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Occlusion for stimulus deprivation amblyopia

  1. Aileen Antonio-Santos1,*,
  2. Satyanarayana S Vedula2,
  3. Sarah R Hatt3,
  4. Christine Powell4

Editorial Group: Cochrane Eyes and Vision Group

Published Online: 6 FEB 2014

Assessed as up-to-date: 28 OCT 2013

DOI: 10.1002/14651858.CD005136.pub3

How to Cite

Antonio-Santos A, Vedula SS, Hatt SR, Powell C. Occlusion for stimulus deprivation amblyopia. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD005136. DOI: 10.1002/14651858.CD005136.pub3.

Author Information

  1. 1

    Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA

  2. 2

    Johns Hopkins University, Baltimore, Maryland, USA

  3. 3

    Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota, USA

  4. 4

    Royal Victoria Infirmary, Department of Ophthalmology, Newcastle upon Tyne, UK

*Aileen Antonio-Santos, Grand Rapids Medical Education Partners, 25 Michigan Street NE, Grand Rapids, Michigan, 49301, USA.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 6 FEB 2014



References to studies excluded from this review

  1. References to studies excluded from this review
  2. Additional references
  3. References to other published versions of this review
Agafonov 2007 {published data only}
  • Agafonov VV. Development of a technique for ametropia correction with phakic intraocular lenses. Vestnik Rossiiskoi akademii meditsinskikh nauk / Rossiiskaia akademiia meditsinskikh nauk 2007, (8):52-6.
Arruga 1966 {published data only}
  • Arruga A. Occlusion therapy in children. International Ophthalmology Clinics 1966;6(3):435-52.
Botabekova 2004 {published data only}
  • Botabekova TK, Kurgambekova NS. A comparative analysis of the efficiency of different methods in the treatment of amblyopia. Vestnik Oftalmologii 2004;120(5):40-1.
Clarke 2003 {published data only}
  • Clarke MP, Wright CM, Hrisos S, Anderson JD, Henderson J, Richardson SR. Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening. BMJ 2003;327(7426):1251.
Cramer 1966 {published data only}
  • Cramer FE, Lamela N, Luqui Lagleyze J, Corsellas A. Use of the electronic flash in the pleoptic treatment of amblyopias [Uso del flash electronico en el tratamiento pleoptico de las ambliopias]. Arquivos Brasileiros de Oftalmologia 1966;29(3):83-8.
Cuppers 1967 {published data only}
  • Cuppers C. Effects of pleoptic therapy with special consideration of permanent results. II [Ergebnisse der pleoptischen Therapy unter besonderer Berucksichtigung der Dauerresultate. II]. Documenta Ophthalmologica 1967;23:570-605.
Fletcher 1969a {published data only}
  • Fletcher MC, Silverman SJ, Boyd J, Callaway M. Biostatistical studies. Comparison of the management of suppression amblyopia by conventional patching, intensive hospital pleoptics, and intermittent office pleoptics. American Orthoptic Journal 1969;19:40-7.
Fletcher 1969b {published data only}
  • Fletcher MC, Abbott W, Girard LJ, Guber D, Silverman SJ, Tomlinson E, et al. Biostatistical studies. Results of biostatistical study of the management of suppression amblyopia by intensive pleoptics versus conventional patching. American Orthoptic Journal 1969;19:8-30.
Flynn 1967 {published data only}
  • Flynn JT, Vereecken E. Effects of pleoptic therapy with special consideration of permanent results. I. Documenta Ophthalmologica 1967;23:550-69.
Flynn 1968 {published data only}
Funghini 1973 {published data only}
  • Funghini G. Interest of orthoptic and pleoptic treatment [L'interesse del trattamento ortottico e pleottico]. Minerva Medica 1973;64(69):3612-5.
Gernet 1958 {published data only}
  • Gernet H. Controlled partial occlusion by polarized glasses in treatment of amblyopia and strabismus: preliminary report. Klinische Monatsblätter für Augenheilkunde und für Augenärztliche Fortbildung 1958;133(3):388-96.
Hartman 1982 {published data only}
  • Hartman DK. CAM vision stimulator; a controlled study. New York State Journal of Medicine 1982;82(5):723-4.
Hertle 2007 {published data only}
  • Hertle RW, Scheiman MM, Beck RW, Chandler DL, Bacal DA, Birch E, et al. Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years. Archives of Ophthalmology 2007;125(5):655-9.
