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Aveen Kadhum, Sanne Pijnenburg, Bronte Janszen, Brigitte Simonsz-Toth, Huibert Jan Simonsz, Sjoukje E Loudon; Long-term visual outcome of occlusion therapy for amblyopia: a 10-year follow-up. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2359.
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To evaluate the current visual acuity in children who were treated with occlusion therapy for amblyopia 10 years ago and identify clinical risk factors for poor visual outcome.
In a previous RCT (2001-2003, N=303 children; Loudon et al.) we investigated whether compliance with occlusion therapy can be improved, and identified risk factors for non-compliance in all newly diagnosed amblyopic children in The Hague. Compliance was measured electronically with the Occlusion Dose Monitor (ODM) one week every three months. Treatment continued until no further improvement in visual acuity was measured on two consecutive visits to the orthoptist. Since December 2015 we are contacting these patients. Each participant received a full orthoptic eye-examination, including current visual acuity and best corrected visual acuity (BCVA) using the Landolt-C chart 17.2’. Reading acuity was tested using the Radner chart. Both charts have a logMAR scale. Alignment was assessed with the Cover/Uncover Test and tests for binocularity were done. The examinations were carried out by the research orthoptist through domiciliary visits and at the out-patient clinic in the Westeinde Hospital, The Hague. Current amblyopia was defined as an inter-ocular visual acuity difference of ≥0.1 logMAR. Nonparametric tests were carried out.
So far, we were able to contact and re-examine 112 participants (37%) approximately ten years after amblyopia treatment (range 9-11 years). Their mean age was 17.6 (SD± 2.1) years and 51 were male (46%). Thirty-one (10%) refused to be re-examined. Mean visual acuity in the amblyopic eye of the 112 participants was 0.02 logMAR (SD± 0.20).Twenty-five (22%) still had amblyopia, of whom 11 had a visual acuity equal or worse than 0.3 logMAR; i.e. visual acuity necessary to read. Factors contributing to a poor visual acuity outcome, included poor visual acuity at start of treatment (p=0.001) and low compliance (p=0.05). Mean compliance in the current amblyopia group was 65.7% (SD±32%) compared to 82.1% (SD±33%) in the treated group. Children who did not patch at all (N=5) now had a mean visual acuity of 0.24 logMAR (SD± 0.37) in the amblyopic eye.
Ten years after patching therapy 10% of the subjects had visual acuity equal or worse than 0.3 logMAR. The visual acuity of the amblyopic eye at the start of therapy is the most important predictor for visual acuity outcome.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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