Atropine penalisation for amblyopia in the UK
Reviewed by Fiona Rowe

The authors aimed to determine the current clinical practice of atropine penalisation (AP) in the UK, to identify perceived barriers limiting use of AP as a first line treatment and ascertain whether any of the barriers could be resolved. An anonymised online survey was distributed through the UK professional society for orthoptists (BIOS). Responses were obtained from 151 orthoptists (13% return). Seventy-one percent indicated they had department protocols regarding the use of AP. Twenty-five percent used AP as the first line of treatment for amblyopia. Children younger than seven years were most commonly targeted. Its use was considered in more moderate to severe density of amblyopia. Eighty-nine percent would stop treatment if no improvement in visual acuity was noted over three consecutive visits. Forty-eight percent favoured daily atropine, 41% alternate day, 29% weekend use and 9% weekly use. Reported recognised side-effects included skin rash / flushing, mood changes, eye irritation / pain. Barriers to use included department-specific problems with use of AP, inability to prescribe and inability to obtain atropine. The survey showed that the percentage of orthoptists offering AP as a first line treatment has increased. It was avoided in older children because of perceived risks of intractable diplopia. Orthoptists still raise concerns regarding general efficacy, side-effects and reverse amblyopia. 

Use of atropine penalisation to treat amblyopia in UK orthoptic practice.
Piano M, Newsham D, O’Connor AR.
JOURNAL OF PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2014;51(6):363-9.