Holmes 2003a {published data only}
  • Holmes JM, Kraker RT, Beck RW, Birch EE, Cotter SA, Everett DF, et al. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology 2003;110(11):2075-87.
Holmes 2003b {published data only}
  • Holmes JM, Beck RW, Kraker RT, Cole SR, Repka MX, Birch EE, et al. Impact of patching and atropine treatment on the child and family in the amblyopia treatment study. Archives of Ophthalmology 2003;121(11):1625-32.
Iacobucci 1977 {published data only}
Iturriaga 2012 {published data only}
  • Iturriaga H, Zanolli M, Damm C, Oporto J, Acuna O, Valenzuela F. Frequent evaluation to improve compliance in patients treated with occlusion for amblyopia: a randomized controlled trial. Binocular Vision and Strabismus Quarterly 2012;27(3):195-204.
Kamlesh 2008 {published data only}
  • Kamlesh GS, Bhola R, Fatima S, Goyal G, Dadeya SC. Levodopa as an adjuvant to conventional occlusion for treatment of amblyopia in children. American Academy of Ophthalmology. 2008:Abstract 176.
Kampf 2008 {published data only}
  • Kampf U, Shamshinova A, Kaschtschenko T, Mascolus W, Pillunat L, Haase W. Long-term application of computer-based pleoptics in home therapy: selected results of a prospective multicenter study. Strabismus 2008;16(4):149-58.
Keith 1980 {published data only}
Kuming 1982 {published data only}
  • Kuming BS, Klugman M. The value of CAM visual stimulation. South African Archives of Ophthalmology 1982;9(3-4):65-70.
Lang 1965 {published data only}
  • Lang J. "Increasing occlusion" in the treatment of amblyopia with eccentric fixation [Die "Ansteigeokklusion" zur Behandlung der Amblyopie mit exzentrischer Fixation]. Ophthalmologica 1965;149(6):456-62.
Lennerstrand 1983 {published data only}
  • Lennerstrand G. Recent advances in the management of amblyopia. International Rehabilitation Medicine 1983;5(3):128-31.
Loudon 2006 {published data only}
  • Loudon SE, Fronius M, Looman CW, Awan M, Simonsz B, van der Maas PJ, et al. Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. Investigative Ophthalmology and Visual Science 2006;47(10):4393-400.
Loudon 2009 {published data only}
  • Loudon SE, Passchier J, Chaker L, de Vos S, Fronius M, Harrad RA, et al. Psychological causes of non-compliance with electronically monitored occlusion therapy for amblyopia. British Journal of Ophthalmology 2009;93(11):1499-503.
Lyon 2013 {published data only}
  • Lyon DW, Hopkins K, Chu RH, Tamkins SM, Cotter SA, Melia BM, et al. Feasibility of a clinical trial of vision therapy for treatment of amblyopia. Optometry and Vision Science 2013;90(5):475-81.
Mackensen 1965 {published data only}
  • Mackensen G, Kroner B, Postic G. On the change of eccentric fixation under occlusion treatment [Zur Anderung der exzentrischen Fixation unter der Okklusionsbehandlung]. Klinische Monatsblätter für Augenheilkunde 1965;147(2):213-30.
Malik 1970 {published data only}
  • Malik SR, Gupta AK, Grover VK. Occlusion therapy in amblyopia with eccentric fixation. British Journal of Ophthalmology 1970;54(1):41-5.
Medghalchi 2011 {published data only}
  • Medghalchi AR, Dalili S. A randomized trial of atropine vs patching for treatment of moderate amblyopia. Iranian Red Cresecent Medical Journal 2011;13(8):578-81.
Mehdorn 1981 {published data only}
  • Mehdorn E, Mattheus S, Schuppe A, Klein U, Kommerell G. Treatment for amblyopia with rotating gratings and subsequent occlusion: a controlled study. International Ophthalmology 1981;3(3):161-6.
Nyman 1983 {published data only}
Pistelka 1973 {published data only}
  • Pistelka Z. In-patient pleoptic and orthoptic treatment and its results in pre-school children [Ustavni pleopticko-ortopticka lecba a jeji vysledky u deti predskolniho veku]. Ceskoslovenska Oftalmologie 1973;29(1):41-9.
Prakash 1986 {published data only}
  • Prakash P, Karmacharya PC, Menon V. Evaluation of CAM vision stimulator in the therapy of amblyopia. Indian Journal of Ophthalmology 1986;34:300-3.
Priegnitz 1965 {published data only}
  • Priegnitz F, Zimmer R. On the occlusive treatment of amblyopia with eccentric fixation [Zur okklusivbehandlung von amblyopien mit exzentrischer fixation]. Das Deutsche Gesundheitswesen 1965;20(42):1915-8.
Repka 2003 {published data only}
