A retrospective review of the associations between amblyopia type, patient age, treatment compliance and referral patterns

Aim: To review presenting ages, referral sources, amblyopia type and treatment compliance in children attending a typical public hospital ophthalmology clinic with no formal amblyopia screening program in place. Methods: One hundred and twenty-seven children attending the outpatients clinics of The Children's Hospital at Westmead for amblyopia management between January 2001 and May 2003 were reviewed. Presenting age, amblyopia type, referral source, treatment prescribed and compliance achieved were analysed using means, 95% confidence intervals (Cl), and Mantel-Haenszel χ² statistic. Results: General practitioners and paediatricians provided most referrals. The mean presenting age was 32.9 (95% Cl 29.0-36.9) months. There was no significant association between presenting age and amblyopia type (χ² = 6.00, P = 0.11, d.f. = 3), but a trend was found with deprivation amblyopia identified earliest, and pure anisometropic amblyopia identified latest (χ² = 5.65, P = 0.02, d.f. = 1). Compliance to patching did not differ significantly between sexes, with calculated aggregate compliance of 67.3% (95% CI: 59-75%) for boys and 66.3% (95% CI: 60-73%) for girls. Compliance to patching also did not differ significantly between amblyopia types (χ ² = 3.61, P = 0.3, d.f. = 3). Compliance was best among younger and older children, and worst among those aged 15-30 months. There was no association between patching compliance and treatment duration. Conclusion: Amblyopia is a preventable form of blindness. A multidisciplinary approach must be talken. Resources and education should be targeted at general practitioners and paediatricians who have the greatest opportunities to perform amblyopia screening. Teachers are an important resource in identifying cases missed at previous informal screening opportunities. Amblyopia treatment must be intensified and individualized between the ages of 15-30 months when compliance is poorest.