Treatment of Residual Amblyopia With Donepezil

Inclusion Criteria: 1. Age ≥8 years 2. Amblyopia associated with strabismus and/or anisometropia 3. Amblyopic eye visual acuity of 20/50 - 20/400 4. Sound eye visual acuity of ≥20/25 5. For 8 to 17 year olds, current amblyopia treatment of at least 2 hours of daily patching for at least 4 weeks during the pre-enrollment period with no improvement in best-corrected amblyopic eye visual acuity (\<5 letters or 1 logMAR line between 2 consecutive visual acuity measurements at least 4 weeks apart while on current treatment) 6. For ≥18 year olds, history of prior amblyopia treatment with patching 7. Wearing optimal optical correction with stable amblyopic eye visual acuity (\<5 letters or 1 logMAR line of improvement during 2 consecutive visual acuity measurements at least 4 weeks apart) 8. Complete eye examination within 6 months prior to enrollment 9. Available for at least 6 months of follow-up, have access to a phone, and willing to be contacted by clinical staff 10. Likely to comply with prescribed treatment and unlikely, if applicable, to continue to improve with 2 hours of daily patching alone Exclusion Criteria: 1. Myopia more than -6.00 D spherical equivalent 2. Presence of associated findings that could cause reduced visual acuity 3. Previous intraocular or refractive surgery 4. Strabismus surgery planned within 22 weeks 5. Current vision therapy or orthoptics 6. Treatment with topical atropine within the past 4 weeks 7. Presence of cardiac condition, asthma, obstructive pulmonary disease, seizure disorder, urinary incontinence, and/or peptic ulcer disease receiving concurrent NSAIDs 8. History of gastrointestinal bleeding from peptic ulcer disease 9. Known psychological problems 10. Known skin reaction to patch or bandage adhesives for 8 to 17 year olds 11. Known allergies or contraindications to the use of acetylcholinesterase inhibitors 12. Prior acetylcholinesterase inhibitor treatment 13. Current use of medication for the treatment of ADHD or psychological disorders 14. Inability to swallow pills equivalent in size to the 5 mg donepezil tablet 15. Females who are pregnant, lactating, or intending to become pregnant within the next 6 months