Part-time Patching Research Articles

Impact of patching treatment on quality of life among children with amblyopia in Gaza Strip, Palestine

Background: Eye patching treatment affects the health-related quality of life of children with amblyopia. However, the extent of this effect in Gazan children with amblyopia remains unknown. This study evaluated the effect of patching on the health-related quality of life in Gazan children with unilateral or bilateral refractive amblyopia. Methods: This cross-sectional study was conducted at Gaza Ophthalmic Hospital, Gaza Strip, Palestine, from September 2019 to October 2020 with adherence to the standard operating procedures of the coronavirus pandemic. Children with refractive amblyopia who completed patching therapy with a successful outcome were recruited. After patching therapy was completed, the parents completed an 18-item parental Amblyopia Treatment Index (ATI) questionnaire via telephone. Results: Twenty-four children having 36 eyes with refractive amblyopia and a mean (standard deviation) age of 7.6 (1.8) years were included. Children underwent 2 h or 2–6 h of daily patching for 12 or 17 weeks. The mean values for total ATI score, adverse effects subscale, difficulty with compliance subscale, and social stigma subscale were 2.6, 2.6, 2.7, and 2.9, respectively, indicating that part-time patching was mostly accepted and had less impact on health-related quality of life. Treatment compliance was high; children complained at the time of patch application but did not pay attention to the patch once it was in place. In most children, the patch caused no adverse effects related to physical activities such as fun activities, learning, writing or drawing, visualizing, or playing with toys. Social stigma due to patch complications or different perceptions was not a concern. However, the perceptions of others were a major concern (n = 19, 79.2%). No significant association was found between the overall ATI score or the score of any of the subscales (adverse effects, difficulty with compliance subscale, or social stigma) and the child’s age, sex, number of lines improved in visual acuity of the amblyopic eye, severity of amblyopia, laterality, or treatment period (all P > 0.05). Conclusions: The ATI questionnaire score and its three subscales revealed that the quality of life among Gazan children with refractive amblyopia was less affected by the part-time patching treatment. In the future, the ATI questionnaire could be used with various treatment modalities and types of amblyopia in the same setting to provide more practical guidelines on the management of amblyopia.

Part-Time Monocular 1% Atropine Therapy for Intermittent Exotropia Control in Young Children

Intermittent exotropia (IXT), a common pediatric ocular disease, lacks defined treatment. Suggested treatments like part-time patching show results similar to observation, and over-minus therapy increases the risk of myopia progression.1,2,3 Often, physicians seek to improve control until children are old enough for viable options like surgery and/or exercises. This retrospective chart review assesses the effectiveness of 1% atropine applied to the dominant eye for 2 consecutive days per week for IXT in children younger than 8 years.

Efficacy of part-time patching in preventing recurrence after bilateral lateral rectus recession in children with intermittent exotropia

BackgroundThis study evaluate the efficacy of part-time patching in preventing recurrence after bilateral lateral rectus recession (BLR) in patients with intermittent exotropia (IXT).MethodsA total of 190 children aged 3–13 years who experienced recurrence after BLR for IXT and received part-time patching were retrospectively reviewed. The patching was prescribed for 2 h per day for more than 6 months. Patients who had a recurrence of 18 PD or more underwent reoperation. Changes in exodeviation and reoperation ratio after part-time patching were analyzed.ResultsA total of 34 patients (17.9%) received reoperation after part-time patching, and the reoperation ratio after 2 years was 20.3% as per the Kaplan–Meier survival analysis. Patients with a recurrence of 7 to 10 PD showed a significantly better effect compared to those with a recurrence of more than 10 PD (p < 0.001), and the reoperation ratio was also lower in the survival analysis (p = 0.004). The factor associated with reoperation in patients with part-time patching was the duration between the operation and the initiation of part-time patching (hazard ratio [HR] = 1.006, p = 0.002).ConclusionsPart-time patching was effective in maintaining the efficacy of surgery and delaying the need of reoperation after BLR. This effect was better in patients with a recurrence of ≤ 10 PD.

