Duration of Occlusion Therapy for Amblyopia Doesn’t Affect AL Elongation

A large study found that while patching therapy has a minimal impact on axial length elongation in children, school-age children with shorter baseline axial lengths experienced slower axial elongation in their patched eyes, while preschool-aged children displayed notable interocular differences. Because of this, researchers suggest tailoring treatment regimens based on age and baseline AL. Photo: National Eye Institute/NIH. Click image to enlarge. Given the popularity of occlusion therapy as a treatment for pediatric amblyopia, a recent study sought to investigate whether the intervention affects elongation of axial length—a key parameter in ocular development that can directly influence refractive outcomes in children. Overall, the authors found no significant relationship between patching duration and axial length elongation.In this retrospective cohort study, data were collected from an ophthalmic center in China, including 2,932 children aged three to 15 years who were categorized into four groups based on their daily patching therapy duration: no patching, low (30 minutes to two hours), moderate (three to four hours) and long (≥five hours). The analysis accounted for various factors, such as age, sex, baseline BCVA, initial axial length and amblyopia type.The results demonstrated an average annual increase in axial length of 0.23±0.22mm across the cohort, which reflects the normal growth pattern observed in pediatric populations during this age range. Notably, patching duration appeared to have no significant overall effect on axial length elongation, even in cases of long daily patching (≥five hours/day).In subgroup analyses, however, researchers did find that age- and baseline-specific dynamics influenced treatment outcomes. Among children aged six to 12 years, those with shorter baseline axial lengths exhibited a reduced rate of axial length elongation in patched eyes when compared to their non-patched counterparts. Additionally, in preschool children aged three to five years, the patched eyes showed slightly less axial length growth compared to fellow eyes.In their paper on the findings, published recently in Investigative Ophthalmology & Vision Science, the researchers explained that these observations from the subgroup analyses “align with developmental and biomechanical trends noted in the literature.” They elaborated, “In school-age children, patching therapy may reduce near-work exposure, mitigating axial elongation. Additionally, differential scleral responsiveness during periods of rapid ocular growth may explain the reduced elongation in shorter axial length quartiles.”In conclusion, the researchers conveyed, “These results reinforce patching therapy as a safe and effective modality for amblyopia management while highlighting the need for tailored therapeutic strategies in specific populations.”Click here for the journal source. Yu W, He Y, Qiu X, et al. Axial length dynamics and safety of occlusion therapy in pediatric amblyopia: A longitudinal analysis. Invest Ophthalmol Vis Sci. 2025;66(9):12.