Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia

Moses Kim; Mi Young Choi

doi:10.3341/jkos.2015.56.2.254

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Kim and Choi: Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia

Original Article

J Korean Ophthalmol Soc 2015;56(2):254-262.

Published online: 6 September 2015

DOI: https://doi.org/10.3341/jkos.2015.56.2.254

Comparison of Results after Daily Patching and Alternate-Day Patching to Treat Amblyopia

Moses Kim, MD, Mi Young Choi, MD, PhD

Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea

Address reprint requests to Mi Young Choi, MD, PhD, Department of Ophthalmology, Chungbuk National University Hospital, #776 1Sunhwan-ro, Seowon-gu, Cheongju 362-711, Korea, Tel: 82-43-269-6335, Fax: 82-43-264-5263 E-mail: mychoi@chungbuk.ac.kr

Received 1 May 201417 June 2014 Accepted 28 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We compared the results of daily patching and alternate-day patching to treat amblyopia.

Methods

Patients with difference in the visual acuity (VA) between the eyes of at least two lines were prescribed spectacles according to the result of cycloplegic refraction. After 4 months, 45 patients with confirmed amblyopia were randomly assigned to daily patching or alternate-day patching group. Patients were patched daily in the daily patching group (n = 24), and patched every other day in another group. The patching time was 2-6 hours according to the VA of the amblyopic eye. The parents were asked to mark on a calendar whether their child performed occlusion or not. The main outcome measure was the mean VA of amblyopic eye and compliance of occlusion after 1, 3, 6 and 9 months. The success of treatment was defined if difference of VA between the eyes was less than or equal to 1 line.

Results

There was no significant difference between the two groups in age, type of amblyopia, VA of the amblyopic eye and total treatment duration. VA of the amblyopic eye was significantly improved at 1 month after occlusion in both groups. At the final visit in both groups, the number of improved VA lines in the amblyopic eye (3.8 lines:3.7 lines, p = 0.754), the final success rate (50.0%:81.0%, p = 0.060) and the compliance of occlusion (94.5%:96.3%, p = 0.803) were not different significantly, but VA of the amblyopic eye (0.2 log MAR:0.1 log MAR, p = 0.042) was better in the alternate-day patching group than that in another group.

Conclusions

There was no difference in the number of improved VA lines in the amblyopic eye, nor were there differences in success rate and compliance of occlusion between the two groups. The final VA was better in the alternate-day patching group than another group. Therefore, the alternate-day patching method is another possible option for the treatment of amblyopia.

Keywords: Alternate-day patching, Amblyopia, Daily patching

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Table 1.

Basic characteristics according to treatment group

	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value
Age (years)	4.5 ± 1.1	5.0 ± 1.7	0.683^∗
<5 (n, %)	11 (45.8)	11 (52.4)	0.398^†
5 ≤ ~ < 7 (n, %)	13 (54.2)	5 (23.8)
7 ≤ ~ < 10 (n, %)	0 (0.0)	5 (23.8)
Sex (n, %)			0.936^‡
Male	10 (41.7)	9 (42.9)
Female	14 (58.3)	12 (57.1)
Initial visual acuity (log MAR)
Amblyopic eye	0.8 ± 0.4	0.6 ± 0.2	0.077^∗
Better eye	0.1 ± 0.2	0.1 ± 0.1	0.346^∗
Depth of amblyopia (n, %)			0.113^†
Severe	8 (33.3)	4 (19.0)
Moderate	11 (45.9)	8 (38.1)
Mild	5 (20.8)	9 (42.9)
Cause of amblyopia (n, %)			0.360^†
Strabismus	2 (8.3)	3 (14.3)
Anisometropia	15 (62.5)	14 (66.7)
Combined	7 (29.2)	4 (19.0)
Binocularity index (score)	3.2 ± 0.6	3.1 ± 0.7	1.000^∗
Duration of treatment (months)	4.7 ± 3.2	4.9 ± 2.5	0.623^∗
Follow-up (months)	6.0 ± 3.4	6.6 ± 2.5	0.809^∗

Values are presented as mean ± SD unless otherwise indicated.

^∗ Mann-Whitney U test; † Linear by linear test

^‡ Pearson’s chisquare test.

Table 2.

Types of amblyopia in each group

	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value
Strabismus (n)
Esotropia	2	1	0.400^∗
Exotropia	0	2
Anisometropia (n)
Hypermetropia	10	8	0.419^†
Myopia	3	2
Astigmatism	2	4
Combined (n)	7	4	0.503^∗

^∗ Fisher’s exact test

^† Linear by linear test.

Table 3.

