Hours Of Patching Research Articles

An Eye-Tracking–Based Dichoptic Home Treatment for Amblyopia: A Multicenter Randomized Clinical Trial

Comparing visual outcomes after use of a novel binocular eye-tracking-based home treatment (CureSight; NovaSight, Ltd) with patching. Prospective, multicenter, randomized, masked, controlled, noninferiority pivotal trial. One hundred three children 4 to < 9 years with anisometropic, small-angle strabismic or mixed-mechanism amblyopia were randomized 1:1 to either CureSight treatment or patching. The CureSight treatment uses combined anaglyph glasses and an eye tracker to induce real-time blur around the fellow eye fovea in dichoptic streamed video content.Participants used the device for 90 minutes/day, 5 days/week for 16 weeks (120 hours). The patching group received 2 hours of patching 7 days/week (224 hours). The prespecified noninferiority margin was 1 line. The primary outcome was the improvement in the amblyopic eye visual acuity (VA), modeled with a repeated measures analysis of covariance. Secondary outcomes included stereoacuity, binocular VA, and treatment adherence rates, analyzed by a 1-sample Wilcoxon test within each group and a 2-sample Wilcoxon test comparing groups. Safety outcomes included the frequency and severity of study-related adverse events (AEs). CureSight group VA improvement was found to be noninferior to patching group improvement (0.28 ± 0.13 logarithm of the minimum angle of resolution [logMAR] [P < 0.0001] and 0.23 ± 0.14 logMAR [P < 0.0001], respectively; 90% confidence interval [CI] of difference, -0.008 to 0.076). Stereoacuity improvement of 0.40 log arcseconds (P < 0.0001) and improved binocular VA (0.13 logMAR; P < 0.0001) were observed in the binocular treatment group, with similar improvements in the patching group in stereoacuity (0.40 log arcseconds; P<0.0001) and binocular VA (0.09 logMAR; P < 0.0001), with no significant difference between improvements in the 2 groups in either stereoacuity (difference, 0; 95% CI, -0.27 to -0.27; P= 0.76) or binocular VA (difference, 0.041; 95% CI, -0.002 to 0.085; P= 0.07). The binocular treatment group had a significantly higher adherence than the patching group (91% vs. 83%; 95% CI, -4.0% to 21%; P= 0.011). No serious AEs were found. Binocular treatment was well tolerated and noninferior to patching in amblyopic children 4 to <9 years of age. High adherence may provide an alternative treatment option for amblyopia. Proprietary or commercial disclosure may be found after the references.

Efficacy of vision-based treatments for children and teens with amblyopia: a systematic review and meta-analysis of randomised controlled trials

ObjectiveTo identify differences in efficacy between vision-based treatments for improving visual acuity (VA) of the amblyopic eye in persons aged 4–17 years old.Data sourcesOvid Embase, PubMed (Medline), the Cochrane Library,...

Amblyopia Outcomes Through Clinical Trials and Practice Measurement: Room for Improvement: The LXXVII Edward Jackson Memorial Lecture

To describe amblyopia prevalence and outcomes using results from randomized studies and a clinical registry. Review of published studies, analysis of data in Intelligent Research in Sight (IRIS) Registry from 2013 to 2019, personal perspective. Literature review, analysis of IRIS Registry data and IRIS-50, a visual acuity quality measure. Clinical trials have reduced the treatment burden of amblyopia by reducing hours of patching and frequency of atropine eye drops with clinical success of about 83%. There is no appreciable age effect if treatment is started before 5 years of age, outcomes are stable to at least 15 years of age, and treatment can be somewhat effective until 12 years of age. The IRIS Registry identified 1,760,066 individuals with amblyopia for a prevalence of 2.47%. Refractive error alone accounted for 68.9% of childhood cases. Mean amblyopic eye visual acuity improved 1.8 lines for children 3-6 years of age and 0.8 lines for 7-12 years, but mean residual amblyopia was more than 2 lines. Among 18,841 children aged 3-7 years eligible for IRIS-50, 77.3% were successful. The odds ratios for success were significantly lower for African-American (0.67; 95% confidence interval [CI]= 0.58 to 0.78) and Hispanic or Latino (0.84; 95% CI= 0.75 to 0.94) children compared with white children. Clinical trials provided evidence of a beneficial effect from several treatments, with substantially reduced doses than previously recommended. Registry data from clinical practice found residual visual acuity impairment among all ages and races, especially among minorities.

