Abstract
Purpose: :
In response to a systematic review of amblyopia treatment, a number of rigorous studies have been undertaken over the last 5 years that have provided new insights into how amblyopia may be most effectively managed. Recently however, it has been reported in the US that few practitioners have made changes to their practice in response to the recent developments and some were even unaware of the research. This study therefore aimed to assess the current practice of amblyopia management in the UK, to determine if this was comparable with the recommendations proposed by the recent research.
Methods: :
A questionnaire was constructed to assess the current practice of amblyopia management in the UK in areas such as: the tests used for diagnosis, amount of occlusion prescribed, use of near activity tasks, implementation of written information, strategies to enhance compliance, tapering of occlusion prior to cessation, use and regimen of atropine penalisation, use of optical penalisation, refractive adaptation, treatment of amblyopia in older children and adults and changes to prescribing behaviour in response to the recent research. The questionnaire was emailed to Head Orthoptists in every UK Eye Department, with the option of returning it by post to enable the responders to maintain their anonymity.
Results: :
No difficulties were encountered in completing the questionnaires and a satisfactory response rate of 59% was obtained. Mean prescribed occlusion wear was 3.6±1.5 (range 1 to 10) hours for moderate amblyopia and 6.0±2.4 (range 2.5 to 12) hours for severe amblyopia. Written information about amblyopia was always given out by only 42% of practitioners and 28% never provided written information. For moderate amblyopia, 83% considered occlusion to be more effective than atropine, only 15% thought they may be equally effective. Ninety per cent of practitioners used atropine to treat amblyopia, but only 4% would consider it as a first line treatment. Of those using atropine, 62% instilled it daily and just 6% used a regime of weekend only instillation. For amblyopia with a refractive component, an adaptive period was given by 94% with a mean of 12.4±5.0 (range 2 to 26) weeks. In terms of plasticity of the visual system and amblyopia, 86% would consider treatment in a child between 8 and 12 years, reducing to 23% for children between the ages of 13 and 17 years and just 14% would consider occluding a patient over the age of 17 years.
Conclusions: :
Despite the dissemination of recent research there is evidence that a substantial proportion of practitioners do not implement a variety of the proposed recommendations for the management of amblyopia.