A randomized trial of increasing patching for amblyopia

David K. Wallace; Elizabeth L. Lazar; Jonathan M. Holmes; Michael X. Repka; Susan A. Cotter; Angela M. Chen; Raymond T. Kraker; Roy W. Beck; Michael P. Clarke; Ingryd J. Lorenzana; David B. Petersen; Joan T. Roberts; Donny W. Suh

doi:10.1016/j.ophtha.2013.04.008

A randomized trial of increasing patching for amblyopia

David K. Wallace, Elizabeth L. Lazar, Jonathan M. Holmes, Michael X. Repka, Susan A. Cotter, Angela M. Chen, Raymond T. Kraker, Roy W. Beck, Michael P. Clarke, Ingryd J. Lorenzana, David B. Petersen, Joan T. Roberts, Donny W. Suh

Ophthalmology

Research output: Contribution to journal › Article › peer-review

30 Scopus citations

Abstract

Objective: After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. Design: Prospective, randomized, multicenter clinical trial. Participants: A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. Intervention: Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. Main Outcome Measures: Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. Results: Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50^-2). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). Conclusions: When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Original language	English (US)
Pages (from-to)	2270-2277
Number of pages	8
Journal	Ophthalmology
Volume	120
Issue number	11
DOIs	https://doi.org/10.1016/j.ophtha.2013.04.008
State	Published - Nov 2013

ASJC Scopus subject areas

Ophthalmology

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10.1016/j.ophtha.2013.04.008

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@article{3fa2901ecf104f40990a4527d4b6cb62,

title = "A randomized trial of increasing patching for amblyopia",

abstract = "Objective: After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. Design: Prospective, randomized, multicenter clinical trial. Participants: A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. Intervention: Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. Main Outcome Measures: Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. Results: Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50-2). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). Conclusions: When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.",

author = "Wallace, {David K.} and Lazar, {Elizabeth L.} and Holmes, {Jonathan M.} and Repka, {Michael X.} and Cotter, {Susan A.} and Chen, {Angela M.} and Kraker, {Raymond T.} and Beck, {Roy W.} and Clarke, {Michael P.} and Lorenzana, {Ingryd J.} and Petersen, {David B.} and Roberts, {Joan T.} and Suh, {Donny W.}",

note = "Funding Information: Supported by National Eye Institute of National Institutes of Health, Department of Health and Human Services ( EY011751 and EY018810 ). The funding organization had no role in the design or conduct of this research. Funding Information: The study was supported through a cooperative agreement with the National Eye Institute of the National Institutes of Health and conducted by the PEDIG. The protocol and Health Insurance Portability and Accountability Act–compliant informed consent forms were approved by institutional review boards, and a parent or guardian (referred to subsequently as parent) of each study participant gave written informed consent. The study adhered to the tenets of the Declaration of Helsinki, oversight was provided by an independent data and safety monitoring committee, and the study is listed on www.clinicaltrials.gov ( NCT00945100 , accessed November 27, 2012). The study protocol is available on the PEDIG website ( www.pedig.net , accessed November 27, 2012) and is summarized next. ",

year = "2013",

month = nov,

doi = "10.1016/j.ophtha.2013.04.008",

language = "English (US)",

volume = "120",

pages = "2270--2277",

journal = "Ophthalmology",

issn = "0161-6420",

publisher = "Elsevier Inc.",

number = "11",

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TY - JOUR

T1 - A randomized trial of increasing patching for amblyopia

AU - Wallace, David K.

AU - Lazar, Elizabeth L.

AU - Holmes, Jonathan M.

AU - Repka, Michael X.

AU - Cotter, Susan A.

AU - Chen, Angela M.

AU - Kraker, Raymond T.

AU - Beck, Roy W.

AU - Clarke, Michael P.

AU - Lorenzana, Ingryd J.

AU - Petersen, David B.

AU - Roberts, Joan T.

AU - Suh, Donny W.

N1 - Funding Information: Supported by National Eye Institute of National Institutes of Health, Department of Health and Human Services ( EY011751 and EY018810 ). The funding organization had no role in the design or conduct of this research. Funding Information: The study was supported through a cooperative agreement with the National Eye Institute of the National Institutes of Health and conducted by the PEDIG. The protocol and Health Insurance Portability and Accountability Act–compliant informed consent forms were approved by institutional review boards, and a parent or guardian (referred to subsequently as parent) of each study participant gave written informed consent. The study adhered to the tenets of the Declaration of Helsinki, oversight was provided by an independent data and safety monitoring committee, and the study is listed on www.clinicaltrials.gov ( NCT00945100 , accessed November 27, 2012). The study protocol is available on the PEDIG website ( www.pedig.net , accessed November 27, 2012) and is summarized next.

PY - 2013/11

Y1 - 2013/11

N2 - Objective: After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. Design: Prospective, randomized, multicenter clinical trial. Participants: A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. Intervention: Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. Main Outcome Measures: Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. Results: Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50-2). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). Conclusions: When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

AB - Objective: After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. Design: Prospective, randomized, multicenter clinical trial. Participants: A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. Intervention: Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. Main Outcome Measures: Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. Results: Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50-2). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). Conclusions: When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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JO - Ophthalmology

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ER -

A randomized trial of increasing patching for amblyopia

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