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Jonathan M Holmes - One of the best experts on this subject based on the ideXlab platform.

  • Designing clinical trials for Amblyopia
    Vision Research, 2015
    Co-Authors: Jonathan M Holmes
    Abstract:

    Randomized clinical trial (RCT) study design leads to one of the highest levels of evidence, and is a preferred study design over cohort studies, because randomization reduces bias and maximizes the chance that even unknown confounding factors will be balanced between Treatment groups. Recent randomized clinical trials and observational studies in Amblyopia can be taken together to formulate an evidence-based approach to Amblyopia Treatment, which is presented in this review. When designing future clinical studies of Amblyopia Treatment, issues such as regression to the mean, sample size and trial duration must be considered, since each may impact study results and conclusions.

  • effect of age on response to Amblyopia Treatment in children
    Archives of Ophthalmology, 2011
    Co-Authors: Jonathan M Holmes, Elizabeth L. Lazar, William F Astle, Sean P. Donahue, Michael X Repka, Linda R Dagi, Richard W Hertle, Michele B Melia, Marcela Frazier, Graham E. Quinn
    Abstract:

    Objective To determine whether age at initiation of Treatment for Amblyopia influences the response among children 3 to less than 13 years of age with unilateral Amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. Methods A meta-analysis of individual subject data from 4 recently completed randomized Amblyopia Treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of Amblyopia, prior Amblyopia Treatment, study Treatment, and protocol. Age was categorized (3 to Results Children from 7 to less than 13 years of age were significantly less responsive to Treatment than were younger age groups (children from 3 to Conclusions Amblyopia is more responsive to Treatment among children younger than 7 years of age. Although the average Treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to Treatment.

  • Effect of age on response to Amblyopia Treatment in children
    Archives of Ophthalmology, 2011
    Co-Authors: Jonathan M Holmes, Marcela G. Frazier, Elizabeth L. Lazar, William F Astle, Sean P. Donahue, B.michelle Melia, Michael X Repka, Linda R Dagi, Richard W Hertle, Graham E. Quinn
    Abstract:

    OBJECTIVE To determine whether age at initiation of Treatment for Amblyopia influences the response among children 3 to less than 13 years of age with unilateral Amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. METHODS A meta-analysis of individual subject data from 4 recently completed randomized Amblyopia Treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of Amblyopia, prior Amblyopia Treatment, study Treatment, and protocol. Age was categorized (3 to

  • Evaluating the burden of Amblyopia Treatment from the parent and child’s perspective
    Journal of Aapos, 2010
    Co-Authors: Joost Felius, Marjean Taylor Kulp, Elizabeth L. Lazar, Jonathan M Holmes, Stephen R Cole, Danielle L. Chandler, Michael R. Hill, Kristine Huang, Noelle S. Matta
    Abstract:

    Purpose To evaluate the psychometric properties of the original Parent and new Child Amblyopia Treatment Index (ATI), questionnaires that assess the burden of Amblyopia Treatment in children and families, and to compare scores between children treated with atropine or patching. Methods Parent ATI and Child ATI were administered to 233 children 7 to Results We analyzed the 3 subscales found in prior Parent ATI studies in younger children and confirmed subscales for adverse effects and Treatment compliance, but not for social stigma, in both parent and child versions. Overall and subscale scores on the Parent ATI and Child ATI were moderately to well correlated except for the social stigma subscale. For both the Parent ATI and the Child ATI, children treated with atropine had better scores than those treated with patching, both overall and on Treatment compliance and social stigma subscales (all p values ≤ 0.01). Conclusions When used for children 7 to

  • evaluating the burden of Amblyopia Treatment from the parent and child s perspective
    Journal of Aapos, 2010
    Co-Authors: Joost Felius, Marjean Taylor Kulp, Elizabeth L. Lazar, Jonathan M Holmes, Stephen R Cole, Danielle L. Chandler, Michael R. Hill, Kristine Huang, Noelle S. Matta, Michele Melia
    Abstract:

