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Aims: To compare visual acuity improvement in children with residual anisometropic amblyopia after previous treatment with spectacles and part-time patching with asymmetric anisometropic correction vs. full amblyopic-eye hyperopic correction. Method: 210 participants with anisometropic amblyopia (40 to 80 letters, approximately 20/50 to 20/320). Eligible participants (mean age 7.4 years, mean baseline visual acuity of 65 letters, mean baseline interocular acuity difference of 4.15 ± 0.96 lines) were randomly assigned to treatment for 24-months with asymmetric hyperopic correction (n = 105) or full amblyopic eye hyperopic correction (n = 105). Change in amblyopic-eye visual acuity from baseline to 3, 6, 12 and 24-month, assessed by a masked examiner until visual acuity stabilized or amblyopia resolved. Results: At 3 months, mean amblyopic-eye visual acuity improved from baseline by 18 letters (95% confidence interval [CI]: 16.9 to 19.8 letters) with asymmetric anisometropic correction and by 3 letters (95% CI: 2.1 to 3.1 letters) with full amblyopiceye hyperopic correction. After adjustment for baseline visual acuity, the letter score difference between groups was 7.9 letters (95% CI: 6.8 to 9.1 letters, P = 0.001, difference of 1.85 logMAR) at 24-months. Significant difference in letter scores was observed between groups after 24-months of treatment. Overall treatment outcome was not related to age, sex, or prior treatment history, but were related to better baseline visual acuity and the degree of anisometropia. Conclusion: Visual acuity was greater improvement with asymmetric anisometropic correction treatment than full amblyopiceye hyperopic correction treatment at 24-month in children with residual anisometropic amblyopia.

A Randomized Clinical Trial of Asymmetric Anisometropic Correction for Anisometropic Amblyopia in Children Aged 4 to 12 Years