COMPARISON OF PATCHING DURATION ON AMBLYOPIC CHILDREN IN CMH MUZAFFARABAD

Objective: To Compare the efficacy of 2 different patching regimens in amblyopic children and highlight the factors affecting compliance.&#x0D; Materials &amp; Methods: The randomized control trial was conducted in Eye OPD SKBZ Hospital Muzaffarabad from September 2017- March 2018. Analysis was limited to children 4 to 16 years of age with unilateral amblyopia. Personal information, visual acuity with and without correction, Cycloplegic refraction &amp; subjective refraction was noted. Children with amblyopic eye acuity of 20/40 to 20/200 (mean 0.56 log MAR, approximately 20/63) and inter ocular acuity difference of 2 or more lines were specified to get either 2 hours (Group A) or 6 hours (Group B) of daily patching, combined with 1 hour of near visual activities per day. Follow up period was 2 weeks, 4 weeks and 3 months.&#x0D; Results: &#x0D; Out of 72 children 44(61.1%) were males and 28(38.9%) were females. The mean age was 10.25 ± 0.67 years. Mean visual acuity was 20/63(+0.5 log Mar) in both groups. In group A, 66.7 % and in group B 83.3% of patients showed improvement. The mean difference of BCVA was 2.77 ± 1.28 SD and 3.41±3.16 SD in group ‘A’ and group ‘B’ respectively. Group A and B showed improvement of 3.0 and 2.0 lines respectively. Both groups showed a poor compliance of 11.2 %.&#x0D; Conclusion:&#x0D; 2 hours of patching along with 1 hour of near activity is sufficient to treat amblyopia as compared to 6 hours of patching. Firstly, screening should be done to diagnose amblyopia at early stage. Secondly compliance is found to be a single most important factor to improve outcomes.

The effect of different amblyopia treatment protocols on axial length of non-amblyopic eyes in anisohyperopic patients

PurposeTo evaluate the effect of full-time and part-time occlusion therapy on axial length (AL) of non-amblyopic eyes in anisohyperopic patients. MethodsSixty-five patients who were treated for anisohyperopic amblyopia were recruited for this prospective cross-sectional study. Treatment was provided as patching of the non-amblyopic for 4 h or less (part-time occlusion therapy, n = 42), patching of the non-amblyopic for 8 h or more (full-time occlusion therapy, n = 13) and refractive correction (spectacles, non-patched group, n = 10). AL measurements were calculated by a Lenstar LS 900 at the last session of amblyopia therapy. ResultsThe mean age of patients treated for anisohyperopic amblyopia was 4.90 ± 0.80 years, and the mean follow-up period was 1.50 ± 0.80 years. The mean of spherical equivalent in amblyopic and non-amblyopic eyes were +3.58 ± 2.26 and +1.84 ± 0.97 diopter (D) before treatment, and +3.21 ± 2.28 and +1.49 ± 0.99 D after treatment, respectively. The mean of spherical equivalent in non-amblyopic eyes before (F = 0.452, df = 2, P = 0.639) and after (F = 0.190, df = 2, P = 0.828) treatment did not have any significant difference between the three groups. The mean AL of amblyopic and non-amblyopic eyes were 22.11 ± 93.0 and 22.68 ± 1.07 mm, respectively. The mean AL of the non-amblyopic eye was significantly higher in the full-time occlusion therapy group when compared to the part-time patch and the non-patched groups (P < 0.001). The mean AL of amblyopic eyes showed no difference across the three treatment groups (P = 0.840). ConclusionsThe results show that a longer AL in the non-amblyopic eye, but not the amblyopic eye, can be expected with longer daily hours of patching in anisohyperopic patients. Future studies are needed to evaluate the effect of patching on AL in children with anisohyperopic amblyopia.

