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Clinical translation of recommendations from randomized clinical trials on patching regimen for amblyopia
Ya-Ping Jin1, Amy H Y Chow, Linda Colpa
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada. Yaping.Jin@utoronto.ca
Insights
Evidence-based amblyopia treatment guidelines are not widely used in clinical practice. This study found that prescribed patching hours often deviate from recommendations, impacting treatment effectiveness.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Evidence-Based Medicine
Background:
- The Pediatric Eye Disease Investigator Group (PEDIG) developed evidence-based recommendations for amblyopia treatment.
- Translating research findings into clinical practice is crucial for effective patient care.
- Amblyopia, or "lazy eye," requires timely and appropriate intervention for optimal visual development.
Purpose of the Study:
- To assess the implementation of PEDIG's evidence-based amblyopia treatment recommendations into clinical practice.
- To identify barriers and necessary steps for effective knowledge translation in pediatric ophthalmology.
Main Methods:
- Retrospective cohort study of children with amblyopia treated between 2007-2009.
- Data collected from academic and community ophthalmologists in a major North American urban center.
- Analysis included prescribed patching hours and visual acuity outcomes (logMAR) compared to PEDIG criteria.
Main Results:
- For moderate amblyopia, prescribed patching (mean 3.2 hours) was significantly longer than the recommended 2 hours; only 24% adhered to recommendations.
- For severe amblyopia, prescribed patching (mean 3.9 hours) was significantly shorter than the recommended 6 hours; only 12% adhered to recommendations.
- Visual acuity outcomes in the cohort were comparable to those in the PEDIG trials, despite deviations in patching protocols.
Conclusions:
- PEDIG's evidence-based amblyopia treatment guidelines have not been widely adopted in this large urban center.
- While there's a trend towards reduced patching duration, actual implementation of recommended hours remains low.
- The Knowledge-to-Action Cycle framework is discussed to guide the implementation of evidence-based practices.
Purpose:
To investigate whether the evidence-based recommendations by the Pediatric Eye Disease Investigator Group (PEDIG) as initial treatment of amblyopia have been implemented into clinical practice and to discuss the necessary steps in translating evidence-based knowledge to inform clinical decision making.
Design:
Retrospective cohort study.
Participants:
Children with amblyopia seen from 2007 through 2009 by academic and community ophthalmologists in a large urban center in North America that serves a population of more than 8 million. Using PEDIG criteria, moderate amblyopia was defined as visual acuity between 20/40 and 20/80 and severe amblyopia was defined as visual acuity between 20/100 and 20/400.
Intervention:
Patching of the sound eye.
Main Outcome Measures:
The number of prescribed patching hours daily and the amblyopic eye visual acuity expressed as logarithm of the minimum angle of resolution (logMAR).
Results:
For moderate amblyopia, the cohort (n = 71) was prescribed a mean of 3.2 hours of daily patching (95% confidence interval [CI]: 2.8-3.6 hours), which is significantly greater than the recommended 2 hours of daily patching for initial treatment. Only 24% (95% CI, 16%-35%) of them were prescribed the recommended initial patching hours. The amblyopic eye acuity on the 3- to 6-month visit in the cohort (0.23 logMAR) was similar to that of the 4-month visit in the PEDIG cohort (0.24 logMAR; P = 0.74). For severe amblyopia, the cohort (n = 52) was prescribed a mean of 3.9 hours of daily patching (95% CI, 3.5-4.3 hours), which is significantly lower than the recommended 6 hours of daily patching for initial treatment. Only 12% (95% CI, 5%-23%) of them were prescribed the recommended initial patching hours. The amblyopic eye acuity at the 7- to 12-month visit in the cohort (0.44 logMAR) was comparable with that of the 4-month visit in the PEDIG cohort (0.40 logMAR; P = 0.35).
Conclusions:
The evidence-based recommendations for amblyopia management have not been translated widely into changes in clinical practice in a large urban center in North America, although there is a general move from full-time to part-time patching since the PEDIG results were published. Using a well-established framework for knowledge translation, the Knowledge-to-Action Cycle, the necessary steps required to implement new knowledge into actual clinical practice are discussed.