The efficacy of part-time patching treatment for intermittent exotropia on different age groups.

Intermittent exotropia (IXT) is one of the most common forms of strabismus usually seen in the pediatric age group, the prevalence of IXT is higher in Africa and the Middle East. IXT treatment strategies include both surgical and non-surgical methods, non-surgical management is preferred in general as it is less invasive and avoids the risks associated with surgery and anesthesia. This study aims to determine the effectiveness of patching therapy for the treatment of IXT in different age groups and to compare the success of patching therapy in preventing surgery in IXT patients in different age groups. A retrospective chart review was conducted from September 2022 until February 2023 at King Abdulaziz University Hospital in Riyadh. The data was collected retrospectively from electronic medical records from 2016 to 2021 of all patients diagnosed with IXT and were managed by patching therapy fitting the inclusion criteria. A total of 76 patients with IXT enrolled in the study with 56.5% of the participants were older than 7 years old. Overall, there was no improvement in the angle of deviation but 34% of patients had improved control over the follow-up period. 55.3% of the participants didn't require surgery. Younger age, longer duration of patching per month, and good compliance were significantly associated with treatment success. Younger age groups were more likely to benefit from patching therapy than older age groups, and good compliance to patching therapy is an important factor in preventing the need for surgery.

Standard Amblyopia Therapy in Adults with Longstanding Amblyopia Improves Visual Acuity and Contrast Sensitivity.

Perceptual learning or dichoptic training may result in improved acuity in adult amblyopes. However, for amblyopic children (<18 years), most clinicians recommend standard part-time patching. The purpose of this study was to determine if standard amblyopia therapy results in an enhancement in vision in the amblyopic eye of adults. Fifteen amblyopes (20/30 or worse) were recruited and nine (age (SD) 32.9 (16.31)) with anisometropia or anisometropia and strabismus (ie, combined mechanism amblyopia) completed the study. Previous therapy did not exclude subjects. The subjects received a comprehensive eye exam and wore their best correction for at least four weeks prior to baseline testing. The non-amblyopic eye was patched for 2 hours per day (Amblyopia iNET training for 30 minutes and near/distance activities for 1.5 hours). The subjects had a baseline amblyopia evaluation followed by one visit per week for 12 weeks. At 12 weeks, the treatment was tapered off over one month and the subjects had a final amblyopia evaluation at 24 weeks. Contrast sensitivity was measured at baseline and 12 weeks with the Quick CSF system. The subjects had a significant improvement in visual acuity across the weeks (p < 0.001). At baseline, weeks 12 and 24, the average logMAR acuities (SE) were 0.55 (0.09), 0.41 (0.08), and 0.38 (0.09), respectively. Weeks 4 to 24 were significantly different (p < 0.001) from baseline. The average acuity improvement over the 24 weeks was 1.7 logMAR lines. There was a significant increase in the area under the log contrast sensitivity function (p = 0.002) and its estimated acuity (p = 0.036) from baseline to 12 weeks. Standard amblyopia treatment can result in an improvement in visual acuity and contrast sensitivity in adults with longstanding anisometropic or combined mechanism amblyopia even if they had prior therapy.

Impact of Part-time Occlusion on Visual Outcomes in Pediatric Patients With Optic Nerve Pathology

The visual outcomes of seven children with specific optic nerve pathologies and coexisting amblyopia after at least 1 year of part-time patching demonstrated a visual acuity improvement of greater than 0.1 logMAR. The results suggest that part-time patching may lead to improvement in visual function even in the setting of optic nerve pathology, albeit with a more limited response compared to full-time patching. [J Pediatr Ophthalmol Strabismus. 2023;60(3):e19-e21.].

