(1) The goal of amblyopia treatment is to normalize visual acuity of the amblyopic eye or, when this is not possible, to improve it to its optimal level. Once this has been accomplished, visual acuity must be maintained at that level.
(2) Before occlusion treatment for amblyopia, a significant refractive error of the amblyopic eye should be corrected to create optimal functional conditions for that eye.
(3) We prefer to use an adhesive patch attached to the skin and occluding the sound eye regardless of the fixation behavior of the amblyopic eye.
(4) Children younger than 6 or 7 years of age are susceptible to visual deprivation, and amblyopia may develop in the occluded eye. This risk is higher during the first 2 years of life and decreases with increasing age. To prevent visual deprivation amblyopia, occlusion of the sound eye is combined with alternate occlusion of the amblyopic eye. The rhythm of this alternation must be modified according to the sensitivity to the treatment. The suggestions given in this algorithm are only general guidelines and may be modified according to each patient's individual sensitivity to occlusion treatment.58, p.471
(5) Older children tolerate constant patching of the sound eye for 4- to 6-week periods. Visual deprivation amblyopia, if it occurs, is rapidly reversible by breif periods of patching the amblyopic eye.
(6) Once visual acuity has been equalized, the goal of treatment has been reached. However, maintenance therapy is required to preserve the treatment result.11
(7) In children who cannot tolerate a patch (skin sensitivity, severe behavioral problems) penalization may be considered.58, p.471 It is not as effective as occlusion treatment and should not be considered as a primary form of therapy.
(8) Total penalization blurs the sound eye at near and distance fixation. This can be accomplished by removing the spectacle lens from the sound eye of a patient with hypermetropia (distance penalization) and atropinization of that eye (near penalization).
(9) Partial penalization consists of blurring the sound eye optically at near or distance fixation; this has been less successful in our experience.58, p. 471
(10) Alternating penalization is successful in preventing recurrence of amblyopia. Two pair of spectacles are prescribed, one overcorrecting the right eye and the other overcorrecting the left eye with +3.00 diopter spherical lenses.