    Purpose To evaluate the psychometric properties of the original Parent and new Child Amblyopia Treatment Index (ATI), questionnaires that assess the burden of Amblyopia Treatment in children and families, and to compare scores between children treated with atropine or patching. Methods Parent ATI and Child ATI were administered to 233 children 7 to Results We analyzed the 3 subscales found in prior Parent ATI studies in younger children and confirmed subscales for adverse effects and Treatment compliance, but not for social stigma, in both parent and child versions. Overall and subscale scores on the Parent ATI and Child ATI were moderately to well correlated except for the social stigma subscale. For both the Parent ATI and the Child ATI, children treated with atropine had better scores than those treated with patching, both overall and on Treatment compliance and social stigma subscales (all p values ≤ 0.01). Conclusions When used for children 7 to

Richard W Hertle - One of the best experts on this subject based on the ideXlab platform.

  • effect of age on response to Amblyopia Treatment in children
    Archives of Ophthalmology, 2011
    Co-Authors: Jonathan M Holmes, Elizabeth L. Lazar, William F Astle, Sean P. Donahue, Michael X Repka, Linda R Dagi, Richard W Hertle, Michele B Melia, Marcela Frazier, Graham E. Quinn
    Abstract:

    Objective To determine whether age at initiation of Treatment for Amblyopia influences the response among children 3 to less than 13 years of age with unilateral Amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. Methods A meta-analysis of individual subject data from 4 recently completed randomized Amblyopia Treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of Amblyopia, prior Amblyopia Treatment, study Treatment, and protocol. Age was categorized (3 to Results Children from 7 to less than 13 years of age were significantly less responsive to Treatment than were younger age groups (children from 3 to Conclusions Amblyopia is more responsive to Treatment among children younger than 7 years of age. Although the average Treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to Treatment.

  • Effect of age on response to Amblyopia Treatment in children
    Archives of Ophthalmology, 2011
    Co-Authors: Jonathan M Holmes, Marcela G. Frazier, Elizabeth L. Lazar, William F Astle, Sean P. Donahue, B.michelle Melia, Michael X Repka, Linda R Dagi, Richard W Hertle, Graham E. Quinn
    Abstract:

    OBJECTIVE To determine whether age at initiation of Treatment for Amblyopia influences the response among children 3 to less than 13 years of age with unilateral Amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. METHODS A meta-analysis of individual subject data from 4 recently completed randomized Amblyopia Treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of Amblyopia, prior Amblyopia Treatment, study Treatment, and protocol. Age was categorized (3 to

  • stability of visual acuity improvement following discontinuation of Amblyopia Treatment in children aged 7 to 12 years
    Archives of Ophthalmology, 2007
    Co-Authors: Richard W Hertle, Darron A. Bacal, Eileen E Birch, Jonathan M Holmes, Michael X Repka, Roy W Beck, Danielle L. Chandler, Mitchell Scheiman, Deborah L Klimek, David R Weakley
    Abstract:

    OBJECTIVE: To assess the stability of visual acuity improvement during the first year after cessation of Amblyopia Treatment other than spectacle wear in children aged 7 to 12 years. METHODS: At the completion of a multicenter randomized trial during which Amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving Treatment (other than spectacle wear) for 1 year. MAIN OUTCOME MEASURE: Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following Treatment discontinuation. RESULTS: During the year following cessation of Treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting Treatment. CONCLUSION: Visual acuity improvement occurring during Amblyopia Treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing Treatment other than spectacle wear. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00094692.