Association Between Occlusion Therapy and Optotype Visual Acuity in Children Using Data From the Infant Aphakia Treatment Study: A Secondary Analysis of a Randomized Clinical Trial.

Patching has been a mainstay in treating unilateral congenital cataract. However, its efficacy has not been rigorously assessed. To examine the association between patching and visual acuity in a cohort of children treated for unilateral congenital cataract. This 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. Cataract extraction and randomization to receipt of an intraocular lens vs being left aphakic for the first 5 years of life. Caregivers 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. The 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. These 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. clinicaltrials.gov Identifier: NCT00212134.

Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study.

PurposeTo identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study.Patients and methodsInfants with a unilateral congenital cataract (n=114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis.ResultsThirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P=0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (P<0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years.ConclusionAmong children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.

Assessment of Adherence to Visual Correction and Occlusion Therapy in the Infant Aphakia Treatment Study.

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-h 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, four years after 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.

"Combined occlusion and atropine therapy" versus "Augmented part-time patching" in children with refractory/residual amblyopia: A pilot study

Purpose:To compare the efficacy of combined occlusion and atropine therapy (COAT) and augmented part-time patching for the treatment of unilateral refractory/residual amblyopia.Methodology:This retrospective study evaluated children between 4 and 11 years with refractory/residual amblyopia who were treated with either additional atropine (COAT group) or increased hours of patching (augmented group). Data were collected on improvement in best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR] units) at each follow-up visit.Results:There were 19 children in the COAT group and 17 children in the augmented group. The baseline BCVA of the amblyopic eye was 0.79 ± 0.36 logMAR in the COAT group and 0.72 ± 0.26 logMAR in augmented group. Children were statistically significantly younger in the COAT group (6.4 ± 2.2 years) compared to the augmented group (8.6 ± 3.3 years, P = 0.02). The mean duration of follow-up was statistically significantly longer in the augmented group (20.2 COAT group; 13.9 months augmented group) (P = 0.03). Compliance was similar in both groups. LogMAR BCVA (adjusted for difference in age and baseline BCVA) was statistically significantly better in the COAT group (0.56 ± 0.04) compared to the augmented group (0.80 ± 0.04) at 3 months (P = 0.000); 6 months (COAT group, 0.50 ± 0.04 vs. augmented group, 0.74 ± 0.04; P = 0.04) and at 1 year (COAT group, 0.42 ± 0.04 vs. augmented group, 0.67 ± 0.04, P = 0.000). There was statistically significantly greater improvement in logMAR BCVA at 6 months in COAT group (0.26 ± 0.15) compared to the augmented group (0.02 ± 0.14), (P = 0.0002). Age, gender, pretreatment BCVA, duration of follow-up, or compliance to patching did not affect improvement in BCVA.Conclusions:COAT may result in greater improvement in BCVA than augmented part-time patching in children with unilateral residual/refractory amblyopia.

Modulating ocular dominance in the adult in real time.

Using a dichoptic spatial phase combination paradigm that assesses the relative contribution that each eye makes to the binocular percept (ocular dominance), we have shown previously that 2.5 hours of patching, be it opaque or translucent, can result in a short-term enhancement of the patched eye's contribution to binocularity. This suggests that it is differential pattern deprivation, rather than the differential luminance deprivation that is driving this ocular dominance change. Here we ask what aspects of the pattern stimulation are important for ocular dominance. Observers dichoptically viewed movies of 2-3 hrs duration in which the spatial information in one eye's view had been altered (pattern deprivation). We measured each eye's contribution to the binocular percept before and after movie viewing using the dichoptic spatial phase task. Scrambling the spatial phases in one eye's view had no effect on ocular dominance, suggesting features constructed from phase-aligned components are unimportant in this regard. At the level at which these changes in dominance occurs only the Fourier amplitude spectrum is important. To verify this we show that graded changes to the magnitude of the amplitude spectrum result in graded changes in ocular dominance. To ascertain whether different parts of the amplitude spectrum are more important than others, we compared highpass with lowpass filtering and show that only the latter affects dominance. Finally, the ocular dominance change is not orientationally-dependent, suggesting the underlying mechanism is isotropic. Short-term changes in ocular dominance in adults can be obtained by altering the contrast of isotropic, high spatial frequency components seen by one eye. Meeting abstract presented at VSS 2015.

