Randomised comparison of three tools for improving compliance with occlusion therapy: an educational cartoon story, a reward calendar, and an information leaflet for parents.

BACKGROUND: We previously demonstrated that compliance with occlusion therapy for amblyopia was improved by the use of an educational programme, especially in children of parents of foreign origin and who spoke Dutch poorly. The programme consisted of: (i) a cartoon story for amblyopic children that explained without words why they should patch, (ii) a calendar with reward stickers, and (iii) an information leaflet for parents. In the current study, we assessed the individual effect of each component on compliance. METHODS: We recruited 120 3- to 6-year-old children who lived in a low socio-economic status (SES) area in The Hague and were starting occlusion therapy for the first time. They were randomised to receive one of the components (three intervention groups), or a picture to colour (control group). The randomisation was blinded for treating orthoptist and researcher. Compliance was measured electronically using the Occlusion Dose Monitor (ODM). Primary outcome was percentage of compliance (actual/prescribed occlusion time). Secondary outcome was absolute occlusion hours per day. Parental fluency in Dutch was rated on a five-point scale. RESULTS: Compliance could be measured electronically in 88 of the 120 children; in 32 others, it failed for various reasons. Parental fluency in Dutch was moderate or worse in 36.4 % (p = 0.327). Average compliance was 55 % standard deviation (SD) 40 (n = 18) in the control group, 89 % SD 25 in the group receiving the educational cartoon (n = 25, P = 0.002 compared with control group), 67 % SD 33 (n = 24, P = 0.301) in the reward-calendar group and 73 % SD 40 (n = 21, P = 0.119) in the parent-information-leaflet group. On average, children in the control group occluded 1:46 SD1:19 hours/day, 2:33 SD 1:18 hours/day in the group receiving the educational cartoon, 1:59 SD 1:13 hours/day in the reward-calendar group and 2:18 SD 1:13 hours/day in the parent-information-leaflet group. No child who received the cartoon story occluded less than 1 hour per day, against seven in the reward-calendar group, five in the parent-information-leaflet group and five in the control group. CONCLUSIONS: Although all three components of the programme improved compliance with occlusion therapy in children in low-SES areas, the educational cartoon had the strongest effect, as it explained without words to a 4- to 5-year-old child why it should wear the eye patch.

Nystagmus characteristics in congenital stationary night blindness (CSNB).

AIM: To analyse nystagmus characteristics in patients with congenital stationary night blindness (CSNB) for differentiation from other forms of early childhood nystagmus. METHODS: Horizontal and vertical eye movements of 10 patients (6-46 years, mean 17.1 years, median 12.5 years) with CSNB (eight with CSNB1, two with CSNB2) were recorded with the scleral magnetic search coil technique or by electro-oculography. Nystagmus characteristics such as the amplitude, frequency, conjugacy and intermittency were analysed. RESULTS: All patients had continuous, pendular, oblique and mostly dysconjugate nystagmus of high frequency and low amplitude. In seven cases, a large horizontal or vertical jerk nystagmus with increasing, decreasing or constant velocity was superimposed. Jerk nystagmus was mostly intermittent and conjugate. Head nodding was found not to be compensatory. CONCLUSIONS: Eye-movement recordings of CSNB patients disclosed specific nystagmus characteristics, such as an oblique direction, superimposed waveforms and dysconjugate eye movements. These features may help to distinct nystagmus in CSNB from other forms of early infancy nystagmus, such as congenital idiopathic nystagmus, latent nystagmus and spasmus nutans. We found nystagmus in CSNB to be similar to the nystagmus reported in blue-cone monochromatism and rod monochromatism, and in patients with a severe sensory defect. The nystagmus characteristics described should prompt electroretinographic investigation in cases of uncertain diagnosis.

[Evaluation of visual acuity in a historical cohort of 137 patients treated for amblyopia by occlusion 30-35 years ago]. / Visusevaluierung in einer historischen Kohorte von 137 okkludierten Patienten, 30-35 Jahre nach Ende der Okklusionsbehandlung.

BACKGROUND: Opinions differ on the course of the visual acuity in the amblyopic eye after cessation of occlusion therapy. This study evaluated visual acuity in a historical cohort treated for amblyopia with occlusion therapy 30-35 years ago. MATERIALS AND METHODS: Between 1968 and 1975, 1250 patients had been treated by the orthoptist in the Waterland Hospital in Purmerend, The Netherlands. Of these, 471 received occlusion treatment for amblyopia (prevalence 5.0%, after comparison with the local birth rate). We were able to contact 203 of these patients, 137 were orthoptically re-examined in 2003. We correlated the current visual acuity with the cause of amblyopia, the age at start and end of treatment, the visual acuity at start and end of treatment, fixation, binocular vision and refractive errors. RESULTS: Mean age at the start of treatment was 5.4 +/- 1.9 years, 7.4 +/- 1.7 years at the end and 37 +/- 2.7 years at follow-up. Current visual acuity in the amblyopic eye was correlated with a low visual acuity at the start (p < 0.0001) and end (p < 0.0001) of occlusion therapy, an eccentric fixation (p < 0.0001), and the cause of amblyopia (p = 0.005). At the end of the treatment, patients with a strabismic amblyopia (n = 98) had a visual acuity in the amblyopic eye of 0.29 logMAR +/- 0.3, and in 2003 0.27 +/- 0.3 logMAR. In patients with an anisometropic amblyopia (> 1 D, n = 16) visual acuity had decreased from 0.17 +/- 0.23 logMAR to 0.21 logMAR +/- 0.23. In patients with both strabismic and anisometropic amblyopia (n = 23), visual acuity had decreased from 0.52 logMAR +/- 0.54 to 0.65 logMAR +/- 0.54. Overall, acuity had decreased in 54 patients (39%) after cessation of treatment. Of these, 18 patients had an acuity decrease to less than 50% of their acuity at the end of treatment. In 15 of these 18 patients anisohypermetropia had increased. CONCLUSIONS: A decrease in visual acuity after cessation of occlusion therapy occurred in patients with a combined cause of amblyopia or with an increase in anisohypermetropia.