  • computerized method of visual acuity testing adaptation of the Amblyopia Treatment study visual acuity testing protocol
    American Journal of Ophthalmology, 2001
    Co-Authors: Pamela S Moke, Eileen E Birch, Jonathan M Holmes, Michael X Repka, Roy W Beck, Richard W Hertle, Raymond T Kraker, Andrew Turpin, Joseph M Miller, Chris A Johnson
    Abstract:

    PURPOSE: To report a computerized method for determining visual acuity in children using the Amblyopia Treatment Study visual acuity testing protocol. METHODS: A computerized visual acuity tester was developed that uses a programmed handheld device that uses the Palm operating system (Palm, Inc, Santa Clara, California). The handheld device communicates with a personal computer running a Linux operating system and 17-inch monitor. At a test distance of 3 m, single letters can be displayed from 20/800 to 20/12. A C program on the handheld device runs the Amblyopia Treatment Study visual acuity testing protocol. Using this method, visual acuity was tested in both the right and left eyes, and then the testing was repeated in 156 children age 3 to 7 years at four clinical sites. RESULTS: Test-retest reliability was high (r =.92 and 0.95 for and right and left eyes, respectively), with 88% of right eye retests and 94% of left eye retests within 0.1 logarithm of minimal angle of resolution (logMAR) units of the initial test. The 95% confidence interval for an acuity score was calculated to be the score +/- 0.13 logMAR units. For a change between two acuity scores, the 95% confidence interval was the difference +/- 0.19 logMAR units. CONCLUSIONS: We have developed a computerized method for measurement of visual acuity. Automation of the Amblyopia Treatment Study visual acuity testing protocol is an effective method of testing visual acuity in children 3 to 7 years of age.

  • the Amblyopia Treatment study visual acuity testing protocol
    Archives of Ophthalmology, 2001
    Co-Authors: Jonathan M Holmes, Eileen E Birch, Michael X Repka, Roy W Beck, Pamela S Moke, Raymond T Kraker, David A Leske, Clifford R Blair, Richard A Saunders, Richard W Hertle
    Abstract:

    Objective To evaluate the reliability of a new visual acuity testing protocol for children using isolated surrounded HOTV optotypes. Methods After initial pilot testing and modification, the protocol was evaluated using the Baylor-Video Acuity Tester (BVAT) to present isolated surrounded HOTV optotypes. At 6 sites, the protocol was evaluated for testability in 178 children aged 2 to 7 years and for reliability in a subset of 88 children. Twenty-eight percent of the 178 children were classified as having Amblyopia. Results Using the modified protocol, testability ranged from 24% in 2-year-olds to 96% in 5- to 7-year-olds. Test-retest reliability was high ( r = 0.82), with 93% of retest scores within 0.1 logMAR unit of the initial test score. The 95% confidence interval for an acuity score was calculated to be the score ±0.125 logMAR unit. For a change between 2 acuity scores, the 95% confidence interval was the difference ±0.18 logMAR unit. Conclusions The visual acuity protocol had a high level of testability in 3- to 7-year-olds and excellent test-retest reliability. The protocol has been incorporated into the multicenter Amblyopia Treatment Study and has wide potential application for standardizing visual acuity testing in children.

Eileen E Birch - One of the best experts on this subject based on the ideXlab platform.

  • Baseline and Clinical Factors Associated with Response to Amblyopia Treatment in a Randomized Clinical Trial.
    Optometry and Vision Science, 2020
    Co-Authors: Eileen E Birch, Reed M. Jost, Krista R. Kelly, Joel N. Leffler, Cynthia L. Beauchamp
    Abstract:

    SIGNIFICANCE We sought to identify baseline and clinical factors that were predictive of the response to Amblyopia Treatment. We report that binocular Amblyopia Treatment may be especially effective for moderate Amblyopia in orthotropic children. PURPOSE We previously reported results from the primary cohort (n = 28) enrolled in a randomized clinical trial (NCT02365090), which found that binocular Amblyopia Treatment was more effective than patching. Enrollment of an additional 20 children was pre-planned to provide the opportunity to examine factors that may be predictive of response to Amblyopia Treatment. METHODS Forty-eight children (4 to 10 years old) were enrolled, with 24 randomized to contrast-rebalanced binocular game Treatment (1 hour a day, 5 days a week) and 24 to patching Treatment (2 hours a day, 7 days a week). The primary outcome was change in amblyopic eye best-corrected visual acuity at the 2-week visit. Baseline factors examined were age at enrollment, visual acuity, stereoacuity, and suppression. Clinical factors were etiology, age at diagnosis, prior Treatment, and ocular alignment. RESULTS At 2 weeks, visual acuity improvement was significantly greater with the binocular game than patching. Children with moderate Amblyopia and orthotropia had more visual acuity improvement with binocular game play than did those with severe Amblyopia. In addition, children who spent more time playing the binocular game had more improvement. We were not able to confidently identify any baseline or clinical factors that were associated with response to patching Treatment. CONCLUSIONS Binocular Amblyopia Treatment was more effective among orthotropic children with moderate Amblyopia than among children with microtropia or severe Amblyopia.