  • Repka MX, Beck RW, Holmes JM, Birch EE, Chandler DL, Cotter SA, et al. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Archives of Ophthalmology 2003;121(5):603-11.
Repka 2007 {published data only}
  • Repka MX, Melia M, Eibschitz-Tsimhoni M, London R, Magoon E, Pediatric Eye Disease Investigator Group. The effect on refractive error of unilateral atropine as compared with patching for the treatment of amblyopia. Journal of AAPOS 2007;11(3):300-2.
Repka 2010 {published data only}
  • Repka MX, Kraker RT, Beck RW, Atkinson SC, Bacal DA, Bremer DL, et al. A pilot study of levodopa as treatment for residual amblyopia in children 8 to 17 years old. Archives of Ophthalmology 2010;128:1215-7.
Roefs 2008 {published data only}
  • Roefs AM, Tjiam AM, Vukovic E, Loudon SE, Felius J, Simonsz HJ. Qol and compliance during occlusion therapy for amblyopia in a prospective, double blind study comparing four brands of occlusion patches. Investigative Ophthalmology and Visual Science 2008:ARVO E-abstract 2583.
Rutstein 2010 {published data only}
  • Rutstein RP, Quinn GE, Lazar EL, Beck RW, Bonsall DJ, Cotter SA, et al. A randomized trial comparing Bangerter filters and patching for the treatment of moderate amblyopia in children. Ophthalmology 2010;117(5):998-1004.
Schor 1983 {published data only}
  • Schor C, Wick B. Rotating grating treatment of amblyopia with and without eccentric fixation. Journal of the American Optometric Association 1983;54(6):545-9.
Shroff 1983 {published data only}
  • Shroff AP, Billore OP, Dubey AK, Antani PR. A combined approach by spectacle correction, occlusion and active pleoptic treatment in management of amblyopia. Indian Journal of Ophthalmology 1983;31(5):568-9.
Sikder 2008 {published data only}
  • Sikder AM, Husain R, Islam S. A randomized trial of part-time versus full-time patching regimens for treatment of amblyopia. Al-Shifa Journal of Ophthalmology 2008;4(1):9-18.
Stankovic 2007 {published data only}
  • Stankovic B, Milenkovic S. Continuous full-time occlusion of the sound eye vs full-time occlusion of the sound eye periodically alternating with occlusion of the amblyopic eye in treatment of amblyopia: a prospective randomized study. European Journal of Ophthalmology 2007;17(1):11-9.
Stewart 2007 {published data only}
Stojcevska 1975 {published data only}
  • Stojcevska V. Pleoptic orthoptic treatment of functional amblyopia [Pleopticko ortopticko lekuvanje na funkcionalnite amblyopii]. Godis̆en Zbornik na Medicinskiot Fakultet vo Skopje 1975;21:201-5.
Thomas 2004 {published data only}
  • Thomas RB, Rao BV, Matalia J. Comparison of atropine and patching treatments. Ophthalmology 2004;111(2):407-8.
Tomlinson 1973 {published data only}
  • Tomlinson E, Jablonski M. Results of modified pleoptic therapy in eccentric fixation. American Orthoptic Journal 1973;23:60-4.
Tommila 1969 {published data only}
Tommila 1974 {published data only}
  • Tommila V. Occlusion therapy of amblyopia [Amblyopian peittohoito]. Duodecim 1974;90(4):295-304.
Tytla 1981 {published data only}
Veronneau 1974 {published data only}
Wallace 2006 {published data only}
  • Wallace DK, Pediatric Eye Disease Investigator Group, Edwards AR, Cotter SA, Beck RW, Arnold RW, et al. A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. Ophthalmology 2006;113(6):904-12.
Wallace 2013 {published data only}
  • Wallace DK, Lazar EL, Holmes JM, Petersen D, Repka MX, Pediatric Eye Disease Investigator Group. A randomized trial of increased patching for amblyopia. Journal of AAPOS 2013;17(1):e10.
Walsh 2009 {published data only}
  • Walsh LA, Hahn EK, LaRoche GR. The method of treatment cessation and recurrence rate of amblyopia. Strabismus 2009;17(3):107-16.
Widder 1967 {published data only}
  • Widder W. Experiences with occlusion therapy in the 5th--7th years of age [Erfahrungen mit der Okklusionstherapie im 5.-7. Lebensjahr]. Klinische Monatsblätter für Augenheilkunde 1967;151(5):684-702.
Yan 2008 {published data only}
  • Yan JJ, Peng HC, Wu CX, Liu ZY, Wang YF. A clinical trial of atropine penalization vs patching for treatment of monocular amblyopia. International Journal of Ophthalmology 2008;8:777-8.
Zang 1988 {published data only}

