Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
This article was corrected | View correction
Mintz-Hittner and Fernandez1 contribute to the debate concerning the influence of age on treatment outcome in amblyopia. They report significant improvements in the visual acuity of 36 children between the ages of 7.0 and 10.3 years undergoing occlusion or penalization therapy. These are heartening results but are not unexpected; we now know that even adults with amblyopia demonstrate residual plasticity of the visual system.2 Levi's remark3 that failure to achieve improvement in the older amblyopic child may "reflect the very real difficulties in maintaining patient (or clinician) motivation or the failure to use the most efficacious treatment modalities" now appears apposite.
Successful treatment prompts us to inquire what specific factors contribute to its effectiveness. Here the authors' views are made clear from the pithy subtitle of their article: "Compliance Cures." Unfortunately, at no point do they mention how the presumed good compliance was actually assessed (although we note the use of "several methods of coercion and bribery" as a means of compliance enhancement). We suspect that as far as occlusion is concerned, only subjective recording methods were employed, on which it is difficult to place numerical confidence limits. In these circumstances, we would urge caution in making bold assertions regarding the relationship between compliance and treatment outcome. We learned this lesson when assuming excellent compliance on the part of a child who made clinically significant gains in visual function while undergoing minimal occlusion. We subsequently discovered that objectively measured compliance was less than 50%.4
Several different means of objectively monitoring compliance4 - 5 are now available, which provide the opportunity to move away from a conception of compliance as a subjective, often binary attribute to one in which it is an objectively measured, quantitative variable. This should allow us to define empirically a dose-response function for occlusion therapy. In other words, we will be able to determine as a function of age, severity, and type of amblyopia how much occlusion a child is likely to require, rather than relying on ad hoc prescribing regimens.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Ophthalmology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.