COMPARISON OF PATCHING DURATION ON AMBLYOPIC CHILDREN IN CMH MUZAFFARABAD
Keywords:Amblyopia, patching, compliance
Objective: To Compare the efficacy of 2 different patching regimens in amblyopic children and highlight the factors affecting compliance.
Materials & 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 & 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.
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 %.
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.
1. Flynn JT, Cassady JC. Current trends in amblyopia therapy. Ophthalmology. 1978;85(5):428–50.
2. Attebo K, Mitchell P, Cumming R, Smith W, Jolly N, Sparkes R. Prevalence and causes of amblyopia in an adult population. Ophthalmol 1998;105(1):154-9.
3. Blanca Ruiz de Zárate Jaime Tejedor. ; Current concepts in the management of amblyopia; Ophthalmology 2007;1(4): 403–414.
4. Hiscox F, Strong N, Thompson JR, Minshull C, Woodruff G. Occlusion for amblyopia: a comprehensive survey of outcome. Eye 1992;6(3): 300-304.
5. Scott WE, Dickey CF. Stability of visual acuity in amblyopic patients after visual maturity. Graefes Arch Clin Exp Ophthalmol. 1988;226(2):154-157.
6. Simons K. Preschool vision screening: rationale, methodology and outcome. Surv Ophthalmol. 1996;41(1):3-30.
7. Pediatric Eye Disease Investigator Group (PEDIG). at http://pedig.jaeb.org/ViewPage.aspx?PageName=General_Info>
8. Repka MX, Beck RW, Holmes JM, et al. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol (Chicago, Ill : 1960). 2003; 121:603-611.
9. Holmes, J. M., Beck, R. W., Kraker, R. T., Cole, S. R., Repka, M. X., Birch, E. E., et al.. Impact of patching and atropine treatment on the child and family in the amblyopia treatment study. Archives of Ophthalmology 2003; 121(11):1625–1632.
10. Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, et al.; Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017 Sep; 5(9):888–97.
11. Mostafa AM, Kassem RR, Abdel Meguid AAE (2010). Factors Affecting Compliances to Two- Hours Versus Six-Hour Occlusion Therapy Regimens for Treatment of Strabismic Amblyopia . J Clinic Experiment Ophthalmol 1:110 .doi :10.4172/2155-9570.1000110.
12. Repka MX, Beck RW, Holmes JM, Birch EE, Chandler DL, et al. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol. 2001; 121: 603-610.
13. The Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol . 2003;121:603-611.
14. Aparajita Chaudhary et al. A comparative study of efficacy of part time occlusion to full time occlusion therapy in moderate and severe Amblyopia in children and factors influencing the outcomes. Indian Journal of Clinical and Experimental Ophthalmology. 2016; 2(2): 162-166
15. Pediatric Eye Disease Investigator Group. A Randomized Trial of Increasing Patching for Amblyopia. Ophthalmology.2013; 120(11): 2270-2277.
16. Ahmed Al- Yahya, Khalid Al-Odan, Khalid Allam, Badriya Al-Onazi, Ahmed Mousa, Ahmed A. Al Saleh. Compliance to Patching in treatment of Amblyopia .Saudi Journal of Ophthalmolgy. 2012; 26 (3): 305-307.