  • Binocular Amblyopia Treatment with contrast-rebalanced movies
    Journal of Aapos, 2019
    Co-Authors: Eileen E Birch, Reed M. Jost, Krista R. Kelly, Cynthia L. Beauchamp, Angie De La Cruz, David R. Stager, Joel N. Leffler
    Abstract:

    Background Binocular Amblyopia Treatments promote visual acuity recovery and binocularity by rebalancing the signal strength of dichoptic images. Most require active participation by the amblyopic child to play a game or perform a repetitive visual task. The purpose of this study was to investigate a passive form of binocular Treatment with contrast-rebalanced dichoptic movies. Methods A total of 27 amblyopic children, 4-10 years of age, wore polarized glasses to watch 6 contrast-rebalanced dichoptic movies on a passive 3D display during a 2-week period. Amblyopic eye contrast was 100%; fellow eye contrast was initially set to a lower level (20%-60%), which allowed the child to overcome suppression and use binocular vision. Fellow eye contrast was incremented by 10% for each subsequent movie. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and at 2 weeks. Results Amblyopic eye best-corrected visual acuity improved from 0.57 ± 0.22 at baseline to 0.42 ± 0.23 logMAR (t26 = 8.09; P  Conclusions In this cohort, passive viewing of contrast-rebalanced dichoptic movies effectively improved visual acuity in amblyopic subjects. The degree of improvement observed was similar to that previously reported for 2 weeks of binocular games Treatment and with 3-4 months of occlusion therapy.

  • comparison of the Amblyopia Treatment study hotv and the electronic early Treatment of diabetic retinopathy study visual acuity protocols in amblyopic children aged 5 to 11 years
    Journal of Aapos, 2009
    Co-Authors: Eileen E Birch, Roy W Beck, Samara F Strauber, Jonathan M Holmes
    Abstract:

    As part of the long-term follow-up of amblyopic children who were enrolled in the Amblyopia Treatment Study, we tested visual acuity in both eyes of 142 patients by using 2 established visual acuity protocols, the Amblyopia Treatment Study HOTV (ATS HOTV) visual acuity protocol and the Electronic-Early Treatment of Diabetic Retinopathy Study (E-ETDRS) protocol, at one of the annual visits. Mean age at the time of testing was 9.0 years (range, 5.6-11.9 years). The ATS-HOTV protocol resulted in a slight mean overestimate of visual acuity relative to the E-ETDRS protocol (0.68 lines for amblyopic eyes; 0.25 lines for fellow eyes). The overestimation occurred primarily when the E-ETDRS visual acuity was poorer than 0.3 logMAR. ATS-HOTV acuity also underestimated interocular visual acuity differences by 0.42 lines. When one uses the ATS-HOTV protocol, it may be wise to exercise caution when interpreting "near-normal" visual acuity or interocular differences as "within normal" because the ATS-HOTV method may have a slight bias toward better performance of amblyopic eyes than E-ETDRS.