Randomized Controlled Trial of Patching vs Acupuncture for Anisometropic Amblyopia in Children Aged 7 to 12 Years

To compare the effectiveness of 2-hour daily patching with the effectiveness of acupuncture in treating anisometropic amblyopia in children aged 7 to 12 years who have worn optimal spectacles for at least 16 weeks. In a single-center randomized controlled trial, 88 eligible children with an amblyopic eye who had a best spectacle-corrected visual acuity (BSCVA) of 0.3 to 0.8 logMAR at baseline were randomly assigned to receive 2 hours of patching of the sound eye daily or 5 sessions of acupuncture weekly. All participants in our study received constant optical correction, plus 1 hour of near-vision activities daily, and were followed up at weeks 5, 10, 15, and 25. The main outcome measure was BSCVA in the amblyopic eye at 15 weeks. The mean BSCVA of the amblyopic eye at 15 weeks improved from baseline by 1.83 and 2.27 lines in the patching and acupuncture groups, respectively. After baseline adjustment, the mean difference of BSCVA between the 2 groups was 0.049 logMAR (95% confidence interval, 0.005-0.092; P = .03), meeting the definition of equivalence (difference within 1 line). The BSCVA had improved by 2 lines or more in 28 (66.7%) and 31 (75.6%) eyes in the patching and acupuncture groups, respectively. Amblyopia was resolved in 7 (16.7%) and 17 (41.5%) eyes in the patching and acupuncture groups, respectively. Acupuncture produced equivalent treatment effect for anisometropic amblyopia, compared with patching, and was statistically superior. Further studies are warranted to investigate its value in the treatment of amblyopia. Acupuncture could potentially become an alternative treatment to occlusion therapy for amblyopia. Centers for Clinical Trials Registry Identifier: CUHK_CCT00248.

Can amblyopia treatment be optimised?

Abstract Purpose To investigate the efficacy of an educational program in improving the compliance with patching treatment. Methods A randomised control trial was conducted with 29 amblyopes receiving no educational program and 31 receiving educational program.The compliance was measured using occlusion dose monitors for the entire patching period of 12 weeks.Our secondary aim was to look at the dose effect response for longer effective hours of patch wear. Results We found that patients who received the educational program complied more and dropped out less ( p=0.02).We also found a significant dose effect relationship in strabismic and mixed group with a greater improvement in visual acuity with longer hours of patching ;greater than 6 hours (p= 0.0001).We did not find any significant relationship in anisometropes. Conclusion An educational program would reduce poorly compliant patients and drop outs in amblyopia treatment.

A Randomized Pilot Study of Near Activities Versus Non-Near Activities During Patching Therapy for Amblyopia