Treatment effect in each group (visual acuity)

Follow-up period	Visual acuity of amblyopic eye (log MAR)				p-value^‡
Follow-up period	Daily-patching group (n = 24)	p-value^∗	Alternate-day patching group (n = 21)	p-value^†	p-value^‡
At baseline	0.5 ± 0.4		0.4 ± 0.2		0.051
1 month	0.3 ± 0.3	0.000	0.2 ± 0.2	0.001	0.129
3 months	0.2 ± 0.2	0.000	0.1 ± 0.1	0.000	0.050
6 months	0.2 ± 0.2	0.001	0.1 ± 0.1	0.000	0.075
9 months	0.2 ± 0.2	0.002	0.1 ± 0.2	0.007	0.671
At last	0.2 ± 0.2	0.000	0.1 ± 0.1	0.000	0.042

Values are presented as mean ± SD.

^∗ p-value of visual acuity at each follow-up period comparing to baseline visual acuity in daily-patching group, Wilcoxon matched – pairs signed-ranks test

^† p-value of visual acuity at each follow-up period comparing to baseline visual acuity in alternate-day patching group, Wilcoxon matched – pairs signed-ranks test

^‡ p-value of visual acuity at each follow-up period in daily-patching group and alternate-day patching group, Mann-Whitney U test.

Table 4.

Treatment effect according to the number of improved lines in each group

Follow-up period	No. of lines of improvement		p-value^∗
Follow-up period	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value^∗
1 month	2.0 ± 1.7	2.0 ± 1.4	0.935
3 months	3.3 ± 1.9	3.4 ± 1.5	0.931
6 months	3.9 ± 1.4	3.9 ± 1.6	0.639
9 months	4.7 ± 1.6	3.7 ± 1.0	0.146
At last	3.8 ± 2.2	3.7 ± 1.7	0.754

Values are presented as mean ± SD.

^∗ Mann-Whitney U test.

Table 5.

The compliance of occlusion therapy

Follow-up period	Occlusion rate (%)		p-value^∗
Follow-up period	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value^∗
1 month	82.2 ± 27.6	91.3 ± 21.7	0.115
3 months	90.7 ± 22.7	96.8 ± 8.5	0.177
6 months	96.3 ± 7.9	94.3 ± 8.4	0.295
9 months	97.1 ± 4.9	95.4 ± 7.6	0.590
At last	94.5 ± 9.1	96.3 ± 6.6	0.803

Values are presented as mean ± SD.

^∗ Mann-Whitney U test.

Table 6.

Occlusion rate according to occlusion time at post-treatment one month

Occlusion time	Occlusion rate (%)		p-value^∗
Occlusion time	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value^∗
2 hours	74.1 ± 0.0	-	-
3 hours	92.3 ± 10.3	98.0 ± 2.8	0.374
4 hours	100.0 ± 0.0	-	-
6 hours	89.7 ± 13.0	92.0 ± 9.1	0.973
p-value^†	0.287	0.046

Values are presented as mean ± SD.

^∗ p-value of occlusion rate between daily-patching and alternate-day patching group at each occlusion time, Mann-Whitney U test

^† p-value of occlusion rate among occlusion time at each patching group, Kruskal-Wallis test.

Table 7.

Occlusion rate according to occlusion time at post-treatment three month

Occlusion time	Occlusion rate (%)		p-value^∗
Occlusion time	Daily-patching group (n = 19)	Alternate-day patching group (n = 20)	p-value^∗
2 hours	100.0 ± 0.0	100.0 ± 0.0	1.000
3 hours	95.6 ± 6.4	98.9 ± 2.0	0.186
4 hours	-	-	-
6 hours	96.1 ± 5.8	91.5 ± 14.7	0.836
p-value^†	0.652	0.350

Values are presented as mean ± SD.

^∗ p-value of occlusion rate between daily-patching and alternate-day patching group at each occlusion time, Mann-Whitney U test

^† p-value of occlusion rate among occlusion time at each patching group, Kruskal-Wallis test.

Table 8.

Occlusion rate according to occlusion time at post-treatment six month

Occlusion time	Occlusion rate (%)		p-value^∗
Occlusion time	Daily-patching group (n = 9)	Alternate-day patching group (n = 10)	p-value^∗
2 hours	-	-	-
3 hours	89.7 ± 11.6	91.9 ± 9.8	0.876
4 hours	-	100.0 ± 0.0	-
6 hours	99.2 ± 1.7	91.7 ± 2.3	0.133
p-value^†	0.180	0.457

Values are presented as mean ± SD.

^∗ p-value of occlusion rate between daily-patching and alternate-day patching group at each occlusion time, Mann-Whitney U test

^† p-value of occlusion rate among occlusion time at each patching group, Kruskal-Wallis test.

Table 9.

