How should I approach the management of a child diagnosed with amblyopia, including the use of occlusion therapy?

Management of a child diagnosed with amblyopia primarily involves early detection and treatment to improve visual acuity and prevent long-term visual impairment. The cornerstone of treatment is occlusion therapy, which entails patching the normal (non-amblyopic) eye to encourage use of the amblyopic eye. The duration and intensity of patching depend on the child's age and the severity of amblyopia, with part-time occlusion often being effective and better tolerated. Compliance with occlusion therapy is critical, as poor adherence is the greatest barrier to visual improvement. In cases where occlusion compliance is problematic, penalization therapy using atropine drops to blur the vision in the normal eye may be considered as an alternative to encourage use of the amblyopic eye.

Alongside occlusion, corrective glasses should be prescribed if refractive errors are present, as many children with amblyopia also have coexisting refractive issues that contribute to the condition. Regular follow-up, including annual refraction assessments, is necessary to monitor changes and adjust treatment accordingly. The management plan should be coordinated by paediatric eye services, typically involving orthoptists and ophthalmologists, to assess the type and severity of amblyopia and to tailor treatment.

Recent clinical trials have explored adjunctive therapies such as vision stimulators (e.g., Cambridge vision stimulator), which may offer comparable outcomes to passive occlusion therapy, but occlusion remains the standard first-line treatment. Early initiation of treatment is associated with better visual outcomes, emphasizing the importance of prompt referral and intervention. Education and support for parents and carers to encourage adherence to treatment regimens are essential components of management.