Clinical translation of recommendations from randomized clinical trials on patching regimen for amblyopia.
Ophthalmology
; 120(4): 657-62, 2013 Apr.
Article
em En
| MEDLINE
| ID: mdl-23395531
ABSTRACT
PURPOSE:
To investigate whether the evidence-based recommendations by the Pediatric Eye Disease Investigator Group (PEDIG) as initial treatment of amblyopia have been implemented into clinical practice and to discuss the necessary steps in translating evidence-based knowledge to inform clinical decision making.DESIGN:
Retrospective cohort study.PARTICIPANTS:
Children with amblyopia seen from 2007 through 2009 by academic and community ophthalmologists in a large urban center in North America that serves a population of more than 8 million. Using PEDIG criteria, moderate amblyopia was defined as visual acuity between 20/40 and 20/80 and severe amblyopia was defined as visual acuity between 20/100 and 20/400. INTERVENTION Patching of the sound eye. MAIN OUTCOMEMEASURES:
The number of prescribed patching hours daily and the amblyopic eye visual acuity expressed as logarithm of the minimum angle of resolution (logMAR).RESULTS:
For moderate amblyopia, the cohort (n = 71) was prescribed a mean of 3.2 hours of daily patching (95% confidence interval [CI] 2.8-3.6 hours), which is significantly greater than the recommended 2 hours of daily patching for initial treatment. Only 24% (95% CI, 16%-35%) of them were prescribed the recommended initial patching hours. The amblyopic eye acuity on the 3- to 6-month visit in the cohort (0.23 logMAR) was similar to that of the 4-month visit in the PEDIG cohort (0.24 logMAR; P = 0.74). For severe amblyopia, the cohort (n = 52) was prescribed a mean of 3.9 hours of daily patching (95% CI, 3.5-4.3 hours), which is significantly lower than the recommended 6 hours of daily patching for initial treatment. Only 12% (95% CI, 5%-23%) of them were prescribed the recommended initial patching hours. The amblyopic eye acuity at the 7- to 12-month visit in the cohort (0.44 logMAR) was comparable with that of the 4-month visit in the PEDIG cohort (0.40 logMAR; P = 0.35).CONCLUSIONS:
The evidence-based recommendations for amblyopia management have not been translated widely into changes in clinical practice in a large urban center in North America, although there is a general move from full-time to part-time patching since the PEDIG results were published. Using a well-established framework for knowledge translation, the Knowledge-to-Action Cycle, the necessary steps required to implement new knowledge into actual clinical practice are discussed.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Privação Sensorial
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Ensaios Clínicos Controlados Aleatórios como Assunto
/
Ambliopia
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Cooperação do Paciente
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Guias de Prática Clínica como Assunto
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article