  • normative pediatric visual acuity using single surrounded hotv optotypes on the electronic visual acuity tester following the Amblyopia Treatment study protocol
    Journal of Aapos, 2008
    Co-Authors: James R Drover, Lauren M Wyatt, Christina S Cheng, Joost Felius, Sarah E Morale, Eileen E Birch
    Abstract:

    Purpose To provide normative pediatric visual acuity data using HOTV optotypes presented on the Electronic Visual Acuity Tester following the Amblyopia Treatment Study (ATS) protocol. Methods Monocular testing was conducted on 384 healthy full-term children ranging from 3 to 10 years of age (mean, 5.4 years; SD, 1.8 years). A total of 373 children completed monocular testing of each eye. In addition, 23 adults (mean, 28.7 years; SD, 4.9 years) were tested for comparison. Both monocular visual acuity and interocular acuity differences were recorded. Results Mean visual acuity improved by slightly more than one line (0.12 logMAR) from 3 years of age to adulthood, increasing from 0.08 logMAR to −0.04 logMAR ( F 6,400 = 26.3, p −26 ). At all ages, mean interocular acuity difference was less than one line on a standard acuity chart (overall mean difference=0.04 logMAR; SD, 0.06 logMAR). Conclusions These results represent the first normative data reported for HOTV optotypes using the ATS protocol on the Electronic Visual Acuity Tester. These data may play an important role in clinical practice, screening, and clinical research.

  • stability of visual acuity improvement following discontinuation of Amblyopia Treatment in children aged 7 to 12 years
    Archives of Ophthalmology, 2007
    Co-Authors: Richard W Hertle, Darron A. Bacal, Eileen E Birch, Jonathan M Holmes, Michael X Repka, Roy W Beck, Danielle L. Chandler, Mitchell Scheiman, Deborah L Klimek, David R Weakley
    Abstract:

    OBJECTIVE: To assess the stability of visual acuity improvement during the first year after cessation of Amblyopia Treatment other than spectacle wear in children aged 7 to 12 years. METHODS: At the completion of a multicenter randomized trial during which Amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving Treatment (other than spectacle wear) for 1 year. MAIN OUTCOME MEASURE: Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following Treatment discontinuation. RESULTS: During the year following cessation of Treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting Treatment. CONCLUSION: Visual acuity improvement occurring during Amblyopia Treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing Treatment other than spectacle wear. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00094692.

Roy W Beck - One of the best experts on this subject based on the ideXlab platform.

  • comparison of the Amblyopia Treatment study hotv and the electronic early Treatment of diabetic retinopathy study visual acuity protocols in amblyopic children aged 5 to 11 years
    Journal of Aapos, 2009
    Co-Authors: Eileen E Birch, Roy W Beck, Samara F Strauber, Jonathan M Holmes
    Abstract:

    As part of the long-term follow-up of amblyopic children who were enrolled in the Amblyopia Treatment Study, we tested visual acuity in both eyes of 142 patients by using 2 established visual acuity protocols, the Amblyopia Treatment Study HOTV (ATS HOTV) visual acuity protocol and the Electronic-Early Treatment of Diabetic Retinopathy Study (E-ETDRS) protocol, at one of the annual visits. Mean age at the time of testing was 9.0 years (range, 5.6-11.9 years). The ATS-HOTV protocol resulted in a slight mean overestimate of visual acuity relative to the E-ETDRS protocol (0.68 lines for amblyopic eyes; 0.25 lines for fellow eyes). The overestimation occurred primarily when the E-ETDRS visual acuity was poorer than 0.3 logMAR. ATS-HOTV acuity also underestimated interocular visual acuity differences by 0.42 lines. When one uses the ATS-HOTV protocol, it may be wise to exercise caution when interpreting "near-normal" visual acuity or interocular differences as "within normal" because the ATS-HOTV method may have a slight bias toward better performance of amblyopic eyes than E-ETDRS.

  • stability of visual acuity improvement following discontinuation of Amblyopia Treatment in children aged 7 to 12 years
    Archives of Ophthalmology, 2007
    Co-Authors: Richard W Hertle, Darron A. Bacal, Eileen E Birch, Jonathan M Holmes, Michael X Repka, Roy W Beck, Danielle L. Chandler, Mitchell Scheiman, Deborah L Klimek, David R Weakley
    Abstract:

    OBJECTIVE: To assess the stability of visual acuity improvement during the first year after cessation of Amblyopia Treatment other than spectacle wear in children aged 7 to 12 years. METHODS: At the completion of a multicenter randomized trial during which Amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving Treatment (other than spectacle wear) for 1 year. MAIN OUTCOME MEASURE: Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following Treatment discontinuation. RESULTS: During the year following cessation of Treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting Treatment. CONCLUSION: Visual acuity improvement occurring during Amblyopia Treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing Treatment other than spectacle wear. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00094692.

