Compliance With Occlusion Therapy for Childhood Amblyopia

Michael P. Wallace, Catherine E. Stewart, Merrick J. Moseley, David A. Stephens, Alistair R. Fielder
2013 Investigative Ophthalmology and Visual Science  
This is the published version of the paper. This version of the publication may differ from the final published version. Permanent repository link: http://openaccess.city.ac.uk/2796/ Link to published version: http://dx.Abstract Purpose: Explore compliance with occlusion treatment of amblyopia in the Monitored and Randomised Occlusion Treatment of Amblyopia Studies (MOTAS and ROTAS), using objective monitoring. Methods: Both studies had a 3-phase protocol: initial assessment, refractive
more » ... refractive adaptation and occlusion. In the occlusion phase, participants were instructed to dose for 6 hrs/day (MOTAS) or randomized to 6 or 12 hrs/day (ROTAS). Dose was monitored continuously using an Occlusion Dose Monitor (ODM). Results: 152 patients (71 male, 81 female; 122 Caucasian, 30 non-Caucasian) of mean ± sd age 68±18 months participated. Amblyopia was defined as an inter-ocular acuity difference of at least 0.1 logMAR and was associated with anisometropia in 50, strabismus in 44, and both (mixed) in 58. Median duration of occlusion was 99 days (interquartile range 72 days). Mean compliance was 44%, mean proportion of days with no patch worn was 42%. Compliance was lower (39%) on weekends compared to weekdays (46%, p=0.04), as was the likelihood of dosing at all (52% vs. 60%, p=0.028). Compliance was lower when attendance was less frequent (p < 0.001) and with prolonged treatment duration (p<0.001). Age, gender, amblyopia type and severity were not associated with compliance. Mixture modelling suggested three subpopulations of patch day doses: under 30 minutes; doses that achieve 30%-80% compliance; and doses that achieve around 100% compliance. 4 Conclusions: This study shows that compliance with patching treatment averages less than 50% and is influenced by several factors. A greater understanding of these influences should improve treatment outcome.
doi:10.1167/iovs.13-11861 pmid:23882695 fatcat:xsjcqxxv3jawtlsyrcnjmkx33m