Additional references

  1. References to studies excluded from this review
  2. Additional references
  3. References to other published versions of this review
AAO 2002
  • American Academy of Ophthalmology, Preferred Practice Pattern: Amblyopia. San Francisco, Calif. American Academy of Ophthalmology 2002.
Adams 1999
Awan 2005
  • Awan M, Proudlock FA, Gottlob I. A randomized controlled trial of unilateral strabismic and mixed amblyopia using occlusion dose monitors to record compliance. Investigative Ophthalmology and Vision Science 2005;46(4):1435-9.
Awaya 1973
  • Awaya S, Miyake Y, Imaizumi Y, Shinose Y, Kanda T, Komoru K. Amblyopia in man, suggestive of stimulus deprivation amblyopia. Japanese Journal of Ophthalmology 1973;17:69-82.
Birch 1986
Birch 1988
Boothe 2000
  • Boothe RG, Fulton AB. Amblyopia. In: Albert DM, Jakobiec FA editor(s). Principles and Practice of Ophthalmology. 2nd Edition. WB Saunders Co, 2000.
Brown 1999
Brown 2000
  • Brown SA, Weih LM, Fu CL, Dimitrov P, Taylor HR, McCarty CA. Prevalence of amblyopia and associated refractive errors in an adult population in Victoria, Australia. Ophthalmic Epidemiology 2000;7(4):249-58.
Buch 2001
Dandona 2003
Dray 2002
  • Dray JP, Leibovitch I. Congenital ptosis and amblyopia: a retrospective study of 130 cases. Journal of Pediatric Ophthalmology and Strabismus 2002;39(4):222-5.
Drummond 1989
Duke-Elder 1973
  • Duke-Elder S, Wybar K. Ocular motility and strabismus. In: Duke-Elder S editor(s). System of Ophthalmology. St. Louis, Missouri: C V Mosby Co, 1973.
Enoch 1983
Fanz 1958
  • Fanz RL. Pattern vision in young infants. Psychological Research 1958;8:43-7.
Ferrone 1994
Fulton 1978
  • Fulton AB, Manning KA, Dobson V. A behavioral method for efficient screening of visual acuity in young infants. II. Clinical application. Investigative Ophthalmology and Vision Science 1978;17(12):1151-7.
Glanville 2006
  • Glanville JM, Lefebvre C, Miles JN, Camosso-Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130-6.
Gregg 1992
Gusek-Schneider 2000
  • Gusek-Schneider GC, Martus P. Stimulus deprivation amblyopia in human congenital ptosis: a study of 100 patients. Strabismus 2000;8(4):261-70.
Harwerth 1990
  • Harwerth RS, Smith EL 3rd, Crawford ML, von Noorden GK. Behavioral studies of the sensitive periods of development of visual functions in monkeys. Behavioural Brain Research 1990;41(3):179-98.
Higgins 2011
  • Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from
Hillis 1983
Hockfield 1998
  • Hockfield S, Lombroso PJ. Development of the cerebral cortex: IX Cortical development and experience: I. Journal of the American Academy of Child and Adolescent Psychiatry 1998;37(9):992-3.
Kanski 1994
  • Kanski JJ. Clinical Ophthalmology. 3rd Edition. Oxford, UK: Butterworth Heinemann, 1994.
Kvarnstrom 2001
Li 2009
Loudon 2002
  • Loudon SE, Polling JR, Simonsz HJ. A preliminary report about the relation between visual acuity increase and compliance in patching therapy for amblyopia. Strabismus 2002;10(2):79-82.
Lundvall 2002
Maurer 1989
