Occlusion for stimulus deprivation amblyopia

Antonio-Santos, Aileen A.; Vedula, Satyanarayana S; Hatt, Sarah R.; Powell, Christine

doi:10.1002/14651858.cd005136.pub3

Cited by 15 publications

(13 citation statements)

References 74 publications

(47 reference statements)

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“…The impact of adherence to occlusion therapy on visual outcome is, therefore, difficult to assess. Further, although the efficacy of occlusion therapy for treating other types of amblyopia has been evaluated (9), its efficacy in children with unilateral congenital cataract has not been rigorously examined (10). …”

Section: Introductionmentioning

confidence: 99%

Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study

et al. 2016

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for the Infant Aphakia Treatment Study Group IMPORTANCE Patching has been a mainstay in treating unilateral congenital cataract. However, its efficacy has not been rigorously assessed.OBJECTIVE To examine the association between patching and visual acuity in a cohort of children treated for unilateral congenital cataract. DESIGN, SETTING, AND PARTICIPANTSThis study was a secondary analysis of a randomized clinical trial (Infant Aphakia Treatment Study) of infants born from August 1, 2004, through December 31, 2008, who were treated with 1 of 2 treatments for unilateral congenital cataract and followed up to 5 years of age. Data analysis was performed from March 1, 2013, to March 1, 2016.INTERVENTIONS Cataract extraction and randomization to receipt of an intraocular lens vs being left aphakic for the first 5 years of life. MAIN OUTCOMES AND MEASURESCaregivers reported patching in the previous 48 hours in quarterly semistructured telephone interviews. The mean number of hours of patching per day was calculated from surgery to the first birthday (n = 92) and between 12 and 48 months of age (n = 102). Monocular optotype acuity was assessed at 4½ years of age by a traveling examiner using the Aphakia Treatment Study HOTV protocol. RESULTSThe Infant Aphakia Treatment Study enrolled 114 children; 57 were randomized to each treatment group. At 4½ years of age, optotype visual acuity was assessed in 112 children. The current analyses exclude an additional 3 children (2 who had adverse events that limited visual potential and 1 who had Stickler syndrome), leaving 109 total children analyzed (59 female [54.1%] and 92 white [84.4%]). Caregivers reported patching their children a mean (SD) of 3.73 (1.47) hours per day in the first year of life and 3.43 (2.04) hours per day thereafter. An association between reported patching and treatment was not identified (mean difference in first year, −0.29 hours per day; 95% CI, −0.90 to 0.33 hours per day; mean difference between 12 and 48 months of age, −0.40 hours per day; 95% CI, −1.20 to 0.40 hours per day). Visual acuity was associated with reported hours of patching in the first year of life (r = −0.32; 95% CI, −0.49 to −0.13) and between 12 and 48 months of age (r = −0.36; 95% CI, −0.52 to −0.18). However, patching accounted for less than 15% of the variance in logMAR acuity at 4½ years of age. CONCLUSIONS AND RELEVANCEThese results support the association of occlusion throughout the preschool years with improved visual acuity in infants treated for unilateral congenital cataract. However, similar visual outcomes were achieved with varying amounts of patching. These conclusions should be interpreted in the context of limitations related to generalizability from incomplete data collected in a clinical trial. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134

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Section: Introductionmentioning

confidence: 99%

Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study

et al. 2016

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“…Such data are of importance in both research and clinical practice. In particular, a recent Cochrane Review recently recommended clinical trials be conducted to evaluate the efficacy of occlusion therapy for children with stimulus deprivation amblyopia, such as caused by unilateral cataract [3]. The methods we investigate here would allow for a quantitative estimation of adherence to occlusion therapy in such a trial.…”

Section: Discussionmentioning

confidence: 99%

“…Although occlusion is a standard part of treatment, its efficacy has not been rigorously assessed [3]. Further, because occlusion is often difficult for caregivers to administer [4, 5], there is a high-level of non-concordance between prescribed and achieved occlusion [6–11].…”

Section: Introductionmentioning

confidence: 99%

Assessment of adherence to visual correction and occlusion therapy in the Infant Aphakia Treatment Study

Drews‐Botsch

Cotsonis

Celano

et al. 2016

Contemporary Clinical Trials Communications

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Occlusion therapy throughout early childhood is believed to be efficacious in treating deprivation amblyopia but has not been rigorously assessed in clinical trials. Further, tools to assess adherence to such therapy over an extended period of time are lacking. Using data from the Infant Aphakia Treatment Study, a randomized clinical trial of treatment for unilateral congenital cataract, we examined the use of quarterly 48-hour recall interviews and annual 7-day prospective diaries to assess reported hours of patching in 114 children throughout the first 5 years of life. Consistency of data reported was assessed using correlation coefficients and intraclass correlation coefficients. Both interview and diary data showed excellent consistency with Cronbach’s Alpha’s ranging from 0.69 to 0.88 for hours of patching and 0.60 to 0.73 for hours of sleep. However, caregivers reported somewhat more adherence in prospective diaries than retrospective interviews. Completion rates, on the other hand, were substantially higher for telephone interviews than prospective diaries. For example, after four years of surgery response rates to telephone interviews exceeded 75% versus completion rates of only 54% for diaries. In situations where occlusion dose monitors cannot be used for assessing adherence to occlusion therapy, such as in infants or over an extended period of time, quantitative assessments of occlusion therapy can be obtained by parental report, either as a series of prospective diaries or a series of recall interviews.

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“…Additionally, while the present systematic review was inclusive of all types of amblyopia, only a small number of participants had form deprivation amblyopia. This was unavoidable due to the low levels of research carried out on this condition 30. Despite these limitations a core set of studies with moderate quality were identified and provide evidence that information giving is an effective method of improving compliance.…”

Section: Discussionmentioning

confidence: 99%

Assessing interventions to increase compliance to patching treatment in children with amblyopia: a systematic review and meta-analysis

2015

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Occlusion for stimulus deprivation amblyopia

Cited by 15 publications

References 74 publications

Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study

Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study

Assessment of adherence to visual correction and occlusion therapy in the Infant Aphakia Treatment Study

Assessing interventions to increase compliance to patching treatment in children with amblyopia: a systematic review and meta-analysis

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