Evaluating Amblyopia Treatment Success Using the American Academy of Ophthalmology IRIS50 Measures

Amblyopia treatment outcomes in patients with neurodevelopmental disorders

PURPOSE

To compare amblyopia treatment outcomes between patients with neurodevelopmental disorders and their typically developing peers.

METHODS

Of 2,311 patients diagnosed with amblyopia between 2010 and 2014 at Boston Children's Hospital, 460 met inclusion criteria (age 2-12 with anisometropic, strabismic, or mixed amblyopia [interocular difference (IOD) ≥2 lines]). Treatment and visual outcomes were analyzed according to neurodevelopmental status: neurodevelopmental delay (DD) versus typical development (TD).

RESULTS

The DD group (n = 54) and TD group (n = 406) were similar in demographics, amblyogenic risk factors, baseline visual measures, prescribed therapy, and adherence (P ≥ 0.10). Between-visit follow-up time was longer for the DD group (0.65 [0.42- 0.97] years) than for the TD group (0.5 [0.36-0.82] years; P = 0.023). IOD improved similarly in each group by the last visit (DD, -0.15 logMAR [-0.31 to -0.02]; TD, -0.2 logMAR [-0.38 to -0.1]; P = 0.09). Each group reached amblyopia resolution by the last visit at similar frequencies (DD, 23/54 [43%]; TD, 211/406 [52%]; P > 0.2). DD diagnosis did not independently influence amblyopia resolution (HR, 0.77; 95% CI, 0.53-1.12; P = 0.17), but each additional month of interval time between follow-up visits reduced the likelihood of resolution by 2.7% (HR, 0.67; 95% CI, 0.51-0.87; P = 0.003).

CONCLUSIONS

Patients with DD and those with TD responded similarly to amblyopia therapy; however, follow-up intervals were longer in patients with DD and correlated with the likelihood of persistent amblyopia, suggesting that greater efforts at assuring follow-up may benefit patients with DD.

Multivariable Analyses of Amblyopia Treatment Outcomes from a Clinical Data Registry

PURPOSE

To present multivariable analyses of factors associated with amblyopia treatment success using outcomes from a clinical registry.

DESIGN

Retrospective database study.

PARTICIPANTS

New patients 3 to 12 years of age being enrolled in the registry from 2013 to 2019.

MAIN OUTCOME MEASURE

The IRIS-50 is an outcome measure for amblyopia treatment developed by the American Academy of Ophthalmology for use with data in the Intelligent Research in Sight (IRIS®) Registry. The measure specifications include unilateral amblyopia associated with strabismus, refractive error, or both.

METHODS

Clinical care prescribed by the ophthalmologist.

RESULTS

Eighteen thousand eight hundred forty-one children 3 to 7 years of age were eligible for IRIS-50, with 77.3% successful. Nine thousand seven hundred sixty-two children 8 to 12 years of age were eligible, with 55.5% successful. For the younger age group, multivariable analyses found that odds ratios (ORs) for success were significantly lower for Black children (0.71; 95% confidence interval [CI], 0.62-0.83) compared with White children. Medicaid insurance was associated independently with significantly lower success (OR, 0.65; 95% CI, 0.60-0.71). Among older children, Black children were less likely to be treated successfully (OR, 0.81; 95% CI, 0.68-0.96) compared with White children, whereas Hispanic children showed an increased chance of success (OR, 1.16; 95% CI, 1.03-1.31). Medicaid insurance for the older children also was associated with a decreased chance of success (OR, 0.84; 95% CI, 0.77-0.93).

CONCLUSIONS

Amblyopia treatment outcomes measured by IRIS-50 were significantly poorer for Black children and those with Medicaid insurance 3 to 12 years of age. Disparate health outcomes demonstrated for these two factors emphasize the need to develop and test strategies to improve treatment outcomes for these children.

Core outcome set for three ophthalmic conditions: a healthcare professional and patient consensus on core outcome sets for amblyopia, ocular motility and strabismus (COSAMS Study)

OBJECTIVES

Amblyopia, strabismus and ocular motility disorders are common conditions with significant impact on visual function, appearance and quality of life. We aimed to establish a core set of outcomes for each of the three conditions for use in clinical trials and routine clinical practice.

DESIGN

A comprehensive databank of outcomes was developed from a systematic review of the literature and a series of focus groups with healthcare professionals, researchers, patients and carers. The databank of outcomes was scored in a two-round Delphi Survey completed by two stakeholder groups: healthcare professionals/researchers and patients/carers. Results of the online Delphi were discussed at a face-to-face consensus meeting where the core outcome sets were finalised.

SETTING

UK-wide consultation.

PARTICIPANTS

Researchers, clinicians, patients and carers.

OUTCOME MEASURES

Core outcome sets.

RESULTS

For amblyopia, strabismus and ocular motility, 40/42/33 participants contributed to both rounds of the Delphi; six/nine/seven members attended consensus meetings, respectively. Consensus was reached on ten core outcomes for both amblyopia and ocular motility and nine for strabismus. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life and ocular alignment. The strabismus and ocular motility disorder core sets included, in addition, measuring the deviation, binocular vision, ocular movement, patient satisfaction and symptoms. The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, spherical and cylindrical refraction, compliance and treatment-related and functionality/long-term impacts.

CONCLUSIONS

The study used robust consensus methods to develop a core outcome set for three ophthalmic conditions. Implementation of these core outcome sets in clinical trials and routine clinical practice will ensure that the outcomes being measured and reported are relevant to all stakeholders. This will enhance the relevance of study findings and enable comparison of results from different studies.

Amblyopia Outcomes Through Clinical Trials and Practice Measurement: Room for Improvement: The LXXVII Edward Jackson Memorial Lecture

PURPOSE

To describe amblyopia prevalence and outcomes using results from randomized studies and a clinical registry.

DESIGN

Review of published studies, analysis of data in Intelligent Research in Sight (IRIS) Registry from 2013 to 2019, personal perspective.

METHODS

Literature review, analysis of IRIS Registry data and IRIS-50, a visual acuity quality measure.

RESULTS

Clinical trials have reduced the treatment burden of amblyopia by reducing hours of patching and frequency of atropine eye drops with clinical success of about 83%. There is no appreciable age effect if treatment is started before 5 years of age, outcomes are stable to at least 15 years of age, and treatment can be somewhat effective until 12 years of age. The IRIS Registry identified 1,760,066 individuals with amblyopia for a prevalence of 2.47%. Refractive error alone accounted for 68.9% of childhood cases. Mean amblyopic eye visual acuity improved 1.8 lines for children 3-6 years of age and 0.8 lines for 7-12 years, but mean residual amblyopia was more than 2 lines. Among 18,841 children aged 3-7 years eligible for IRIS-50, 77.3% were successful. The odds ratios for success were significantly lower for African-American (0.67; 95% confidence interval [CI] = 0.58 to 0.78) and Hispanic or Latino (0.84; 95% CI = 0.75 to 0.94) children compared with white children.

CONCLUSIONS

Clinical trials provided evidence of a beneficial effect from several treatments, with substantially reduced doses than previously recommended. Registry data from clinical practice found residual visual acuity impairment among all ages and races, especially among minorities.