  • Maurer D, Lewis TL, Brent HP. The effects of deprivation on human visual development: studies of children treated for cataracts. In: Morrison FJ, Lord C, Keating DP editor(s). Applied Developmental Psychology Vol 3: Psychological Development in Infancy. San Diego, CA: Academic Press, 1989:39-227.
Mayer 1989
  • Mayer DL, Moore B, Robb RM. Assessment of vision and amblyopia by preferential looking tests after early surgery for unilateral congenital cataracts. Journal of Pediatric Ophthalmology and Strabismus 1989;26(2):61-8.
McCulloch 1994
Mein 1991
  • Mein J, Trimble R. Diagnosis and Management of Ocular Motility Disorders. 2nd Edition. Oxford, UK: Blackwell Scientific Publications, 1991.
Moseley 2002
Newman 2000
  • Newman DK, East MM. Prevalence of amblyopia among defaulters of preschool vision screening. Ophthalmic Epidemiology 2000;7(1):67-71.
Pratt-Johnson 2001
  • Pratt-Johnson JA, Tillson G. Management of Strabismus and Amblyopia: A Practical Guide. 2nd Edition. New York, USA: Thieme, 2001.
Rahi 2002
  • Rahi J, Logan S, Timms C, Russell Eggitt I, Taylor D. Risk, causes, and outcomes of visual impairment after loss of vision in the non-amblyopic eye: a population-based study. Lancet 2002;360(9333):597-602.
Robb 1987
  • Robb RM, Mayer DL, Moore BD. Results of early treatment of unilateral congenital cataracts. Journal of Pediatric Ophthalmology and Strabismus 1987;24(4):178-81.
Schmidt 1994
Schulz 1982
  • Schulz E. Amblyopia and refractive error in patients who suffered from eyelid haemangioma in early childhood [Deprivationsamblyopie und refraktionsanomalie bei fruhkindlichen lidhamangiomen]. Klinische Monatsblätter für Augenheilkunde 1982;181(3):192-4.
Sebris 1987
  • Sebris S, Dobson V, Macdonald M, Teller DY. Acuity cards for visual acuity assessment of infants and children in clinical settings. Clinical Vision Science 1987;2:45-58.
Simon 1987
  • Simon JW, Parks MM, Price EC. Severe visual loss resulting from occlusion therapy for amblyopia. Journal of Pediatric Ophthalmology and Strabismus 1987;24(5):244-6.
Stewart 2003
Stewart 2005
  • Stewart CE, Fielder AR, Stephens DA, Moseley MJ, MOTAS Cooperative. Treatment of unilateral amblyopia: factors influencing visual outcome. Investigative Ophthalmology and Vision Science 2005;46(9):3152-60.
Taylor 1997
  • Taylor D, Hoyt C. Practical Pediatric Ophthalmology. 1st Edition. Oxford, UK: Blackwell Science, 1997.
Taylor 2011
Taylor 2012
Von Noorden 1973
  • von Noorden GK. Experimental amblyopia in monkeys. Further behavioral observations and clinical correlations. Investigative Ophthalmology 1973;12(10):721-6.
Von Noorden 1981
Wiesel 1963
  • Wiesel TN, Hubel DH. Comparison of the effects of unilateral and bilateral eye closure on cortical unit responses in kittens. Journal of Neurophysiology 1963;28(6):1029-40.
Wright 1986
Zipf 1976

References to other published versions of this review

  1. References to studies excluded from this review
  2. Additional references
  3. References to other published versions of this review
Antonio-Santos 2004
  • Antonio-Santos A, Mathew M, Powell C, Hatt S. Interventions for stimulus deprivation amblyopia. Cochrane Database of Systematic Reviews 2004, Issue 4. [DOI: 10.1002/14651858.CD005136]
Antonio-Santos 2006