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Updated: Mar 14, 2026
The Measurement and Treatment of Suppression in Amblyopia
Published on: December 14, 2012
The role of feedback in amblyopia treatment - a multi-centre randomised control trial
Gail D E Maconachie1,2, Michael Hisaund3, Seema Teli3
1The University of Leicester Ulverscroft Eye Unit, Department of Psychology and Visual Sciences, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK. g.d.maconachie@sheffield.ac.uk.
Insights
Electronically monitored feedback did not improve amblyopia treatment adherence in children. However, awareness of monitoring and frequent contact led to high adherence, emphasizing early intervention for better visual outcomes.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Clinical Trials
Background:
- Amblyopia treatment, often using conventional occlusion, faces significant adherence challenges.
- This study pioneers the investigation of electronically monitored adherence feedback in a randomized controlled trial (RCT) to address this barrier.
Purpose of the Study:
- To evaluate the efficacy of objective, electronically monitored adherence feedback in improving treatment adherence for amblyopia.
- To identify factors influencing visual outcomes and adherence in pediatric amblyopia patients.
Main Methods:
- A multicenter, two-armed RCT involving 102 children (3-8 years) with monocular amblyopia.
- Participants were randomized to receive adherence feedback or serve as controls, with patching and glasses adherence monitored over 12 weeks.
Main Results:
- No significant difference in patching or glasses adherence was found between the feedback and control groups.
- High overall adherence to glasses (10.3 h/day) and patching (7.9 h/day) was observed.
- Younger age, less prior patching, and higher adherence correlated with better visual outcomes; females showed lower glasses adherence.
Conclusions:
- While feedback did not directly enhance adherence, awareness of monitoring and frequent patient-clinician contact promoted high, sustained adherence.
- The findings underscore the critical importance of early treatment and consistent adherence for achieving optimal visual outcomes in amblyopia.
- This study demonstrates the feasibility of monitoring patching and glasses adherence in pediatric amblyopia patients.
Background:
Conventional occlusion is an effective treatment for amblyopia; however, adherence remains a significant barrier. This is the first randomised controlled trial (RCT) investigating whether objective, electronically monitored adherence "feedback" improves amblyopia treatment adherence.
Methods:
This unmasked, parallel two-armed multicentre RCT included 102 children aged 3-8 yrs with monocular amblyopia (≥0.3 logMAR interocular difference). Participants could have up to 18 months of previous patching and were prescribed 10 h/6days of patching. Participants were randomised to a Feedback Group (n = 51), receiving feedback from treatment monitors, or Controls (n = 51). Change in adherence (CA) was measured from the first to last available monitor for patching and glasses over 12 weeks. Regression models explored factors influencing visual outcome and adherence.
Results:
Of 102 participants, 74 were analysed for patching and 78 for glasses. Mean patching CA was -0.39 ± 2.01 h/day (control) versus -0.32 ± 2.20 h/day (feedback), with no significant group difference (P = 0.89). Median glasses-wearing CA was -0.55 IQR:2.55 h/day (control) vs. -0.05 IQR:1.73 h/day (feedback), also non-significant (P = 0.38). Overall average adherence to glasses was 10.3 h/day and 7.9 h/day for patching. Younger age, less previous patching, and higher adherence to treatment significantly predicted better visual outcome. Females had significantly lower glasses-wearing adherence.
Conclusion:
This study shows for the first time that patching and glasses adherence can be monitored and fed back to patients and their carers. While we found no additional influence of feedback on adherence, we observed that when children and their guardians were aware of active monitoring and frequently seen, we observed high and sustained levels of adherence. The significant correlations to visual outcomes further highlight the importance of early treatment in amblyopia.
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