Can Patching Be Improved in Amblyopia Treatment?

Abstract

Abstract: : Purpose: The outcome of patching therapy for amblyopia is often poor. One possible explanation is poor adherence (compliance). We recently found a significant dose/effect relationship between hours patched and visual improvement in a randomised control trial.We aimed to explore reasons for poor adherence and to inform the development of interventions to improve adherence. Methods: Semi structured interviews using a prompt guide were undertaken with 25 parents of children currently or recently undergoing occlusion therapy treatment. Parental perceptions of amblyopia, and experiences of experience of patching were explored. Parents priorities for the designing of interventions to increase the amount of patching time were identified. Interviews were tape–recorded and transcribed verbatim. Data analysis was based on the constant comparative method assisted by qualitative analysis software (QSR N5). Results: Most families perceived patching treatment for amblyopia as difficult. Many did not understand the rationale for the treatment, for others the treatment was lacking in credibility. Parents were confused about the roles of different staff in diagnosing and treatment amblyopia and lacked information presented in ways that could help them negotiate the treatment. The parental and child commitment required to implement the treatment was daunting and patching appeared most successful when it could be integrated with other routines, when parents were convinced of the value and likely success of the treatment, and when parents used encouragement strategies. The appearance of the patch was a source of anxiety and stigma. There was little opportunity for parents to hear from role models who had patched successfully or to hear about experiences of families who are currently patching. Conclusions: Most families perceive patching therapy for amblyopia as very difficult. Parents need to be provided with easily understood, well presented and credible information that they can share with their child. The appearance of the patches needs to be improved. There is a need for families to be able to share their experiences with others, including those who have successfully patched

Keywords: amblyopia • visual acuity