Comparison of alternate part-time patching and pencil push-up training for patients with intermittent exotropia

BackgroundTo compare the effect of alternate part-time patching and pencil push-up training on control ability in patients with intermittent exotropia.MethodsPatients (3–7 years old) with previously untreated intermittent exotropia were randomly assigned to receive alternate part-time patching, pencil push-up training, or observation. Control ability was assessed using the Office Control Score. Stereoacuity at 40 cm was evaluated with Titmus. Results were compared after a 12-week follow-up.ResultsNinety-two patients (28 in patching, 30 in pencil push-ups, and 34 in observation group) completed 12-week follow-up assessments. Based on 6-point scale, the mean deviation control was significantly better in patching and pencil push-up group after 12 weeks at distance (P = 0.002 and 0.026, respectively). Furthermore, there were greater control changes in patching and pencil push-up groups in comparison with observation group from baseline to 12 weeks (P<0.001; P = 0.003, respectively). After 12 weeks of treatment, stereoacuity and stereoacuity changes were not significantly different between either the intervention group or control group (P = 0.140 and 0.393, respectively).ConclusionsBased on the common office control scale, alternate part-time patching and pencil push-up training were effective treatment strategies for intermittent exotropia.

Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years.

Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years.

Effects of Vision Therapy on Bilateral Amblyopia Unresponsive to Conventional Treatment: A Retrospective Comparative Study

Background: In this study we aim to determines the effect of our vision therapy program for 7- to 10-year-old patients who exhibit bilateral amblyopia that is no longer responsive to conventional treatment. Methods: Children with bilateral amblyopia between the ages of 7 and 10 treated with vision therapy at the China Medical University Hospital between 2016 and 2019 were retrospectively reviewed. Age and visual acuity-matched bilateral amblyopes are included as a control group. The visual acuity for both groups showed no improvement for more than 3 months with part-time patching and full refraction correction. The initial and final visual acuity, stereopsis, and refractive status were analyzed. Results: Here, 15 cases were included as the treatment group and 16 cases as a control group. At the endpoint, the study group shows a significant improvement in BCVA, with a mean of 0.32 ± 0.15 logMAR (3 lines improvement) versus 0.003 ± 0.19 logMAR (nearly no improvement) for the control group (p < 0.001). The benefits of treatment are most obvious in the first 3 months after treatment (p < 0.001) and last until the end point. Stereoacuity also improves from 190.00 ± 163.34 to 85.00 ± 61.24 arc seconds, which is a 55.26% improvement. Conclusions: Vision therapy, comprising orthoptic therapy, perceptual learning and dichoptic training, is a successful program for increasing visual acuity and stereoacuity in 7- to 10-year-old children with bilateral amblyopia that is unresponsive to conventional treatment.

Efficacy of vision therapy for unilateral refractive amblyopia in children aged 7\u201310\u2009years

BackgroundThere is a critical period for visual development, conventionally considered to be the first 6 years of life. Children aged 7 years and older are significantly less responsive to amblyopia treatment. This study investigated the efficacy of binocular vision therapy in amblyopic children aged 7–10 years.MethodsThis retrospective study enrolled 36 children with unilateral amblyopia who were divided into a case group (receiving vision therapy, optical correction, and part-time patching of the weaker eye) and a control group (receiving optical correction and part-time patching of the weaker eye). Visual acuity (VA) was measured at baseline, at the 3-month, 6-month, and 9-month visits, and 3 months after cessation of treatment.ResultsThere were 19 subjects in the case group and 17 subjects in the control group. Mean VA in the case group improved from 0.39 ± 0.24 logMAR at baseline to 0.10 ± 0.23 logMAR at the endpoint of treatment (p < 0.001, paired t-test). Mean VA in the control group improved from 0.64 ± 0.30 logMAR at baseline to 0.52 ± 0.27 logMAR at the endpoint of treatment (p = 0.015, paired t-test). The improvement was significantly greater in the case group than in the control group (p = 0.006, two-samples independent t-test). All subjects underwent follow-up examinations within 6 to 12 months. There was no regression of VA in the case group 3 months after cessation of vision therapy. The patients in the case group who received visual therapy were with better VA improvement then patients with only optic correction and patching.ConclusionsVision therapy combined with conventional treatment (optical correction and part-time patching) is more effective than conventional treatment alone in children aged 7–10 years with unilateral refractive amblyopia. The treatment results not only in greater vision gain, but also in shorter duration of treatment.

