A Cross-Sectional Study on the Management of Amblyopia

Aishwarya.M et al | DOI: 10.65188/nurexus.1078

Page 21

Journal of MedVerse Research & Practice

ISSN: 3107-4278

A Cross-Sectional Study on the Management of Amblyopia

Dr. Aishwarya M,

Dr.C.Indhu,

Dr.K.Namitha Bhuvaneshwari

Postgraduate, Associate Professor, Professor and HOD,

Department of Ophthalmology, Madras Medical College Hospital & Research Institute, Chennai.

E-mail: aishu.sara789@gmail.com

Submission Date: 13.03.2026

Accepted Date:27.04.2026

Published Date: 30.04.2026

DOI: 10.65188/nurexus.1079

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted

use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Amblyopia is a leading cause of preventable visual impairment in children and results from abnormal

visual development during early childhood. Early diagnosis and appropriate management are essential to prevent

permanent visual loss.

Aim: To evaluate the patterns of amblyopia management and assess factors influencing visual outcomes in a cross-

sectional study.

Methods: This cross-sectional observational study was conducted on 90 patients aged 3–15 years diagnosed with

amblyopia at Madras Medical College over a period of one year. All patients underwent detailed ophthalmic

evaluation including visual acuity assessment, cycloplegic refraction, and ocular examination. Amblyopia was

classified into anisometropic, strabismic, deprivation, and mixed types. Treatment modalities included refractive

correction, occlusion therapy, atropine penalization, or combination therapy. Visual outcomes and compliance were

analyzed.

Results: Anisometropic amblyopia was the most common type (44.4%), followed by strabismic amblyopia (27.8%).

Occlusion therapy was the most frequently used treatment modality (50%). A total of 64.4% of patients showed

improvement in visual acuity. A statistically significant association was found between treatment compliance and

visual improvement (p < 0.001).

Conclusion: Amblyopia is a treatable condition when diagnosed early and managed appropriately. Occlusion therapy

remains the mainstay of treatment, and compliance plays a critical role in determining visual outcomes. Early

screening and patient education are essential to improve treatment success.

Keywords: Amblyopia; Cross-sectional study; Occlusion therapy; Anisometropia; Visual acuity; Pediatric

ophthalmology; Treatment compliance

Introduction

Amblyopia, commonly referred to as “lazy eye,” is a developmental disorder of vision characterized by

reduced best corrected visual acuity in one or both eyes without any identifiable structural abnormality of

the eye or visual pathways (1). It typically arises during early childhood due to abnormal visual experience

and is one of the leading causes of preventable visual impairment in children worldwide (2). Early detection

and timely intervention are crucial, as untreated amblyopia can result in permanent visual deficits extending

into adulthood (3). The common etiological factors for amblyopia include uncorrected refractive errors

(anisometropia or high bilateral refractive error), strabismus, and visual deprivation due to conditions such

as congenital cataract or ptosis (4). Among these, anisometropic amblyopia is considered the most prevalent

form (5). The condition is often asymptomatic in early stages, making routine vision screening in children

essential for early diagnosis (6).

ORIGINAL ARTICLE

Aishwarya.M et al | DOI: 10.65188/nurexus.1078

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Management of amblyopia primarily focuses on improving visual acuity by addressing the underlying cause

and promoting the use of the amblyopic eye. Standard treatment modalities include refractive correction

with spectacles, occlusion therapy (patching of the dominant eye), and pharmacological penalization using

atropine (7). The success of treatment depends on several factors, including the age at initiation, severity of

amblyopia, compliance with therapy, and duration of treatment (8). Despite the availability of effective

treatment options, amblyopia remains underdiagnosed and undertreated, particularly in developing

countries (9). Poor awareness, delayed presentation, and issues related to compliance with patching therapy

contribute significantly to suboptimal outcomes (10). Understanding current patterns of amblyopia

management and their effectiveness is essential for improving treatment strategies and patient outcomes.

