Holmes Jonathan M, Clarke Michael P
Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Lancet. 2006 Apr 22;367(9519):1343-51. doi: 10.1016/S0140-6736(06)68581-4.
Results from recent randomised clinical trials in amblyopia should change our approach to screening for and treatment of amblyopia. Based on the current evidence, if one screening session is used, screening at school entry could be the most reasonable time. Clinicians should preferably use age-appropriate LogMAR acuity tests, and treatment should only be considered for children who are clearly not in the typical range for their age. Any substantial refractive error should be corrected before further treatment is considered and the child should be followed in spectacles until no further improvement is recorded, which can take up to 6 months. Parents and carers should then be offered an informed choice between patching and atropine drops. Successful patching regimens can last as little as 1 h or 2 h a day, and successful atropine regimens as little as one drop twice a week. Intense and extended regimens might not be needed in initial therapy.
近期弱视随机临床试验的结果应改变我们对弱视筛查和治疗的方法。基于目前的证据，如果只进行一次筛查，入学时筛查可能是最合理的时间。临床医生最好使用适合年龄的LogMAR视力测试，并且仅应考虑对明显不在其年龄典型范围内的儿童进行治疗。在考虑进一步治疗之前，应矫正任何显著的屈光不正，并且应让孩子佩戴眼镜随访，直到记录到没有进一步改善，这可能需要长达6个月的时间。然后，应向家长和照顾者提供关于眼罩治疗和阿托品滴眼液治疗的明智选择。成功的眼罩治疗方案每天可短至1小时或2小时，成功的阿托品治疗方案每周只需一滴，每天两次。初始治疗可能不需要强化和延长治疗方案。