Occlusion rate according to occlusion time at post-treatment nine month

Occlusion time	Occlusion rate (%)		p-value^∗
Occlusion time	Daily-patching group (n = 6)	Alternate-day patching group (n = 4)	p-value^∗
2 hours	-	-	-
3 hours	95.6 ± 7.7	86.1 ± 11.8	0.400
4 hours	-	-	-
6 hours	96.7 ± 3.4	95.4 ± 2.9	1.000
p-value^†	0.817	0.439

Values are presented as mean ± SD.

^∗ p-value of occlusion rate between daily-patching and alternate-day patching group at each occlusion time, Mann-Whitney U test

^† p-value of occlusion rate among occlusion time at each patching group, Kruskal-Wallis test.

Table 10.

Binocularity index

Follow-up period	Binocularity index (score)		p-value^∗
Follow-up period	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value^∗
At baseline	3.2 ± 0.6	3.1 ± 0.7	0.489
At last	3.7 ± 0.5	3.4 ± 0.7	0.638
p-value^†	0.317	0.059

Values are presented as mean ± SD.

^∗ p-value of binocularity index at each follow-up period in daily-patching group and alternate-day patching group, Mann-Whitney U test

^† p-value of binocularity index at baseline and last follow-up period in each group, Wilcoxon matched – pairs signed-ranks test.

Table 11.

Visual acuity outcomes stratified by baseline characteristics in each group

	No. of line of improvement		p-value^∗
	Daily-patching group (n = 24)	Alternate-day patching group (n = 21)	p-value^∗
Age (years)			0.980
< 5	3.7 ± 2.3	3.7 ± 2.3
5 ≤ ~ < 7	3.9 ± 2.3	3.6 ± 0.5
7 ≤ ~ < 10	-	3.8 ± 0.8
Sex			0.761
Male	3.3 ± 2.2	3.2 ± 1.5
Female	4.2 ± 2.3	4.1 ± 1.8
Depth of amblyopia			0.505
Severe	4.9 ± 2.3	4.5 ± 2.6
Moderate	3.5 ± 2.4	3.5 ± 2.1
Mild	2.8 ± 1.3	3.6 ± 0.5
Cause of amblyopia			0.510
Strabismus	5.0 ± 0.0	5.0 ± 3.0
Anisometropia	3.5 ± 2.3	3.6 ± 1.6
Combined	4.3 ± 2.5	3.3 ± 0.5

Values are presented as mean ± SD.

^∗ Kruskal-Wallis test.

Table 12.

Demographic characteristics and visual acuity improvement in daily-patching group

	Success (n = 12)	Failure (n = 12)	p-value
Age (years)	4.6 ± 0.9	4.4 ± 1.4	0.905^∗
Baseline acuity of amblyopic eye (log MAR)	0.4 ± 0.3	0.6 ± 0.3	0.084^∗
Compliance (%)	96.6 ± 7.8	92.4 ± 10.1	0.107^∗
Cause of amblyopia (n)			0.083^†
Strabismus	2	0
Anisometropia	8	7
Combined	2	5

Values are presented as mean ± SD unless otherwise indicated.

^∗ Mann-Whitney U test

^† Linear by linear test.

Table 13.

Demographic characteristics and visual acuity improvement in alternate-day patching group

	Success (n = 17)	Failure (n = 4)	p-value
Age (years)	5.1 ± 1.8	4.5 ± 1.7	0.490^∗
Baseline acuity of amblyopic eye (log MAR)	0.3 ± 0.2	0.6 ± 0.2	0.023^∗
Compliance (%)	97.5 ± 5.6	90.9 ± 8.9	0.018^∗
Cause of amblyopia (n)			0.088^†
Strabismus	3	0
Anisometropia	12	2
Combined	2	2

Values are presented as mean ± SD unless otherwise indicated.

^∗ Mann-Whitney U test

^† Linear by linear test.

Table 14.

Demographic characteristics of treatment failure patients in daily-patching and alternate-day patching group

	Daily-pathcing group (n = 12)	Alternate day-patching group (n = 4)	p-value
Age (years)	4.4 ± 1.4	4.5 ± 1.7	0.951^∗
Baseline acuity of amblyopic eye (log MAR)	0.6 ± 0.3	0.6 ± 0.2	0.758^∗
Compliance (%)	92.4 ± 10.1	90.9 ± 8.9	0.538^∗
Follow-up (months)	4.2 ± 3.4	7.5 ± 3.0	0.086^∗
Cause of amblyopia (n)			0.778^†
Strabismus	0	0
Anisometropia	7	2
Combined	5	2
Depth of amblyopia (n)			0.819^†
Severe	6	2
Moderate	5	2
Mild	1	0

Values are presented as mean ± SD unless otherwise indicated.

^∗ Mann-Whitney U test

^† Linear by linear test.

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