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Optometric Management

Article | 2025 Optometric Management Symposium

Amblyopia Treatment Extends Past Preschool Years

Clinical trials show treatment is effective into adolescence, with digital tools adding new options.

By: Jennifer Ford, content director
Optometric Management November 16, 2025

At the 2025 Optometric Management Symposium, Susan A. Cotter, OD, MS, FAAO, presented an evidence-based update on amblyopia management, challenging long-held treatment dogma and highlighting new therapeutic options. The name of her lecture: "Amblyopia Management Today: Evidence-Based Updates for Clinical Practice." 

A Long-Held Treatment Dogma

Traditionally managed with full-time patching, amblyopia has been widely believed to be untreatable beyond age 9. However, clinical trials led by the Pediatric Eye Disease Investigator Group (PEDIG) have shown that less intensive patching—2 hours daily for moderate cases1 and 6 for severe2—can be effective, and that treatment responsiveness extends into adolescence.3 Atropine penalization has also proven to be as effective as patching for moderate amblyopia, with good tolerability and flexibility for families.4-6

New Therapeutic Options

Dr. Cotter emphasized that optical correction alone is a legitimate first-line therapy, because wearing glasses can significantly improve visual acuity in many children.7,8 Beyond conventional approaches, she reviewed evidence on Bangerter filters9 and digital dichoptic therapeutics, including 2 US Food and Drug Administration-approved binocular digital therapies: 1 shown in a clinical trial to be superior to glasses alone,10 and the other demonstrated to be noninferior to patching.11 Questions remain about their long-term effectiveness, their role in older children, and, for the first therapy, how it compares with patching. At the same time, she pointed to emerging virtual reality-based options that may hold even greater promise.

Keep Tabs on Amblyopia

Her message to optometrists: amblyopia management is evolving rapidly. Clinicians should consider patient-specific factors, remain open to both traditional and emerging digital therapies, while ensuring their use is evidence-based, and recognize that treatment can be effective well beyond the preschool years.

“NIH-supported research has changed how we treat amblyopia, showing effectiveness beyond early childhood and with less intensive regimens,” Dr. Cotter said. “Ongoing trials will clarify the role of emerging digital binocular therapies.” OM

References

  1. Repka MX, Beck RW, Holmes JM, et al. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol. 2003;121(5):603-611. doi:10.1001/archopht.121.5.603

  2. Pediatric Eye Disease Investigator Group. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology. 2003;110(11):2075-2087. doi:10.1016/S0161-6420(03)00918-8

  3. Scheiman MM, Hertle RW, Beck RW, et al. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005;123(4):437-447. doi:10.1001/archopht.123.4.437

  4. Repka MX, Cotter SA, Beck RW, et al. A randomized trial of atropine regimens for treatment of moderate amblyopia in children. Ophthalmology. 2004;111(11):2076-2085. doi:10.1016/j.ophtha.2004.04.032

  5. Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2002;120(3):268-278. doi:10.1001/archopht.120.3.268

  6. Holmes JM, Beck RW, Kraker RT, et al; Pediatric Eye Disease Investigator Group. Impact of patching and atropine treatment on the child and family in the amblyopia treatment study. Arch Ophthalmol. 2003;121(11):1625-32. doi: 10.1001/archopht.121.11.1625. PMID: 14609923.

  7. Cotter SA; Pediatric Eye Disease Investigator Group, Edwards AR, et al. Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology. 2006;113(6):895-903. doi:10.1016/j.ophtha.2006.01.068

  8. Writing Committee for the Pediatric Eye Disease Investigator Group; Cotter SA, Foster NC, Holmes JM, et al. Optical treatment of strabismic and combined amblyopia. Ophthalmology. 2012;119(1):150-158. doi:10.1016/j.ophtha.2011.06.043

  9. Pediatric Eye Disease Investigator Group Writing Committee, Rutstein RP, Quinn GE, et al. A randomized trial comparing Bangerter filters and patching for the treatment of moderate amblyopia in children. Ophthalmology. 2010;117(5):998-1004.e6. doi:10.1016/j.ophtha.2009.10.014

  10. Xiao S, Angjeli E, Wu HC, et al. Randomized controlled trial of a dichoptic digital therapeutic for amblyopia. Ophthalmology. 2022;129(1):77-85. doi:10.1016/j.ophtha.2021.09.001

  11. Wygnanski-Jaffe T, Kushner BJ, Moshkovitz A, Belkin M, Yehezkel O; CureSight Pivotal Trial Group. High-adherence dichoptic treatment versus patching in anisometropic and small angle strabismus amblyopia: a randomized controlled trial. Am J Ophthalmol. 2025;269:293-302. doi:10.1016/j.ajo.2024.08.011