  • impact of patching and atropine Treatment on the child and family in the Amblyopia Treatment study
    Archives of Ophthalmology, 2003
    Co-Authors: Jonathan M Holmes, Joost Felius, Eileen E Birch, Michael X Repka, Roy W Beck, Stephen R Cole, Raymond T Kraker, Stephen P Christiansen, David K Coats, Marjean Taylor Kulp
    Abstract:

    OBJECTIVE: To assess the psychosocial impact on the child and family of patching and atropine as Treatments for moderate Amblyopia in children younger than 7 years. METHODS: In a randomized, controlled clinical trial, 419 children younger than 7 years with amblyopic eye visual acuity in the range of 20/40 to 20/100 were assigned to receive Treatment with either patching or atropine at 47 clinical sites. After 5 weeks of Treatment, a parental quality-of-life questionnaire was completed for 364 (87%) of the 419 patients. Main Outcome Measure Overall and subscale scores on the Amblyopia Treatment Index. RESULTS: High internal validity and reliability were demonstrated for the Amblyopia Treatment Index questionnaire. The overall Amblyopia Treatment Index scores and the 3 subscale scores were consistently higher (worse) in the patching group compared with the atropine-treated group (overall mean, 2.52 vs 2.02, P<.001; adverse effects of Treatment: mean, 2.35 vs 2.11, P =.002; difficulty with compliance: mean, 2.46 vs 1.99, P<.001; and social stigma: mean, 3.09 vs 1.84, P<.001, respectively). CONCLUSION: Although the Amblyopia Treatment Index questionnaire results indicated that both atropine and patching Treatments were well tolerated by the child and family, atropine received more favorable scores overall and on all 3 questionnaire subscales.

  • Impact of patching and atropine Treatment on the child and family in the Amblyopia Treatment study.
    Archives of Ophthalmology, 2003
    Co-Authors: Jonathan M Holmes, Joost Felius, Eileen E Birch, Michael X Repka, Roy W Beck, Stephen R Cole, Raymond T Kraker, Stephen P Christiansen, David K Coats, Marjean Taylor Kulp
    Abstract:

    OBJECTIVE: To assess the psychosocial impact on the child and family of patching and atropine as Treatments for moderate Amblyopia in children younger than 7 years. METHODS: In a randomized, controlled clinical trial, 419 children younger than 7 years with amblyopic eye visual acuity in the range of 20/40 to 20/100 were assigned to receive Treatment with either patching or atropine at 47 clinical sites. After 5 weeks of Treatment, a parental quality-of-life questionnaire was completed for 364 (87%) of the 419 patients. Main Outcome Measure Overall and subscale scores on the Amblyopia Treatment Index. RESULTS: High internal validity and reliability were demonstrated for the Amblyopia Treatment Index questionnaire. The overall Amblyopia Treatment Index scores and the 3 subscale scores were consistently higher (worse) in the patching group compared with the atropine-treated group (overall mean, 2.52 vs 2.02, P

  • The course of moderate Amblyopia treated with atropine in children: Experience of the Amblyopia Treatment study
    American Journal of Ophthalmology, 2003
    Co-Authors: Roy W Beck
    Abstract:

    PURPOSE: To assess the course of the response to atropine Treatment of moderate Amblyopia and to assess factors predictive of the Treatment response in children 3 years old to younger than 7 years old. DESIGN: Multicenter, randomized clinical trial comparing atropine and patching (one of the Amblyopia Treatment studies). METHODS: A total of 195 children 3 years old to younger than 7 years of age with Amblyopia in the range of 20/40 to 20/100 from the atropine Treatment arm of this trial were enrolled and included in this analysis. At baseline, daily topical atropine was prescribed for the sound eye. During follow-up, a plano spectacle lens was prescribed for the sound eye for patients whose Amblyopia had not been successfully treated with atropine alone. Follow-up examinations were performed at 5 weeks, 16 weeks, and 6 months. The primary outcome measure was visual acuity in the amblyopic eye at 6 months. RESULTS: Mean visual acuity improved from baseline by 1.3 lines after 5 weeks of Treatment, by 2.4 lines after 16 weeks, and by 2.8 lines at 6 months. Visual acuity of 20/30 or better and/or 3 or more lines of improvement from baseline was achieved by 75% of the patients. Improvement occurred over the entire range of baseline acuities (20/40 to 20/100) and was not related to patient age (P = .36). Among the 134 patients improving 3 or more lines from baseline, 7% achieved their maximum improvement by 5 weeks and 46% by 16 weeks. Among the 55 patients who did not respond adequately to atropine alone and were prescribed a plano lens for the sound eye, the mean improvement before the use of the plano lens was 1.0 lines, compared with 1.6 lines after prescribing the plano lens (P = .11). None of the demographic or clinical factors assessed was predictive of the response to Treatment. A shift in fixation preference at/near from the atropinized sound eye to the amblyopic eye was not required for the amblyopic eye to improve; amblyopic eye acuity improved 3 or more lines in 29 (60%) of the 48 patients who were found to be using the atropinized sound eye on fixation preference testing. A 2 or more line decrease in sound eye visual acuity occurred more frequently when a plano lens was prescribed in addition to atropine (7 of 43, 16%) compared with Treatment with atropine alone (4 of 123, 3%; P = .01). CONCLUSIONS: A beneficial effect of atropine is present throughout the age range of 3 years old to younger than 7 years old, and with an acuity range of 20/40 to 20/100. A shift in near fixation to the amblyopic eye is not essential for atropine to be effective in all cases. Sound eye acuity should be monitored when a plano spectacle lens is prescribed for the sound eye to augment the Treatment effect of atropine. © 2003 by Elsevier Inc. All rights reserved.

Michael X Repka - One of the best experts on this subject based on the ideXlab platform.

  • Amblyopia Treatment 2009
    Essentials in Ophthalmology, 2020
    Co-Authors: Michael X Repka
    Abstract:

    Wearing optimum refractive correction before initiation of patching or other Amblyopia therapy is associated with improvement in Amblyopia in about three quarters of children and a cure in about one fourth. This improvement may facilitate subsequent Treatment. For initial therapy of moderate anisometropic and strabismic Amblyopia among children 3–7 years of age, patching and atropine are equivalent. Atropine is slightly more acceptable than patching on the basis of parental questioning. For initial therapy of moderate Amblyopia, 2 h of daily patching or twice weekly topical atropine administered to the sound eye are equally effective. For initial therapy of severe Amblyopia for children 3 to less than 7 years of age, 6 h of daily patching and full-time patching appear to be equally effective. Amblyopia therapy can be beneficial for older children up to 17 years of age, especially if they have not been previously treated. There have not been any studies to date which demonstrate the best therapy for patients with residual Amblyopia following initial therapy. There are also no studies that have identified the best Treatments for deprivation Amblyopia.

  • effect of age on response to Amblyopia Treatment in children
    Archives of Ophthalmology, 2011
    Co-Authors: Jonathan M Holmes, Elizabeth L. Lazar, William F Astle, Sean P. Donahue, Michael X Repka, Linda R Dagi, Richard W Hertle, Michele B Melia, Marcela Frazier, Graham E. Quinn
    Abstract:

    Objective To determine whether age at initiation of Treatment for Amblyopia influences the response among children 3 to less than 13 years of age with unilateral Amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. Methods A meta-analysis of individual subject data from 4 recently completed randomized Amblyopia Treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of Amblyopia, prior Amblyopia Treatment, study Treatment, and protocol. Age was categorized (3 to Results Children from 7 to less than 13 years of age were significantly less responsive to Treatment than were younger age groups (children from 3 to Conclusions Amblyopia is more responsive to Treatment among children younger than 7 years of age. Although the average Treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to Treatment.