This cross-sectional study aims to evaluate the management practices of amblyopia, assess treatment

patterns, and identify factors influencing visual outcomes in patients presenting to a tertiary care center.

Materials & Methods

Study Design, Study Setting, Sample Size

This hospital-based cross-sectional observational study was conducted over a period of one year in the

Department of Ophthalmology at Madras Medical College, Chennai. The study aimed to evaluate the

management and treatment outcomes of amblyopia in pediatric patients. A total of 90 patients diagnosed

with amblyopia were enrolled using consecutive sampling from the ophthalmology outpatient department.

Study Population

The study included pediatric patients aged 3–15 years diagnosed with amblyopia and attending the

ophthalmology outpatient department during the study period.

Inclusion Criteria

Children aged 3–15 years with a best-corrected visual acuity of less than 6/9 in one or both eyes, without

any structural ocular abnormality, and willing to undergo treatment and follow-up were included in the

study.

Exclusion Criteria

Patients with retinal or optic nerve diseases, previous intraocular surgery, neurological disorders affecting

vision, incomplete clinical records, or poor follow-up compliance were excluded from the study.

Study Tool

Data were collected using a predesigned structured proforma comprising demographic details, clinical

history, and ophthalmic findings. All participants underwent a comprehensive ophthalmic evaluation,

including assessment of visual acuity using age-appropriate charts (Snellen or Lea symbols), cycloplegic

refraction, ocular alignment assessment by cover test and Hirschberg test, slit-lamp biomicroscopy, and

fundus examination. Amblyopia was classified as anisometropic, strabismic, deprivation, or mixed based

on its etiology. Following cycloplegic refraction, all patients received appropriate refractive correction.

Treatment consisted of occlusion therapy, pharmacological penalization with atropine, or a combination of

both, depending on the type and severity of amblyopia. Treatment compliance was assessed through

parental reporting during scheduled follow-up visits.

Data Collection

After obtaining written informed consent from parents or guardians, demographic and clinical details were

recorded using the study proforma. Clinical examination findings, treatment modality, compliance, and

follow-up visual acuity were documented systematically. The primary outcome measure was improvement

in best-corrected visual acuity following treatment. Secondary outcome measures included the distribution

of amblyopia types, treatment modalities employed, and the association between treatment compliance and

visual outcomes.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences

Aishwarya.M et al | DOI: 10.65188/nurexus.1078

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(SPSS) software version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as

mean ± standard deviation, while categorical variables were presented as frequencies and percentages.

Associations between categorical variables were analyzed using the Chi-square test. A p-value <0.05 was

considered statistically significant.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of Madras Medical College before

commencement. Written informed consent was obtained from the parents or legal guardians of all

participants. The study adhered to the ethical principles of the Declaration of Helsinki, and confidentiality

of participant information was maintained throughout the study.

Results

A total of 90 patients diagnosed with amblyopia were included in the study. The mean age of the participants

was 8.6 ± 3.2 years, with the majority in the age group of 6–10 years. There were 52 (57.8%) males and 38

(42.2%) females.

Table 1: Demographic Distribution

Variable

Number (n=90)

Percentage (%)

Age 3–5 years

20%

Age 6–10 years

46.7%

Age 11–15 years

33.3%

Male

57.8%

Female

42.2%

The majority of patients (46.7%) were in the 6–10 years age group, highlighting the common age of

presentation for amblyopia. There was a slight male predominance (57.8%) in the study population.

Table 2: Types of Amblyopia

Type of Amblyopia

Number

Percentage (%)

Anisometropic

44.4%

Strabismic

27.8%

Deprivation

11.1%

Mixed

16.7%

Anisometropic amblyopia was the most common type (44.4%), followed by strabismic amblyopia (27.8%),

indicating refractive error as the leading cause of amblyopia in this study.

