Amblyopia treatment sometimes has no effect and frequently does not improve visual acuity to normal levels. This is often assumed to be because treatment has been started too late to be effective or is unable to be implemented at the prescribed level. While this may often be the case, it is important to realise that subtle ocular and cerebral pathology may also underlie failure to respond to treatment. Optic nerve hypoplasia is easily missed on indirect ophthalmoscopy and should be specifically excluded. Inaccurate refractive correction, which inevitably occurs during periods of emmetropisation, should also be checked for.
Lack of compliance has been shown, using electronic monitors of patching compliance, to be a frequent occurrence in children undergoing patching treatment. In one study, concor dance with patching was 48 % (2.8 h vs 6 h prescribed) and acuity gain was linearly correlated with occlusion dose . All improvement occurred within 12 weeks of patching.
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