance as using an opaque eye patch to treat amblyopia. In a large research study (published in 2002), it was shown that over the usual range of amblyopia, the use of Atropine drops was about as effective as the use of an opaque patch. Recently it was shown that weekend Atropine (Saturday and Sunday) is as effective as daily Atropine for many patients.

The drop has two different effects:

A. It blurs the vision for 1-3 days (the effect we want) and
B. It dilates the pupil for 3-7 days.

When Atropine is used in combination with the correct distance lens, it blurs close up vision in the better seeing eye with a small effect on distance vision. This then encourages the use of the eye with poor vision and improves vision in that eye over time.

Atropine can also be used with the "wrong" lens (e.g. plane glass), and with this combination the effect is greater than when used with the "correct" spectacle lens. As well as blurring close up vision it now also blurs distance vision all the time.

In a study done in our office, parents who had used both Atropine and an opaque patch at different times to treat amblyopia were asked which they preferred. 2/3 preferred Atropine, 1/3 preferred the patch.

Amblyopia treatment is like going on a diet. Sticking to the diet works, cheating doesn't, and the weight can come back when the treatment is stopped.

Some facts about Atropine:

Atropine drops usually do not sting. If kept refrigerated, you can use them until they run out. Be careful to wash your hands before and after giving the eye drops. If you forget to wash your hands you may inadvertently put some in your own eye.

If your child will not co-operate with drops, give the drop while the child asleep. It is important to open the lids slightly and ensure that the drop goes somewhere between the lids.

Toxic effects from using the drop are extremely rare. These can include fever, redness and swelling around the eye, facial flushing and delirium. Do not use them again if you suspect this is happening to your child. Notify the Doctor as soon as possible.

If the eyes are usually straight, Atropine may be marginally safer than opaque patching. In some patients, opaque patching seems to precipitate a misalignment. Even though this can only happen in a child whose eye is almost misaligned already, parents understandably blame the opaque patch. This may be less likely with Atropine.

Usual dosage regimes

The usual concentration is 0.5%. 1% is used if 0.5% is not available. Most commonly, you will be asked to use the drops every weekend for a week or two, and then come in for a check-up a week or so after you have finished using the drops.

If there is any doubt as to the efficacy of the drop, you will sometimes be asked to use them daily, and to come in whilst you are still using the drops.

If your child has a head injury and is examined by a doctor in an emergency room make sure the doctor knows that the child is receiving Atropine drops for amblyopia. Having one pupil that is dilated and not responsive to a torch light can lead the treating doctor to believe there may be something neurologically wrong with your child and unnecessary CT scans etc could be scheduled.

If using the Atropine seems to be interfering with school work, it should not be used. Please let us know as soon as possible.