To plan a future randomized clinical trial, we conducted a pilot study to determine whether children randomized to near or non-near activities would perform prescribed activities. A secondary aim was to obtain a preliminary estimate of the effect of near versus non-near activities on amblyopic eye visual acuity, when combined with 2 hours of daily patching. Sixty-four children, 3 to less than 7 years of age, with anisometropic, strabismic, or combined amblyopia (20/40 to 20/400) were randomly assigned to receive either 2 hours of daily patching with near activities or 2 hours of daily patching without near activities. Parents completed daily calendars for 4 weeks recording the activities performed while patched and received a weekly telephone call in which they were asked to describe the activities performed during the previous 2 hours of patching. Visual acuity was assessed at 4 weeks. The children assigned to near visual activities performed more near activities than those assigned to non-near activities (by calendars, mean 1.6 +/- 0.5 hours versus 0.2 +/- 0.2 hours daily, P < 0.001; by telephone interviews, 1.6 +/- 0.4 hours versus 0.4 +/- 0.5 hours daily, P < 0.001). After 4 weeks of treatment, there was a suggestion of greater improvement in amblyopic eye visual acuity in those assigned to near visual activities (mean 2.6 lines versus 1.6 lines, P = 0.07). The treatment group difference in visual acuity was present for patients with severe amblyopia but not moderate amblyopia. Children patched and instructed to perform near activities for amblyopia spent more time performing those near activities than children who were instructed to perform non-near activities. Our results suggest that performing near activities while patched may be beneficial in treating amblyopia. Based on our data, a formal randomized amblyopia treatment trial of patching with and without near activities is both feasible and desirable.

A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors

Objective To assess whether the relative treatment effect of patching compared with atropine for moderate amblyopia varies according to patient age, cause of amblyopia or depth of amblyopia, and initial number of patching hours prescribed. Design Multicenter, randomized clinical trial. Participants Four hundred nineteen children younger than 7 years of age with amblyopia in the range of 20/40 to 20/100. Methods Patients were assigned randomly to receive treatment with either patching or atropine and followed up for 6 months. Primary outcome measure Single-surrounded HOTV optotype visual acuity in the amblyopic eye after 6 months. Results Improvement in the amblyopic eye visual acuity was slightly greater in the patching group compared with the atropine group in all subgroups based on patient characteristics. The relative treatment effect did not vary with age ( P = 0.84), cause of amblyopia ( P = 0.68), or baseline amblyopic eye acuity ( P = 0.59). Patients with acuity of 20/80 to 20/100 who were prescribed 10 or more hours a day of patching showed a more rapid improvement in acuity than did patients prescribed a lesser amount of patching ( P = 0.01) or than did patients in the atropine group ( P < 0.001), but by 6 months, the differences were not significant ( P = 0.47 and 0.15, respectively). Conclusions A beneficial effect of both patching and atropine is present throughout the age range of 3 to younger than 7 years old and the acuity range of 20/40 to 20/100. Patients with acuity of 20/80 to 20/100 improve faster when a greater number of hours of patching is prescribed, but by 6 months, the amount of improvement is not related to the number of hours of patching initially prescribed.

The Clinical Profile of Moderate Amblyopia in Children Younger Than 7 Years

To describe the demographic and clinical characteristics of a cohort of children with moderate amblyopia participating in the Amblyopia Treatment Study 1, a randomized trial comparing atropine and patching. The children enrolled were younger than 7 years and had strabismic, anisometropic, or combined strabismic and anisometropic amblyopia. Visual acuity, measured with a standardized testing protocol using single-surround HOTV optotypes, was 20/40 to 20/100 in the amblyopic eye, with an intereye acuity difference of 3 or more logMAR lines. There were 419 children enrolled, 409 of whom met these criteria and were included in the analyses. The mean age of the 409 children was 5.3 years. The cause of the amblyopia was strabismus in 38%, anisometropia in 37%, and both strabismus and anisometropia in 24%. The mean visual acuity of the amblyopic eyes (approximately 20/60) was similar among the strabismic, anisometropic, and combined groups (P =.24), but visual acuity of the sound eyes was worse in the strabismic group compared with the anisometropic group (P<.001). For the patients randomized into the patching group, 43% were initially treated for 6 hours per day, whereas 17% underwent full-time patching. Patients with poorer visual acuity in the amblyopic eye were prescribed more hours of patching than patients with better acuity (P =.003). In the Amblyopia Treatment Study 1, there were nearly equal proportions of patients with strabismic and anisometropic amblyopia. A similar level of visual impairment was found irrespective of the cause of amblyopia. There was considerable variation in treatment practices with regard to the number of hours of initial patching prescribed.