Br J Ophthalmol 1999;83:582-587 ( May )

Natural history of amblyopia untreated owing to lack of compliance

Kurt Simons,^a Mark Preslan^b

^a Krieger Children's Eye Center, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA, ^b Department of Ophthalmology, University of Maryland, Baltimore, USA

Correspondence to: Kurt Simons, Krieger Children's Eye Center, The Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287-9028, USA.

Accepted for publication 12 November 1998

AIMSA prospective study of the efficacy of amblyopia treatment in preschool children has recently been called for, requiring an untreated control group. The present study assessed data from patients with amblyopia untreated owing to lack of compliance, or with amblyopia risk factors, to determine outcome.
METHODSLongitudinal data were obtained from 18 4-6 year old patients who had initially been screened for amblyopia, strabismus, and/or bilateral refractive error, failed to comply with prescribed treatment, and in whom amblyopia was detected at a rescreening approximately a year later. The data from three previous studies comparing outcome of patients compliant and non-compliant with amblyopia treatment were also reanalysed.
RESULTSOne child of the 18, who wore glasses sporadically, showed some improvement in visual acuity in the amblyopic eye. Otherwise, no child showed an improvement, and seven of the 17 (41%) for whom visual acuities were available at both screenings showed a deterioration of visual acuity in the amblyopic eye, including three who apparently developed amblyopia for the first time. A child with an ametropic risk factor for amblyopia whose visual acuity was not obtained at the first screening and who was largely non-compliant presented with amblyopia at the second screening. The reanalysed data from the three previous studies demonstrated a significantly poorer visual acuity outcome in the amblyopic eye in the non-compliant patient groups than in the compliant groups in each study.
CONCLUSIONPreschool children with amblyopia or its risk factors are at risk of having the current amblyopia deteriorate, or of developing amblyopia, if not treated. These results raise questions about the ethical acceptability of a prospective study of amblyopia treatment at these ages.

---

© 1999 by British Journal of Ophthalmology
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Arnold, R. W., Armitage, M. D., Limstrom, S. A. (2008). Sutured Protective Occluder for Severe Amblyopia. Arch Ophthalmol 126: 891-895 [Abstract] [Full Text]  
• Loudon, S. E., Fronius, M., Looman, C. W. N., Awan, M., Simonsz, B., van der Maas, P. J., Simonsz, H. J. (2006). Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor.. IOVS 47: 4393-4400 [Abstract] [Full Text]  
• Dixon-Woods, M, Awan, M, Gottlob, I (2006). Why is compliance with occlusion therapy for amblyopia so hard? A qualitative study. Arch. Dis. Child. 91: 491-494 [Abstract] [Full Text]  
• Holguin, A. M. C., Congdon, N., Patel, N., Ratcliffe, A., Esteso, P., Flores, S. T., Gilbert, D., Rito, M. A. P., Munoz, B. (2006). Factors associated with spectacle-wear compliance in school-aged mexican children.. IOVS 47: 925-928 [Abstract] [Full Text]  
• Pediatric Eye Disease Investigator Group, (2005). Randomized Trial of Treatment of Amblyopia in Children Aged 7 to 17 Years. Arch Ophthalmol 123: 437-447 [Abstract] [Full Text]  
• Hunter, D. G. (2005). Treatment of Amblyopia in Older Children. Arch Ophthalmol 123: 557-558 [Full Text]  
• O'Brien, G. (2004). Treatment of unilateral visual impairment on preschool vision screening: Preschool vision screening should continue, perhaps earlier. BMJ 328: 348-348 [Full Text]  
• Konig, H.-H., Barry, J.-C. (2004). Cost-Utility Analysis of Orthoptic Screening in Kindergarten: A Markov Model Based on Data From Germany. Pediatrics 113: e95-108 [Abstract] [Full Text]  
• Clarke, M P, Wright, C M, Hrisos, S, Anderson, J D, Henderson, J, Richardson, S R (2003). Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening. BMJ 327: 1251- [Abstract] [Full Text]  
• Pediatric Eye Disease Investigator Group, (2003). Impact of Patching and Atropine Treatment on the Child and Family in the Amblyopia Treatment Study. Arch Ophthalmol 121: 1625-1632 [Abstract] [Full Text]  
• Fleck, B W (2003). Amblyopia therapy. Br. J. Ophthalmol. 87: 255-256 [Full Text]  
• Cobb, C J, Russell, K, Cox, A, MacEwen, C J (2002). Factors influencing visual outcome in anisometropic amblyopes. Br. J. Ophthalmol. 86: 1278-1281 [Abstract] [Full Text]  
• Ohlsson, J, Baumann, M, Sjostrand, J, Abrahamsson, M (2002). Long term visual outcome in amblyopia treatment. Br. J. Ophthalmol. 86: 1148-1151 [Abstract] [Full Text]  
• Dorey, S. E, Adams, G. G W, Lee, J. P, Sloper, J. J (2001). Intensive occlusion therapy for amblyopia. Br. J. Ophthalmol. 85: 310-313 [Abstract] [Full Text]  
• Hartmann, E. E., Dobson, V., Hainline, L., Marsh-Tootle, W., Quinn, G. E., Ruttum, M. S., Schmidt, P. P., Simons, K., on Behalf of the Maternal and Child Health Bureau, (2000). Preschool Vision Screening: Summary of a Task Force Report. Pediatrics 106: 1105-1116 [Full Text]  
• Cleary, M. (2000). Efficacy of occlusion for strabismic amblyopia: can an optimal duration be identified?. Br. J. Ophthalmol. 84: 572-578 [Abstract] [Full Text]