Abstract
Amblyopia is a common cause of visual impairment in children and young adults. The cornerstone in the management of this disorder is based on increasing visual stimulation of the amblyopic eye by occlusion, by administering atropine or by causing optical penalization of the dominant eye. All these treatment options have shown some limits in terms of efficacy, due to the suboptimal treatment adherence for the patients and the lack of long-term clinical outcomes. Moreover, although it is well known that clinical efficacy decreases with age, new evidence is suggesting that cortical plasticity can be induced also in older children. For these reasons, new treatment options are being studied, in order to extend the “treatment window” beyond the critical period also in older patients. In this review, we will discuss all the most promising novel pharmacological agents in the management of amblyopia.
Similar content being viewed by others
References
Jefferis JM, Connor AJ, Clarke MP (2015) Amblyopia. BMJ (Clin Res ed) 351:h5811
LeVay S, Hubel DH, Wiesel TN (1975) The pattern of ocular dominance columns in macaque visual cortex revealed by a reduced silver stain. J Comp Neurol 159(4):559–576
LeVay S, Wiesel TN, Hubel DH (1980) The development of ocular dominance columns in normal and visually deprived monkeys. J Comp Neurol 191(1):1–51
Allen B, Spiegel DP, Thompson B, Pestilli F, Rokers B (2015) Altered white matter in early visual pathways of humans with amblyopia. Vis Res 114:48–55
Duan Y, Norcia AM, Yeatman JD, Mezer A (2015) The structural properties of major white matter tracts in strabismic amblyopia. Invest Ophthalmol Vis Sci 56(9):5152–5160
Epelbaum M, Milleret C, Buisseret P, Dufier JL (1993) The sensitive period for strabismic amblyopia in humans. Ophthalmology 100(3):323–327
Vagge A, Nelson LB (2016) Amblyopia update: new treatments. Curr Opin Ophthalmol 27(5):380–386
Hendrickson AE (1994) Primate foveal development: a microcosm of current questions in neurobiology. Invest Ophthalmol Vis Sci 35(8):3129–3133
Friendly DS (1987) Amblyopia: definition, classification, diagnosis, and management considerations for pediatricians, family physicians, and general practitioners. Pediatr Clin N Am 34(6):1389–1401
Carlton J, Kaltenthaler E (2011) Amblyopia and quality of life: a systematic review. Eye (Lond) 25(4):403–413
DeSantis D (2014) Amblyopia. Pediatr Clin North Am 61(3):505–518
Holmes JM, Beck RW, Kraker RT, Astle WF, Birch EE, Cole SR et al (2004) Risk of amblyopia recurrence after cessation of treatment. J AAPOS 8(5):420–428
Gore C, Wu C (2016) Medical Therapies of amblyopia: translational research to expand our treatment armamentarium. Semin Ophthalmol 31(1–2):155–158
Secades JJ, Lorenzo JL (2006) Citicoline: pharmacological and clinical review, 2006 update. Methods Find Exp Clin Pharmacol 28(Suppl B):1–56
Davalos A, Alvarez-Sabin J, Castillo J, Diez-Tejedor E, Ferro J, Martinez-Vila E et al (2012) Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). Lancet 380(9839):349–357
Cacabelos R, Caamano J, Gomez MJ, Fernandez-Novoa L, Franco-Maside A, Alvarez XA (1996) Therapeutic effects of CDP-choline in Alzheimer’s disease. Cognition, brain mapping, cerebrovascular hemodynamics, and immune factors. Ann N Y Acad Sci 777:399–403
Roberti G, Tanga L, Michelessi M, Quaranta L, Parisi V, Manni G et al (2015) Cytidine 5′-diphosphocholine (citicoline) in glaucoma: rationale of its use, current evidence and future perspectives. Int J Mol Sci 16(12):28401–28417
Rejdak R, Toczolowski J, Solski J, Duma D, Grieb P (2002) Citicoline treatment increases retinal dopamine content in rabbits. Ophthalmic Res 34(3):146–149
Campos EC, Schiavi C, Benedetti P, Bolzani R, Porciatti V (1995) Effect of citicoline on visual acuity in amblyopia: preliminary results. Graefes Arch Clin Exp Ophthalmol 233(5):307–312
Porciatti V, Schiavi C, Benedetti P, Baldi A, Campos EC (1998) Cytidine-5′-diphosphocholine improves visual acuity, contrast sensitivity and visually-evoked potentials of amblyopic subjects. Curr Eye Res 17(2):141–148
Fresina M, Dickmann A, Salerni A, De Gregorio F, Campos EC (2008) Effect of oral CDP-choline on visual function in young amblyopic patients. Graefes Arch Clin Exp Ophthalmol 246(1):143–150
Pawar PV, Mumbare SS, Patil MS, Ramakrishnan S (2014) Effectiveness of the addition of citicoline to patching in the treatment of amblyopia around visual maturity: a randomized controlled trial. Indian J Ophthalmol 62(2):124–129
Kasamatsu T, Pettigrew JD (1979) Preservation of binocularity after monocular deprivation in the striate cortex of kittens treated with 6-hydroxydopamine. J Comp Neurol 185(1):139–161
