The emotional impact of amblyopia treatment in preschool children: Randomized controlled trial

doi:10.1016/j.ophtha.2003.12.059

Ophthalmology

Volume 111, Issue 8, August 2004, Pages 1550-1556

Poster presented at: American Academy of Ophthalmology Annual Meeting, November, 2001; New Orleans, Louisiana. Orally presented at: British Orthoptic Society Annual Scientific Conference, July, 2002; Chester, United Kingdom.

https://doi.org/10.1016/j.ophtha.2003.12.059 Get rights and content

Abstract

Purpose

To investigate the emotional status of children undergoing active treatment for amblyopia.

Design

Postal survey, in the context of a prospective, multicenter, randomized controlled trial.

Participants

Parents of 177 children with a unilateral visual impairment referred from preschool vision screening. The children had been recruited to a randomized controlled trial of treatment for unilateral visual impairment and randomly assigned to receive either glasses with or without patches, glasses alone, or treatment deferred for 1 year.

Methods

A self-completion questionnaire, including a psychometric behavioral scale, was sent to the parents of all children recruited to the trial at age 4 years, to 66 whose deferred treatment began at age 5 years, and finally to 151 remaining in the trial at the end of follow-up.

Main outcome measures

Mean scores per treatment group on the Revised Rutter Parent Scale for Preschool Children. Comparison of parent responses to questions assessing the child's general well-being and difficulties associated with treatment.

Results

Completed questionnaires were returned for 144 of 177 (81%) children at a mean age (standard deviation) of 48 months (5.0), for 45 of 66 (68%) at a mean age of 61 months (5.8), and for 78 of 151 (52%) at a mean age of 67 months (5.0). Most parents reported having difficulty with patching their child regardless of age (77% at age 4 years and 73% at age 5 years), with fewer reporting difficulties with glasses alone (42% and 53%, respectively). Children were significantly more upset by patching than by glasses only (chi-square test, P = 0.03 for age 4 years and P = 0.01 for age 5 years), as were the parents of 4-year-olds (chi-square test, P = 0.01). Most parents thought their children were happy, cooperative, and good tempered, and behavioral scores did not differ between treatment groups.

Conclusions

Treatment for unilateral visual impairment is not easy to implement and is commonly associated with some degree of distress. Despite this, no impact on the child's global well-being or behavior was seen either during or after the treatment period.

Section snippets

Materials and methods

This study was approved by the UK, Northern and Yorkshire, Multicentre Regional Ethical Committee.

Results

Questionnaires were sent for all 177 trial subjects 3 months after recruitment, and 144 (81%) were returned. The mean age (standard deviation [SD]) of the children at this stage was 48 (5.0) months; there were 73 boys and 71 girls. At the end of the deferral period, questionnaires were sent for 66 children who had been prescribed treatment of glasses with or without occlusion for the first time. Forty-five (68%) were returned at a mean age (SD) of 61 (5.8) months for 28 male and 17 female

Discussion

This study represents the first attempt to quantify the emotional impact of active orthoptic treatment for unilateral visual impairment in the context of a prospective randomized controlled trial. The intention to treat analysis between randomly allocated treatment groups at age 4 removed the possibility of selection bias. A valuable, but more limited, evaluation was possible for children treated at age 5 and for all children once treatment had stopped.

