Epidemiology of Compliance to Patching in the Treatment of Amblyopia in An-Najah University Hospital

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عبسة, روان
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An-Najah National University
Background: Amblyopia, ‘lazy’ eye is a unilateral or bilateral reduction in vision for which no organic cause is present by physical examination of the eye with a prevalence of approximately 5% of the childhood population. It is commonly associated with a strabismus, refractive error or both. The most common form of treatment is conventional occlusion (daily patching of the good eye). Clinical studies have attempted to investigate the optimal treatment of the disease and investigate compliance; however, an evidence-base for treatment is still incomplete. Aim: To study the degree of compliance and explore factors affecting compliance in patients undergoing occlusion therapy for amblyopia in our practice. Study design: Cross -sectional study design. Methods: A total of 80 child (aged 3-9years), undergoing unilateral amblyopia treatment at the pediatric ophthalmology clinic of An-Najah University Hospital, Nablus, were recruited for this study. Parents were asked to estimate number of hours of patching for the previous month, and completed questionnaire. Clinical data, for each patient were collected from the hospital chart and were entered in a data collection sheet. Compliance with patching therapy was assessed by self-report accounts of parents and was graded into adequate and inadequate. Adequate compliance was graded into, excellent, very good and good. Non-compliance was calculated as a ratio of the difference between prescribed and administered hours to prescribed hours. Association between various factors and degree of compliance was studied by using univariate analysis plan. Results: The total number of the patients participated in the study was 80. The mean age was (5±1.9), range (3-9 years), of those 52.5% was females which was higher than males (47. 5%).Compliance rate was about (81%). About 16.2% of them experienced excellent compliance rate, 42.5% experienced very good compliance rate, and 41.3% experienced good compliance rate. About parents and their children perception, 97.5% of the parents believed that eye patching is important. 82.5% of them were always watching their child while wearing the patch. About 61.3% of the patients refused using the patch and 76.3% of them felt uneasy with the patch. Univariate analysis showed that there was no significant association (p-value ˃0.05) between compliance and all the factors except for gender and place of residence which were statically significant, (p-value=0.0172, 0.003) respectively. For gender factor, about 26.2% female experienced excellent compliance, compared with 5.3% of male patient’s experience. About 31% of female patients experienced very good compliance compared with 55.3% of male patients. Also 42.9% of female patients experienced good compliance, compared with 39.5 % of male patients. For the place of residence, about 27.8% lived in the city had excellent compliance compared with 6.8% lived in the suburbs. About 50% lived in the city had very good compliance compared with 36.4% lived in the suburbs. While 22.2% patients lived in the city experienced good compliance compared with 56.8% of them lived in the suburbs (p=0.003). Conclusion: Amblyopia is an understudied and neglected public health problem that can impair children’s lives. Compliance is an important factor affecting the outcome. The more we understand the influencing factors, the greater the positive effect on treatment. In this study the average compliance rate was relatively high (81%) comparing to other studies. Gender and place of residence are the significant factors affecting the compliance.