THE EFFICACY OF OPTICAL AND PHARMACOLOGICAL PENALIZATION

Purpose: Optical and pharmacological penalization of sound eyes are in frequently used alternatives to occlusion for treating amblyopia. The authors evaluated the efficacy of penalization as their primary treatm ent of amblyopia. Methods: One hundred sixty-six patients underwent pe nalization treatment for strabismic or anisometropic amblyopia for a m inimum of 3 months. Both atropine and optical penalization methods wer e used. Results: Visual acuity improved in 67 (77%) of 87 patients tre ated with optical penalization. There was a significant improvement of the geometric mean visual acuity of the amblyopic eyes from 20/38 to 20/28 (P < 0.001). Visual acuity of 60 (76%) of 79 patients treated wi th pharmacological penalization improved. There was a significant impr ovement of mean visual acuity of the amblyopic eyes from 20/61 to 20/4 0 (P < 0.001). Neither therapy produced an instance of occlusion ambly opia. Thirteen patients discontinued therapy because of blur or discom fort. Conclusion: This study demonstrates that penalization methods ar e effective methods for the treatment of amblyopia, with a low risk of occlusion amblyopia. Patient acceptance of these methods was excellen t. Penalization should be considered more often for the primary treatm ent of amblyopia.