It is clear that many parents have some

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Amblyopia and the whole child
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Amblyopia is a disorder of neurodevelopment that occurs when there is discordant binocular visual experience during the first years of life. While treatments are effective in improving visual acuity, there are significant individual differences in response to treatment that cannot be attributed solely to difference in adherence. In this considerable variability in response to treatment, we argue that treatment outcomes might be optimized by utilizing deep phenotyping of amblyopic deficits to guide alternative treatment choices. In addition, an understanding of the broader knock-on effects of amblyopia on developing visually-guided skills, self-perception, and quality of life will facilitate a whole person healthcare approach to amblyopia.
Treatment compliance in amblyopia: A mini-review and description of a novel online platform for compliance tracking
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Citation Excerpt :
The functional impact of patching was also mentioned in many studies, with parents and children reporting that patching interfered with daily activities and schooling.12,22,37 Social and interpersonal factors, such as bullying from peers and the effect of patching on self-esteem are also noted.12,22,41 One interpersonal element that has repeatedly been shown to influence compliance is the interaction between families and clinic staff.
Patient compliance with amblyopia therapies, including eye patching and atropine drops, is crucial for optimal visual acuity outcomes. Studies utilizing objective measures of compliance measurement have consistently shown that a majority of patients receive significantly less treatment than prescribed. We review the subjective and objective compliance rates reported in the literature, assess possible explanations for poor compliance, and describe studies of interventions to improve compliance. Additionally, we report our experience implementing Inside Out Care, a novel online platform designed to improve monitoring of amblyopia patient compliance, in our clinics. We have found that this platform, which is accessible via both computer and smartphone, has improved monitoring of amblyopia patient patching compliance, as well as allowed for enhanced doctor-patient communication.
Increased Incidence of Mental Disorders in Children with Cataract: Findings from a Population-based Study
2022, American Journal of Ophthalmology
To examine the incidence of mental disorders in children with cataract compared with children without cataract.
Nationwide cohort study based on entries in comprehensive national databases.
The incidence of mental disorders in children born between 2000 and 2017 diagnosed with cataract before 10 years of age (n = 485) was compared with sex- and age-matched controls (n = 4358). Analyses were corrected to somatic disease in the child and parental socioeconomic status and psychiatric morbidity. The study was conducted as 2 university hospitals in Denmark managing children 6 years of age our younger with cataract.
The incidence of mental disorders was nearly doubled in children with cataract compared with controls (odds ratio [OR], 1.83; 95% CI, 1.28–3.63). The risk of anxiety disorders was quadrupled (OR, 4.10; 95% CI, 1.90–8.84) and the risk of developmental delay was doubled (OR, 2.66; 95% CI, 1.45–4.90). The risk of mental disorders was significantly higher in children diagnosed with cataract in the first 3 years of life compared with controls (OR, 2.36; 95% CI, 1.53–3.64), whereas those diagnosed with cataract later in childhood did not have an increased risk (OR, 1.24; 95% CI, 0.66–2.30).
The risk of mental disorders, in particular anxiety and neurodevelopmental delay, is markedly increased in children with cataract and even more so in those diagnosed within the first 3 years of life. Psychiatric screening instruments may be integrated in the management of these children.
Pickwell’s Binocular Vision Anomalies
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Quality of life and mental health in amblyopic children treated with and without occlusion therapy
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Citation Excerpt :
Another novel aspect of this study is that we assessed anxiety, stress, depression, and HRQoL among caregivers to rule out their influence on the children's results. Most studies on the effects of amblyopia or amblyopia treatment have reported findings from the perspective of adults,22-25 but, as stated by Carlton and Kaltenhaler4 in their systematic review of amblyopia and QoL, “It is not possible to state that the impact of amblyopia treatment felt by the child is the same as that perceived by the adult on what and how their child's experience was.” In our study, we used three questionnaires suitable for children aged 8-17 years to analyze potential psychosocial effects of patching.
To assess the long-term (≥1 year) psychosocial effects of occlusion therapy in children with refractive amblyopia and their caregivers.
Multiple self-reported questionnaires were used to investigate HRQoL, anxiety, depression, and stress in a cross-sectional study of children with refractive amblyopia and their caregivers. Children were divided into two subgroups: those treated with glasses only and those treated with both glasses and occlusion therapy who had stopped wearing a patch at least 1 year earlier.
A total of 79 children were included: 32 in the refraction-only group and 47 in the glasses + occlusion group. Median age of subjects was 12 years (IQR = 3.0). Mean age of the 79 caregivers was 41.9 ± 5.0 years. No significant differences were found for any of the psychosocial outcomes analyzed between children treated with glasses and patching and those treated with glasses only. The differences remained insignificant between children according to age of first occlusion (<6 vs ≥6 years). The only significant (but not clinically relevant) difference observed for caregivers was a higher score in the depression dimension of the Hospital Anxiety and Depression Scale for caregivers of children treated with glasses only (P = 0.036; effect size = 0.23).
In our study cohort, patching was not associated with long-term negative psychosocial outcomes in children with refractive amblyopia treated with occlusion therapy.

View all citing articles on Scopus

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Manuscript no. 23048.

Supported by National Health Service Research & Development (grant no.: RRCC7R), Northern and Yorkshire Region, County Durham, United Kingdom.

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Original articleThe emotional impact of amblyopia treatment in preschool children: Randomized controlled trial☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Lancet

J AAPOS

Am J Ophthalmol

Parent Educ Couns

Vision screening in preschool childrena comparison of orthoptists and clinical medical officers as primary screeners

BMJ

Incidence of loss of vision in the healthy eye in amblyopia

Br J Ophthalmol

Preschool vision screeninga prospective comparative evaluation

Eye

Effectiveness of occlusion therapy in ametropic amblyopiaa pilot study

Br J Ophthalmol

Natural history of amblyopia untreated owing to lack of compliance

Br J Ophthalmol

Factors affecting the outcome of children treated for amblyopia

Eye

Factors affecting treatment compliance in amblyopia

J Pediatr Ophthalmol Strabismus

Preschool Vision Screening: Results of a Systematic Review. CRD report 9

Original article
The emotional impact of amblyopia treatment in preschool children: Randomized controlled trial☆