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Amy Chow, Yaping Jin, Linda Colpa, Agnes M. Wong; Practice Patterns and Efficacy of Patching Treatment for Amblyopia: A Toronto Experience. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3891.
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In 2003, daily patching of 2 hours for moderate amblyopia and 6 hours for severe amblyopia were recommended by the Pediatric Eye Disease Investigator Group (PEDIG) based on results from randomized clinical trials. The purposes of this study were to examine whether this evidence-based recommendation has been translated into clinical practice in Toronto, and to compare responses to the patching regimen in Toronto with those reported in PEDIG studies.
The medical records of 361 patients referred to the orthoptic service at The Hospital for Sick Children (SickKids) in Toronto for amblyopia check in 2007-2009 were reviewed. Of these patients, 162 were referred by 6 SickKids staff and 199 by 32 community ophthalmologists. Using the same inclusion and exclusion criteria as PEDIG, 71 children with moderate amblyopia and 53 with severe amblyopia were included in the analysis. The prescribed patching hours and the visual acuity of both eyes in patients in Toronto were compared with those in PEDIG studies.
Compared to PEDIG recommendations, patients in Toronto were prescribed 1 hour more for moderate amblyopia (mean=3 hours; range=0.5-10 hours; p<0.01) and 2 hours less for severe amblyopia daily (mean=4 hours; range=0.5-7 hours; p<0.01). Compared to the initial visit, the prescribed patching hours in Toronto were reduced by 1 hour (p<0.05) at the 13-18 month visit for moderate amblyopia, but was virtually unchanged for severe amblyopia (3.9 hours at the first visit and 3.2 hours at the 13-18 month visit; p=0.12).For moderate amblyopia, the amblyopic eye visual acuity at the 3-6 month visit in Toronto (0.23 logMAR) was similar to that of 4-month visit in PEDIG studies (0.24 logMAR; p=0.74). For severe amblyopia, the amblyopic eye visual acuity at the 3-6 month visit in Toronto (0.51 logMAR) was worse than that of 4-month visit in PEDIG studies (0.40 logMAR; p=0.02). However, at the 7-12 month visit, the amblyopic eye visual acuity in patients with severe amblyopia in Toronto (0.45 logMAR) reached a similar level as that of 4-month visit in PEDIG studies (0.40 logMAR; p=0.35).
Although the number of hours of patching prescribed for amblyopia in Toronto differed from those recommended by PEDIG studies, similar treatment efficacy was obtained.
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