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Clinical science
Psychological causes of non-compliance with electronically monitored occlusion therapy for amblyopia
  1. S E Loudon1,
  2. J Passchier2,
  3. L Chaker1,
  4. S de Vos1,
  5. M Fronius3,
  6. R A Harrad4,
  7. C W N Looman5,
  8. B Simonsz1,5,
  9. H J Simonsz1
  1. 1
    Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2
    Department of Medical Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3
    Department of Ophthalmology, JW Goethe University, Frankfurt am Main, Germany
  4. 4
    Bristol Eye Hospital, Bristol, UK
  5. 5
    Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr S E Loudon, Department of Ophthalmology, Room Ee 1607, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; s.loudon{at}


Aim: To analyse psychological causes for low compliance with occlusion therapy for amblyopia.

Method: In a randomised trial, the effect of an educational programme on electronically measured compliance had been assessed. 149 families who participated in this trial completed a questionnaire based on the Protection Motivation Theory after 8 months of treatment. Families with compliance less than 20% of prescribed occlusion hours were interviewed to better understand their cause for non-compliance.

Results: Poor compliance was most strongly associated with a high degree of distress (p<0.001), followed by low perception of vulnerability (p = 0.014), increased stigma (p = 0.017) and logistical problems with treatment (p = 0.044). Of 44 families with electronically measured compliance less than 20%, 28 could be interviewed. The interviews confirmed that lack of knowledge, distress and logistical problems resulted in non-compliance.

Conclusion: Poor parental knowledge, distress and difficulties implementing treatment seemed to be associated with non-compliance. For the same domains, the scores were more favourable for families who had received the educational programme than for those who had not.

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  • Funding Health Research and Development Council of The Netherlands; MF: Albert von Metzler Foundation, Augenstern Association, Research Award of the German Society of Ophthalmology (DOG), Germany.

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval Ethics approval was provided by Erasmus MC University Medical Center Rotterdam.

  • Patient consent Obtained.

  • ▸ A supplemental file is published online only at