  • Effect of age on response to Amblyopia Treatment in children
    Archives of Ophthalmology, 2011
    Co-Authors: Jonathan M Holmes, Marcela G. Frazier, Elizabeth L. Lazar, William F Astle, Sean P. Donahue, B.michelle Melia, Michael X Repka, Linda R Dagi, Richard W Hertle, Graham E. Quinn
    Abstract:

    OBJECTIVE To determine whether age at initiation of Treatment for Amblyopia influences the response among children 3 to less than 13 years of age with unilateral Amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity. METHODS A meta-analysis of individual subject data from 4 recently completed randomized Amblyopia Treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of Amblyopia, prior Amblyopia Treatment, study Treatment, and protocol. Age was categorized (3 to

  • stability of visual acuity improvement following discontinuation of Amblyopia Treatment in children aged 7 to 12 years
    Archives of Ophthalmology, 2007
    Co-Authors: Richard W Hertle, Darron A. Bacal, Eileen E Birch, Jonathan M Holmes, Michael X Repka, Roy W Beck, Danielle L. Chandler, Mitchell Scheiman, Deborah L Klimek, David R Weakley
    Abstract:

    OBJECTIVE: To assess the stability of visual acuity improvement during the first year after cessation of Amblyopia Treatment other than spectacle wear in children aged 7 to 12 years. METHODS: At the completion of a multicenter randomized trial during which Amblyopia treated with patching and atropine improved by at least 2 lines on the electronic Early Treatment of Diabetic Retinopathy Study testing protocol, 80 patients aged 7 to 12 years were followed up while not receiving Treatment (other than spectacle wear) for 1 year. MAIN OUTCOME MEASURE: Ten letters or more (> or =2 lines) worsening of visual acuity (measured using the electronic Early Treatment of Diabetic Retinopathy Study testing protocol) during the year following Treatment discontinuation. RESULTS: During the year following cessation of Treatment, the cumulative probability of worsening visual acuity (> or =2 lines) was 7% (95% confidence interval, 3%-17%); 82% of patients maintained an increase in visual acuity of 10 letters or more compared with their visual acuity before starting Treatment. CONCLUSION: Visual acuity improvement occurring during Amblyopia Treatment is sustained in most children aged 7 to 12 years for at least 1 year after discontinuing Treatment other than spectacle wear. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00094692.

  • impact of patching and atropine Treatment on the child and family in the Amblyopia Treatment study
    Archives of Ophthalmology, 2003
    Co-Authors: Jonathan M Holmes, Joost Felius, Eileen E Birch, Michael X Repka, Roy W Beck, Stephen R Cole, Raymond T Kraker, Stephen P Christiansen, David K Coats, Marjean Taylor Kulp
    Abstract:

    OBJECTIVE: To assess the psychosocial impact on the child and family of patching and atropine as Treatments for moderate Amblyopia in children younger than 7 years. METHODS: In a randomized, controlled clinical trial, 419 children younger than 7 years with amblyopic eye visual acuity in the range of 20/40 to 20/100 were assigned to receive Treatment with either patching or atropine at 47 clinical sites. After 5 weeks of Treatment, a parental quality-of-life questionnaire was completed for 364 (87%) of the 419 patients. Main Outcome Measure Overall and subscale scores on the Amblyopia Treatment Index. RESULTS: High internal validity and reliability were demonstrated for the Amblyopia Treatment Index questionnaire. The overall Amblyopia Treatment Index scores and the 3 subscale scores were consistently higher (worse) in the patching group compared with the atropine-treated group (overall mean, 2.52 vs 2.02, P<.001; adverse effects of Treatment: mean, 2.35 vs 2.11, P =.002; difficulty with compliance: mean, 2.46 vs 1.99, P<.001; and social stigma: mean, 3.09 vs 1.84, P<.001, respectively). CONCLUSION: Although the Amblyopia Treatment Index questionnaire results indicated that both atropine and patching Treatments were well tolerated by the child and family, atropine received more favorable scores overall and on all 3 questionnaire subscales.