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A retrospective review of the associations between amblyopia type, patient age, treatment compliance and referral
Brian E-G Chua1, Kim Johnson, Frank Martin
1Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Insights
Amblyopia management in children shows that while patching compliance is moderate (around 67%), it is lowest in toddlers aged 15-30 months. Early screening by general practitioners and pediatricians is crucial for preventing vision loss.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Amblyopia, or 'lazy eye,' is a leading cause of preventable vision impairment in children.
- Early detection and intervention are critical for successful amblyopia treatment outcomes.
- Public hospital clinics without formal screening programs present unique challenges for amblyopia management.
Purpose of the Study:
- To analyze the characteristics of children with amblyopia attending a public hospital clinic.
- To evaluate referral sources, presenting ages, and amblyopia types.
- To assess treatment compliance with patching therapy and identify factors influencing it.
Main Methods:
- Retrospective review of 127 children diagnosed with amblyopia between January 2001 and May 2003.
- Analysis of presenting age, amblyopia type, referral source, and patching compliance.
- Statistical analysis included means, 95% confidence intervals, and Mantel-Haenszel chi2 tests.
Main Results:
- Most referrals originated from general practitioners and pediatricians.
- The mean age of presentation was 32.9 months; deprivation amblyopia tended to be identified earliest.
- Overall patching compliance was approximately 67%, with no significant difference between sexes or amblyopia types, but was lowest in children aged 15-30 months.
Conclusions:
- Amblyopia is preventable, necessitating a multidisciplinary approach and targeted education for primary care physicians.
- Teachers can play a role in identifying missed cases.
- Treatment intensification and individualization are recommended for children aged 15-30 months due to poorer compliance in this age group.
Aim:
To review presenting ages, referral sources, amblyopia type and treatment compliance in children attending a typical public hospital ophthalmology clinic with no formal amblyopia screening program in place.
Methods:
One hundred and twenty-seven children attending the outpatients clinics of The Children's Hospital at Westmead for amblyopia management between January 2001 and May 2003 were reviewed. Presenting age, amblyopia type, referral source, treatment prescribed and compliance achieved were analysed using means, 95% confidence intervals (CI), and Mantel-Haenszel chi2 statistic.
Results:
General practitioners and paediatricians provided most referrals. The mean presenting age was 32.9 (95% CI 29.0-36.9) months. There was no significant association between presenting age and amblyopia type (chi2 = 6.00, P = 0.11, d.f. = 3), but a trend was found with deprivation amblyopia identified earliest, and pure anisometropic amblyopia identified latest (chi2 = 5.65, P = 0.02, d.f. = 1). Compliance to patching did not differ significantly between sexes, with calculated aggregate compliance of 67.3% (95% CI: 59-75%) for boys and 66.3% (95% CI: 60-73%) for girls. Compliance to patching also did not differ significantly between amblyopia types (chi2 = 3.61, P = 0.3, d.f. = 3). Compliance was best among younger and older children, and worst among those aged 15-30 months. There was no association between patching compliance and treatment duration.
Conclusion:
Amblyopia is a preventable form of blindness. A multidisciplinary approach must be taken. Resources and education should be targeted at general practitioners and paediatricians who have the greatest opportunities to perform amblyopia screening. Teachers are an important resource in identifying cases missed at previous informal screening opportunities. Amblyopia treatment must be intensified and individualized between the ages of 15-30 months when compliance is poorest.