Poverty predicts amblyopia treatment failure

Clinical impressions suggested a hypothesis that poverty is associated with poorer results in amblyopia therapy. To test this hypothesis, we compared patients with amblyopia who had Medicaid assistance with those who did not.

Of 1272 patients recorded to have amblyopia in the eye center computer, 280 met inclusion criteria of first visit under age 10 years and had treatment instituted and visual acuities recorded then and at follow-up visits. Seventy-one had Medicaid assistance, and 209 did not. Age at first visit, age at final visit, severity of amblyopia as measured by visual acuity at the first visit, and number of visits were all statistically indistinguishable. A large difference in final visual acuity, number of missed visits, and the parent's estimate of compliance was found.

The likelihood of good final visual acuity of 20/30 or better was 26.8% in the Medicaid group and 58% in the non-Medicaid group. The likelihood of a poor final visual acuity of 20/70 or worse was 33.8% in the Medicaid group versus 11.5% in the non-Medicaid group.

These results established socioeconomic status, measured by qualification for Medicaid assistance, to be an important predictor for success for amblyopia therapy. Work is in progress to better understand more specific factors and to meet the therapeutic challenge of amblyopia therapy for children.