Iuvone PM, Tigges M, Fernandes A, Tigges J (1989) Dopamine synthesis and metabolism in rhesus monkey retina: development, aging, and the effects of monocular visual deprivation. Vis Neurosci 2(5):465–471
Imamura K, Kasamatsu T (1989) Interaction of noradrenergic and cholinergic systems in regulation of ocular dominance plasticity. Neurosci Res 6(6):519–536
LeWitt PA (2016) New levodopa therapeutic strategies. Parkinsonism Relat Disord 22(Suppl 1):S37–S40
Papageorgiou E, Asproudis I, Maconachie G, Tsironi EE, Gottlob I (2019) The treatment of amblyopia: current practice and emerging trends. Graefes Arch Clin Exp Ophthalmol 257(6):1061–1078
Gottlob I, Stangler-Zuschrott E (1990) Effect of levodopa on contrast sensitivity and scotomas in human amblyopia. Invest Ophthalmol Vis Sci 31(4):776–780
Leguire LE, Walson PD, Rogers GL, Bremer DL, McGregor ML (1993) Longitudinal study of levodopa/carbidopa for childhood amblyopia. J Pediatr Ophthalmol Strabismus 30(6):354–360
Yang CI, Yang ML, Huang JC, Wan YL, Jui-Fang Tsai R, Wai YY et al (2003) Functional MRI of amblyopia before and after levodopa. Neurosci Lett 339(1):49–52
Procianoy E, Fuchs FD, Procianoy L, Procianoy F (1999) The effect of increasing doses of levodopa on children with strabismic amblyopia. J AAPOS 3(6):337–340
Leguire LE, Rogers GL, Bremer DL, Walson PD, McGregor ML (1993) Levodopa/carbidopa for childhood amblyopia. Invest Ophthalmol Vis Sci 34(11):3090–3095
Pediatric Eye Disease Investigator G, Repka MX, Kraker RT, Dean TW, Beck RW, Siatkowski RM et al (2015) A randomized trial of levodopa as treatment for residual amblyopia in older children. Ophthalmology 122(5):874–881
Leguire LE, Komaromy KL, Nairus TM, Rogers GL (2002) Long-term follow-up of L-dopa treatment in children with amblyopia. J Pediatr Ophthalmol Strabismus 39(6):326–330
Mohan K, Dhankar V, Sharma A (2001) Visual acuities after levodopa administration in amblyopia. J Pediatr Ophthalmol Strabismus 38(2):62–67
Repka MX, Kraker RT, Beck RW, Atkinson CS, Bacal DA, Bremer DL et al (2010) Pilot study of levodopa dose as treatment for residual amblyopia in children aged 8 years to younger than 18 years. Arch Ophthalmol 128(9):1215–1217
Wong DT, Bymaster FP, Engleman EA (1995) Prozac (fluoxetine, Lilly 110140), the first selective serotonin uptake inhibitor and an antidepressant drug: twenty years since its first publication. Life Sci 57(5):411–441
Guest PC, Knowles MR, Molon-Noblot S, Salim K, Smith D, Murray F et al (2004) Mechanisms of action of the antidepressants fluoxetine and the substance P antagonist L-000760735 are associated with altered neurofilaments and synaptic remodeling. Brain Res 1002(1–2):1–10
Maya Vetencourt JF, Sale A, Viegi A, Baroncelli L, De Pasquale R, O’Leary OF et al (2008) The antidepressant fluoxetine restores plasticity in the adult visual cortex. Science 320(5874):385–388
Sharif MH, Talebnejad MR, Rastegar K, Khalili MR, Nowroozzadeh MH (2019) Oral fluoxetine in the management of amblyopic patients aged between 10 and 40 years old: a randomized clinical trial. Eye (Lond) 33(7):1060–1067
Cummings J, Lai TJ, Hemrungrojn S, Mohandas E, Yun Kim S, Nair G et al (2016) Role of donepezil in the management of neuropsychiatric symptoms in Alzheimer’s disease and dementia with lewy bodies. CNS Neurosci Ther 22(3):159–166
Rokem A, Silver MA (2010) Cholinergic enhancement augments magnitude and specificity of visual perceptual learning in healthy humans. Curr Biol 20(19):1723–1728
Rokem A, Silver MA (2013) The benefits of cholinergic enhancement during perceptual learning are long-lasting. Front Comput Neurosci 7:66
Chung STL, Li RW, Silver MA, Levi DM (2017) Donepezil does not enhance perceptual learning in adults with amblyopia: a pilot study. Front Neurosci 11:448
Treatment of Residual Amblyopia With Donepezil. 2012–2019
Maconachie GD, Gottlob I (2015) The challenges of amblyopia treatment. Biomed J 38(6):510–516
Li T, Qureshi R, Taylor K (2019) Conventional occlusion versus pharmacologic penalization for amblyopia. Cochrane Database Syst Rev 8:CD006460
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
The authors confirm that the statement of consent to publish this case and these images was gathered from the patient.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Vagge, A., Ferro Desideri, L. & Traverso, C.E. An update on pharmacological treatment options for amblyopia. Int Ophthalmol 40, 3591–3597 (2020). https://doi.org/10.1007/s10792-020-01535-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-020-01535-w