Table 3: Treatment Modalities Used

Treatment Modality

Number

Percentage (%)

Spectacles alone

22.2%

Patching (Occlusion therapy)

50%

Atropine penalization

11.1%

Combination therapy

16.7%

Occlusion therapy was the most commonly used treatment modality (50%), followed by spectacles alone.

Combination therapy was used in selected moderate to severe cases.

Table 4: Visual Acuity Improvement

Outcome

Number

Percentage (%)

Improved (≥2 lines)

64.4%

No significant improvement

35.6%

A majority of patients (64.4%) showed improvement in visual acuity, indicating the effectiveness of

amblyopia treatment when appropriately administered.

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Table 5: Association Between Compliance and Visual Outcome

Compliance

Improved (%)

Not Improved (%)

p-value

Good (n=55)

45 (81.8%)

10 (18.2%)

<0.001

Poor (n=35)

13 (37.1%)

22 (62.9%)

There was a statistically significant association between treatment compliance and visual improvement (p

< 0.001). Patients with good compliance showed significantly better visual outcomes compared to those

with poor compliance.

Discussion

Amblyopia remains one of the leading causes of preventable visual impairment in children, and its

successful management depends largely on early diagnosis and appropriate treatment. In the present study,

the majority of patients were in the 6–10 years age group, which is consistent with the findings of Holmes

JM et al. (13), who reported that amblyopia is most commonly detected during early school years due to

increased visual demands. In our study, anisometropic amblyopia was the most common type observed.

This finding is in agreement with Pediatric Eye Disease Investigator Group (PEDIG) (14), which identified

anisometropia as the leading cause of amblyopia in children. Similarly, Attebo K et al. (15) also reported a

higher prevalence of anisometropic amblyopia compared to other types.

Occlusion therapy (patching) was the most commonly used treatment modality in our study. This aligns

with the findings of Repka MX et al. (16), who demonstrated that patching remains the standard and most

effective treatment for amblyopia. Additionally, the use of atropine penalization in selected cases in our

study is supported by Pediatric Eye Disease Investigator Group (PEDIG) (17), who found atropine to be

equally effective as patching in moderate amblyopia. A significant proportion of patients in our study

showed improvement in visual acuity following treatment. This is comparable to the results of Cotter SA

et al. (18), who reported substantial visual improvement with appropriate amblyopia therapy. The

improvement observed highlights the effectiveness of early intervention and proper management.

Compliance was found to be a major factor influencing treatment outcomes in our study, with better visual

improvement seen in patients with good compliance. This finding is consistent with Newsham D (19), who

emphasized that poor adherence to patching therapy is a major barrier to successful amblyopia treatment.

Furthermore, our findings are supported by Stewart CE et al. (20), who reported that both age at initiation

and compliance significantly affect visual outcomes in amblyopia management. Early treatment combined

with good compliance leads to better prognosis.

Strengths

The study employed a standardized ophthalmic evaluation and evidence-based treatment protocols to assess

visual outcomes in pediatric amblyopia. The inclusion of treatment compliance enabled evaluation of its

influence on therapeutic success.

Limitations

The study was conducted at a single tertiary care center with a relatively small sample size, which may

limit the generalizability of the findings. Treatment compliance was assessed through parental reporting,

which may be subject to reporting bias.

Conclusion

Amblyopia is a significant yet treatable cause of visual impairment in children, and early detection plays a

crucial role in achieving favorable outcomes. The present study demonstrated that anisometropic amblyopia

is the most common type, and occlusion therapy remains the primary mode of management. A majority of

patients showed improvement in visual acuity following appropriate treatment. Treatment compliance was

Aishwarya.M et al | DOI: 10.65188/nurexus.1078

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identified as a key factor influencing visual outcomes, with better results observed in patients adhering to

therapy. The findings emphasize the importance of early diagnosis, timely intervention, and patient/parent

education to improve compliance and treatment success.

Conflict of Interest: The authors declare that there is no conflict of interest.

Funding: No external funding was received for this study.

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