Atropine is a pharmacological treatment used by ophthalmologists and optometrists in those countries where they are licensed to use these drops. The pupil of the good eye is kept dilated and the focusing mechanism is paralyzed with the atropine drops causing a blurred image in the good eye.
The effect of atropine is similar to the opaque lens or a patch. The advantage over a patch is that the child cannot remove it, and the child looks better cosmetically. While some studies indicate that atropine works as well as full-time occlusion, for me it is even worse than a patch.
This is because atropine is total full-time occlusion that cannot be removed. In addition, parents must keep in mind that the child must continue to use this drug for an extended period of time, sometimes a year or more, and the negative effects on the focusing mechanism of the eye can last long after the drug treatment is discontinued.
Like any medication that affects the central nervous system, its use involves risks and the possibility of many negative side effects such as redness or swelling of the eyes, dry mouth, and difficulty with urination and constipation.
According to Dr. Press an important principle to keep in mind is that when atropine does work, it is because it takes advantage of the vision therapy principle of MFBF, or Monocular Fixation in a Binocular Field. In other words, the brain is forced to use the amblyopic eye as the better eye, while the regularly better eye artificially functions like the amblyopic eye.
As will be discussed at length in Chapter 18, there are many less invasive and much more effective treatment methods available, all without the potential risks and negative side effects involved with atropine and full-time patching. The use of atropine shouldn’t be the first and/or the only course of treatment.
Some patients come into my office telling me that their ophthalmologist recommended refractive surgery to normalize vision in their amblyopic eye. Although the refractive surgery may reduce the anisometropia, complete recovery of binocularity with stereopsis requires behavioral optometric vision therapy.