Bifocal Lenses Plus Atropine Improve Vision in Hyperopic Anisometropic Amblyopia

A combination of bifocal wear with atropine penalization improves vision more than atropine alone in children with hyperopic anisometropic amblyopia.

Treating hyperopic anisometropic amblyopia using a bifocal lens on the amblyopic eye and atropine penalization on the contralateral eye results in greater visual acuity gains in 6 months than atropine penalization alone, according to research published in Eye. 

Researchers conducted a proof-of-concept study including children treated with bifocals plus atropine  (n=16; mean age, 5.57 years) and control group participants treated with atropine penalization alone (n=19; mean age, 5.62 years). All patients underwent visual acuity (VA) measurement, prism and cover test, stereoacuity and contrast sensitivity analysis and accommodation measurements. All assessments were performed at baseline and 6-month follow-up, except for accommodative measurements, which were remeasured at 9 to 11 months. 

Main outcome measures were VA changes as measured by logarithm of the minimum angle of resolution (logMAR) lines and secondary outcome measures were changes in stereoacuity and contrast sensitivity at 6 months.   

Bifocal wearing in the amblyopic eye is feasible for the treatment of amblyopia.

Children treated with the combination of bifocals and atropine penalization experienced greater VA improvement compared with control group participants at 6-month follow-up (3.3±0.9 logMAR lines vs 2.6±0.8 logMAR lines; P =.04), the study authors report. No significant differences in stereoacuity or contrast sensitivity were noted between the cohorts and differences in accommodative gain decreased among both children treated with bifocals plus atropine (0.69±0.15 vs 0.82±0.2; P =.4) and control individuals (0.62±0.16 vs 0.79±0.2; P = 0.3).

“Bifocal wearing in the amblyopic eye is feasible for the treatment of amblyopia,” according to the study authors. “This therapeutic strategy may be advantageous in treating hyperopic anisometropic amblyopia, but longer follow-up and larger sample size studies are necessary to establish the efficacy of bifocals as an aid in the treatment of this group of amblyopic patients.”

Study limitations include a small size and an inability to accurately track patient compliance.


Tejedor J, Gutiérrez-Carmona FJ. Bifocal use in hyperopic anisometropic amblyopia treated with atropine: a proof-of-concept randomized trial. Eye. Published online September 20, 2022. doi:10.1038/s41433-022-02247-4