Refractive Accommodative Esotropia Treated by Asymmetric Refractive Accommodative Esotropia Correction

To compare deviation improvement in children with residual refractive accommodative esotropia after previous treatment with spectacles, part-time patching and visual training with asymmetric refractive accommodative esotropia correction vs. full hyperopic correction. 72 participants (F=34, mean age 5.81 years) with residual partially refractive accommodative esotropia, mean deviation without glasses was 18.33±5.61 prism dioptres (PD) at distance and 22.64±5.82 PD at near. Participants (mean baseline visual acuity 62.43±18.97 letters) were randomly assigned to treatment for 24-months with asymmetric refractive accommodative esotropia correction (n=36) or full hyperopic correction (n=36). Change in deviation, visual acuity, refraction and anisometropia from baseline to the 24-month assessed by a masked examiner until deviation resolved and visual acuity stabilized. At 24 months, mean deviation with glasses improved from baseline by 21 PD with asymmetric esotropia correction, by 7 PD with full hyperopic correction at near vision. Mean visual acuity was improved from baseline 72.08±16.62 letters to 108.06±2.47 letters; refraction was decreased from baseline 5.03±2.75 dioptres (D) to 2.49±1.39 D in refractive accommodative esotropia eye (EE) in asymmetric refractive accommodative esotropia correction group, Visual acuity difference between EE and dominated eye (DE) was reduced from baseline 3.22±3.39 to 0.25±0.44. Anisometropia was improved from the baseline 1.65±1.78 D to 0.14±0.14 D. Overall treatment outcome was not related to age, sex, or prior treatment history, but were related to better baseline deviation and visual acuity. Conclusion: Deviation and visual acuity were greater improvement with asymmetric esotropia correction than full hyperopic correction treatment at 24-month in children with residual refractive accommodative esotropia.

Factors associated with the effectiveness of part-time patching for intermittent exotropia in children.

To evaluate the factors associated with the efficacy of low-dose part-time patching in children with intermittent exotropia (IXT). In this prospective observational study, we enrolled 186 patients diagnosed with IXT. Outcome measures included office based control scales, magnitude of exo-deviation, and stereoacuity at near and distance after daily patching for 2 h. We analyzed the clinical data and demographic factors association with improvement of IXT. The study was completed by 152 subjects of total enrolled patients on a consecutive basis followed up for 1 year. Decrease in the magnitude of exo-deviation, improvement of control, and or gain of stereoacuity were observed in 31.6% patients of the recruited subjects after part-time patching. Multivariate analyses showed that prognostic factors determining improvement to part-time patching included convergence insufficiency (CI) type IXT (p = 0.016), poor distance stereopsis (p = 0.044), and large exotropic deviation at distance (p = 0.025). CI-type exotropia, large distance magnitude of exo-deviation, or poor distance stereopsis appear to be associated with a better response to part-time patching. Therefore low dose part-time patching may be a useful non-surgical treatment alternative to delay surgery in these cases.

Visual acuity and stereoacuity improvement in children with and without fusion maldevelopment nystagmus syndrome

To evaluate visual acuity and stereoacuity improvement in children with and without associated fusion maldevelopment nystagmus syndrome (FMNS) treated with part-time patching.

Fixational eye movements abnormalities and rate of visual acuity and stereoacuity improvement with part time patching

Residual amblyopia is seen in 40% of amblyopic patients treated with part-time patching. Amblyopic patients with infantile onset strabismus or anisometropia can develop fusion maldevelopment nystagmus syndrome (FMNS). The purpose of this study was to understand the effects of presence of FMNS and clinical subtype of amblyopia on visual acuity and stereo-acuity improvement in children treated with part-time patching. Forty amblyopic children who had fixation eye movement recordings and at least 12 months of follow-up after initiating part-time patching were included. We classified amblyopic subjects per the fixational eye movements characteristics into those without any nystagmus, those with FMNS and patients with nystagmus without any structural anomalies that do not meet the criteria of FMNS or idiopathic infantile nystagmus. We also classified the patients per the clinical type of amblyopia. Patching was continued until amblyopia was resolved or no visual acuity improvement was noted at two consecutive visits. Children with anisometropic amblyopia and without FMNS have a faster improvement and plateaued sooner. Regression was only seen in patients with strabismic/mixed amblyopia particularly those with FMNS. Patients with FMNS had improvement in visual acuity but poor stereopsis with part-time patching and required longer duration of treatment.

