April 2009
Volume 50, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2009
How Dutch Orthoptists Handle Non-Compliance With Occlusion Therapy for Amblyopia
Author Affiliations & Notes
  • A. M. Tjiam
    Ophthalmology,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • E. Vukovic
    Ophthalmology,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • W. L. Asjes-Tydeman
    Public Health,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • M. M. Sinoo
    Orthoptics, Utrecht University, Utrecht, The Netherlands
  • S. E. Loudon
    Ophthalmology,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • H. J. Simonsz
    Ophthalmology,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • J. R. Polling
    Ophthalmology,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • Footnotes
    Commercial Relationships  A.M. Tjiam, None; E. Vukovic, None; W.L. Asjes-Tydeman, None; M.M. Sinoo, None; S.E. Loudon, None; H.J. Simonsz, None; J.R. Polling, None.
  • Footnotes
    Support  ZonMw The Netherlands organisation for health research and development #6320.0008
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 4711. doi:
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      A. M. Tjiam, E. Vukovic, W. L. Asjes-Tydeman, M. M. Sinoo, S. E. Loudon, H. J. Simonsz, J. R. Polling; How Dutch Orthoptists Handle Non-Compliance With Occlusion Therapy for Amblyopia. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4711.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Non-compliance causes treatment failure in occlusion therapy for amblyopia. Predictors of low compliance are low initial visual acuity, a low parental fluency in Dutch, a low level of education, and country of origin (IOVS 2006; 47: 4393-400). We examined how Dutch orthoptists handle non-compliance with occlusion therapy in general and sought for differences related to the risk factors.

Methods: : A structured questionnaire was sent to all Dutch orthoptists. Nine orthoptists in low-SES areas (group A) and 23 orthoptists dispersed over the Netherlands (group B) were studied in more detail with a semi-structured interview, structured questionnaires and direct, non-participated observations. Patients’ demographic characteristics, organizational structure of the clinic, attendance-rates, concept of non-compliance, awareness of non-compliance, attitude towards non-compliance, approach towards non-compliance and communication with parent and child were evaluated. In children living in low-SES areas compliance was measured electronically.

Results: : Mean age of patients of B-orthoptists was 4.2 ± 1.1 years and A-orthoptists 4.6 ± 1.2 years. Patients of B-orthoptists had less than moderate fluency in Dutch in 4.6% and A-orthoptists in 36.9%. Patients of A-orthoptists were Dutch in 33.9%, Surinamese in 7.5%, Moroccan in 21.8% and Turkish in 13.2%. The electronic measurements of the compliance showed that approx. 48% of the children occluded less than 50% of the prescribed occlusion time; 16.7% did not occlude at all. One-hundred-and-seventy-four of all Dutch orthoptists (58%), who answered the structured questionnaire, estimated their patients’ compliance to be 72.7%, on average. The A and B-orthoptists estimated their patient’ compliance to be 66% and 75.5%, respectively. Patients of A-orthoptists did not show up at appointments in 9.6% and B-orthoptists in 6%. None of the B-orthoptists and four of the nine A-orthoptists found themselves inadequate in dealing with non-compliance. A-orthoptists gave 2’30" explanation about diagnosis and treatment to parents and B-orthoptists 4’21". All orthoptists did not communicate with the child during their explanation.Conclusion Orthoptists underestimated the size of poor compliance with occlusion therapy. Despite differences in fluency in Dutch, explanation of A-orthoptists is shorter, which is caused by a shorter allotted time for a patients’ first visit (21’ versus 27’24").

Clinical Trial: : www.trialregister.nl/trialreg/index.asp ISRCTN 22835481

Keywords: amblyopia • strabismus 
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