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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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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.
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.
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
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