The influence of alternate part-time patching on control of intermittent exotropia: a randomized clinical trial.

To evaluate the effect of alternate part-time patching on deviation control in patients with intermittent exotropia in comparison to observation. In a randomized clinical trial, untreated 3-8-year-old children with intermittent exotropia were randomly divided into patching group who treated with alternate part-time patching and observation group. Deviation control was assessed with 3-point and 6-point scales. Stereoacuity and suppression were evaluated with Titmus and Worth-4-dot tests respectively. All exams were repeated 3 and 6 months after beginning of treatment. Seventy-six patients (35 in patching and 41 in observation group) with a mean age of 4.99 ± 1.33 years completed the 6-month course of study. Based on 3-point scale, deviation control was significantly better in patching group after 3 and 6 months at near and after 3 months at far (p = 0.011, 0.011, and 0.03, respectively) but non-significant after 6 months at far (p = 0.16). According to 6-point scale, deviation control was also significantly better in patching group after 3 months (p = 0.03 at far, 0.003 at near) and 6 months (p = 0.03 at far, 0.003 at near). Three and 6 months stereoacuity was not significantly different between groups (p = 0.86 for both). However, there was greater stereoacuity changes among patching group in comparison with observation group from baseline to 3 and 6 months (p = 0.006 for both). Patching seems effective in improving deviation control of 3-8-year-old children with intermittent exotropia in comparison with observation based on two common office control scales. NCT03700632 (10/9/2018).

Perceptual Learning Versus Part-Time Patching for Deprivation Amblyopia in Limbal Dermoid Children After Keratoplasty: A Randomized Controlled Trial

Perceptual Learning Versus Part-Time Patching for Deprivation Amblyopia in Limbal Dermoid Children After Keratoplasty: A Randomized Controlled Trial

Part time patching treatment outcomes in children with amblyopia with and without fusion maldevelopment nystagmus: An eye movement study.

PurposeWe investigated how the abnormalities of fixation eye movements (FEMs) of the amblyopic eye were linked with treatment outcomes following part-time patching therapy in children with amblyopia.MethodsWe recruited 53 patients, with at least 12 months of patching, and measured FEMs at the end of treatment. Subjects were classified based on FEM waveforms (those without nystagmus = 21, those with nystagmus without fusion maldevelopment nystagmus (FMN) = 21, and those with FMN = 11) and based on clinical type of amblyopia (anisometropic = 18, strabismic = 6, and mixed = 29). The treatment outcomes such as duration of treatment of receiving part-time patching therapy, visual acuity and stereo-acuity deficits at the end of treatment were determined. Bivariate contour ellipse area (BCEA), fast (fixational saccade/quick phases), and slow (inter-saccadic drifts/slow phases) FEMs of the fellow and amblyopic eye were analyzed.ResultsAnisometropic group had less residual amblyopia (0.23±0.19logMAR acuity) compared to strabismic/mixed (0.36±0.26) groups (p = 0.007). Treatment duration in patients without nystagmus was lower (12.6±9.5months) compared to nystagmus without FMN (25.6±23.2) and FMN (29.5±20.4) groups (p = 0.006). Patients without nystagmus had better stereopsis at the end of treatment (2.3±0.84logarcsecs) compared to nystagmus without FMN (2.6±0.84) group (p = 0.003). The majority of patients with FMN (8/11) had absent stereopsis. BCEA of the amblyopic eye was higher in patients with greater residual visual acuity deficits in patients without nystagmus. No such association was seen in Nystagmus no FMN and FMN groups. Increased amplitude of fast FEMs, increased eye position variance and eye velocity of slow FEMs were seen in patients who had received longer duration of part time patching therapy and in those with greater residual amblyopia, and poor stereopsis at the end of treatment.ConclusionsAssessment of FEM waveforms and fast and slow FEM characteristics are important measures while describing fixation instability in amblyopia. Several FEM abnormalities were associated with stereo-acuity and visual acuity deficits and treatment duration in patients with amblyopia treated with part time patching therapy.

Binocular game versus part-time patching for treatment of anisometropic amblyopia in Chinese children: a randomised clinical trial

AimsTo compare amblyopic-eye visual acuity (VA) and binocularity improvement of a binocular game with part-time patching in the treatment of Chinese children with anisometropic amblyopia.Methods103 Chinese children aged 3–13 years...

The Effect of Combined Patching and Citalopram on Visual Acuity in Adults with Amblyopia: A Randomized, Crossover, Placebo-Controlled Trial.

Nonhuman animal models have demonstrated that selective serotonin reuptake inhibitors (SSRIs) can enhance plasticity within the mature visual cortex and enable recovery from amblyopia. The aim of this study was to test the hypothesis that the SSRI citalopram combined with part-time patching of the fellow fixing eye would improve amblyopic eye visual acuity in adult humans. Following a crossover, randomized, double-blind, placebo-controlled design, participants completed two 2-week blocks of fellow fixing eye patching. One block combined patching with citalopram (20 mg/day) and the other with a placebo tablet. The blocks were separated by a 2-week washout period. The primary outcome was change in amblyopic eye visual acuity. Secondary outcomes included stereoacuity and electrophysiological measures of retinal and cortical function. Seven participants were randomized, fewer than our prespecified sample size of 20. There were no statistically significant differences in amblyopic eye visual acuity change between the active (mean ± SD change = 0.08 ± 0.16 logMAR) and the placebo (mean change = −0.01 ± 0.03 logMAR) blocks. No treatment effects were observed for any secondary outcomes. However, 3 of 7 participants experienced a 0.1 logMAR or greater improvement in amblyopic eye visual acuity in the active but not the placebo blocks. These results from a small sample suggest that larger-scale trials of SSRI treatment for adult amblyopia may be warranted. Considerations for future trials include drug dose, treatment duration, and recruitment challenges. This study was preregistered as a clinical trial (ACTRN12611000669998).

A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in Children Aged 13 to 16 Years With Amblyopia

To compare visual acuity (VA) improvement in teenagers with amblyopia treated with a binocular iPad game vs part-time patching. One hundred participants aged 13 to <17 years (mean 14.3 years) with amblyopia (20/40 to 20/200, mean ∼20/63) resulting from strabismus, anisometropia, or both were enrolled into a randomized clinical trial. Participants were randomly assigned to treatment for 16weeks of either a binocular iPad game prescribed for 1 hour per day (n= 40) or patching of the fellow eye prescribed for 2 hours per day (n= 60). The main outcome measure was change in amblyopic eye VA from baseline to 16weeks. Mean amblyopic eye VA improved from baseline by 3.5 letters (2-sided 95% confidence interval [CI]: 1.3-5.7 letters) in the binocular group and by 6.5 letters (2-sided 95% CI: 4.4-8.5 letters) in the patching group. After adjusting for baseline VA, the difference between the binocular and patching groups was-2.7 letters (95% CI:-5.7 to 0.3 letters, P= .082) or 0.5 lines, favoring patching. In the binocular group, treatment adherence data from the iPad device indicated that only 13% of participants completed >75% of prescribed treatment. In teenagers aged 13 to <17 years, improvement in amblyopic eye VA with the binocular iPad game used in this study was not found to be better than patching, and was possibly worse. Nevertheless, it remains unclear whether the minimal treatment response to binocular treatment was owing to poor treatment adherence or lack of treatment effect.