Augmenting Atropine Treatment for Amblyopia in Children 3 to < 8 Years Old
试验速览
- 阶段
- 3 期
- 状态
- 已完成
- 发起方
- 入组人数
- 73
- 试验地点
- 2
- 主要终点
- Distribution of 10-week Amblyopic-Eye Visual Acuity
研究概览
简要总结
This study is designed to evaluate the effectiveness of adding a plano lens to weekend atropine after visual acuity has stabilized with weekend atropine but amblyopia is still present. Children ages 3 to <8 years with visual acuity of 20/50 to 20/400 in the amblyopic eye will be enrolled in a run-in phase with weekend atropine until no improvement, followed by randomization of eligible patients to weekend atropine treatment with a plano lens over the sound eye versus without a plano lens over the sound eye. The primary objective is to determine if adding a plano lens to weekend atropine will improve visual acuity in patients with amblyopia still present after visual acuity has stabilized with initial treatment.
详细描述
Amblyopia is the most common cause of monocular visual impairment in both children and young and middle-aged adults. Both patching and atropine are accepted treatment modalities for the management of moderate amblyopia in children.1 Many practitioners prescribe weekend atropine as initial therapy for amblyopia. However, many children fail to achieve normal visual acuity in the amblyopic eye after treatment with this regimen. In a randomized trial conducted by PEDIG comparing atropine regimens, 58 of 83 patients with moderate amblyopia (70%) had amblyopic eye visual acuity of 20/32 or worse after 4 months of treatment with weekend atropine.2 In another PEDIG randomized trial comparing atropine with a plano lens versus without a plano lens for initial treatment of amblyopia, 60 of 84 patients with moderate amblyopia (71%) had amblyopic eye visual acuity of 20/32 or worse after 16 weeks of treatment with weekend atropine.3 When improvement stops after initial therapy and amblyopia is still present, treatment options include increasing the dosage of current treatment, switching to another treatment, maintaining the same treatment and dosage, or combining treatments. Many clinicians will add a plano lens over the sound eye to atropine treatment, in part because families using atropine have become comfortable with its use. This option is limited to children with hypermetropia in the sound eye. However, it is unknown whether adding a plano lens over the sound eye will improve amblyopic eye visual acuity more than continuing atropine alone in patients who have shown no improvement after initial treatment with atropine. In a PEDIG randomized trial comparing patching to atropine for initial treatment of amblyopia, a plano lens was prescribed for the sound eye for 55 patients who had not improved to 20/30 or at least 3 lines after 4 months of daily atropine use.1, 4 Their mean acuity improvement prior to using the plano lens was 1.0 line, compared with 1.6 lines after prescribing the plano lens. We are unaware of any reports of the response of treatment of amblyopia still present after initial treatment with weekend atropine.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 3 Years 至 7 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Major Eligibility Criteria for Run-in Phase
- •Age 3 to < 8 years
- •Amblyopia associated with strabismus, anisometropia, or both
- •Visual acuity in the amblyopic eye between 20/50 and 20/400 inclusive
- •Visual acuity in the sound eye 20/32 or better and inter-eye acuity difference >3 logMAR lines
- •Amblyopia treatment within the past 6 months subject to the following stipulations:
- •No more than 6 weeks of any amblyopia treatment other than spectacles (except for patients being treated with atropine who are entering the study on treatment)
- •No simultaneous treatment with patching and atropine
- •No use of atropine in combination with the sound eye spectacle lens reduced by more than 1.50 D
- •Maximum level of treatment within the past 6 months:
- •Patching: up to 2 hours daily
- •Atropine: up to once daily
- •Wearing spectacles with optimal correction (if amblyopic eye acuity is 20/80 or better, then VA must be stable in glasses; if amblyopic eye acuity is 20/100 or worse, then spectacles and atropine can be initiated simultaneously).
- •Hypermetropia and spectacle correction in sound eye of +1.50 D or more
- •Eligibility Criteria for Randomization:
- •Amblyopic eye acuity of 20/40 to 20/160 with an inter-ocular difference of >2 lines, or amblyopic eye acuity of 20/32 with 3 lines of IOD.
- •Compliance with weekend atropine treatment based on investigator judgment.
排除标准
- •Currently using vision therapy or orthoptics
- •Ocular cause for reduced visual acuity (nystagmus per se does not exclude the patient if the above visual acuity criteria are met)
- •Prior intraocular or refractive surgery
- •Known allergy to atropine or other cycloplegic drugs
- •Down Syndrome present
研究组 & 干预措施
Intensified treatment
Weekend atropine 1% with plano lens over the sound eye
干预措施: Atropine (Drug)
Intensified treatment
Weekend atropine 1% with plano lens over the sound eye
干预措施: Plano lens (Device)
Control
Weekend atropine 1%
干预措施: Atropine (Drug)
结局指标
主要结局
Distribution of 10-week Amblyopic-Eye Visual Acuity
时间窗: 10 weeks after randomization
The masked 10-week amblyopic eye visual acuity scores were tabulated for both treatment groups, and included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data. The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.
Mean 10-week Amblyopic-Eye Visual Acuity
时间窗: 10 weeks after randomization
The primary outcome analysis was a treatment group comparison of the masked 10-week amblyopic eye visual acuity using an analysis of covariance (ANCOVA) model, adjusting for visual acuity at randomization. The analysis included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data. The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.
Distribution of the Change in Amblyopic-Eye Visual Acuity
时间窗: Randomization to 10 weeks
The change in 10-week amblyopic eye visual acuity scores since randomization was tabulated for both treatment groups, and included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data. The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.
Mean Change in Amblyopic-Eye Visual Acuity at 10 Weeks From Randomization
时间窗: Randomization to 10 weeks
The change in 10-week amblyopic eye visual acuity was computed for both treatment groups and included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data. The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.
次要结局
- Treatment Group Comparison of the Proportion of Participants Who Achieved 20/25 or Better Visual Acuity at 10 Weeks Since Randomization(10 weeks after randomization)
- Treatment Group Comparison of the Proportion of Participants Who Have Improved by 2 or More logMAR Visual Acuity Lines at 10 Weeks Since Randomization(10 weeks after randomization)
- Spectacle Compliance at 10 Weeks by Treatment Group(10 weeks after randomization)
- Average Spectacle Compliance by Treatment Group(10 weeks after randomization or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Atropine Compliance at 10 Weeks by Treatment Group(10 weeks after randomization)
- Average Atropine Compliance by Treatment Group(10 weeks after randomization or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Distribution of Interocular Difference at 12-week Exam(12 weeks after randomization)
- Mean Interocular Difference at 12-week Exam(12 weeks after randomization)
- Distribution of 12-week Fellow-Eye Visual Acuity(12 weeks after randomization)
- Mean Fellow-Eye Visual Acuity at 12-week Exam(12 weeks after randomization)
- Distribution of Change in Fellow-Eye Visual Acuity at 12 Weeks From Randomization(12 weeks after randomization)
- Mean Change in Fellow-Eye Visual Acuity at 12 Weeks From Randomization(12 weeks after randomization)
- Distribution of Baseline Characteristics at the 10-week Outcome(10 weeks after randomization)
- Mean Amblyopic Eye Visual at Randomization According to Baseline Characteristics for 10-week Outcome(10 weeks after randomization)
- Treatment Comparison of Mean Amblyopic Eye Visual Acuity Change at 10-weeks According to Baseline Characteristics(10 weeks after randomization)
- Distribution of Amblyopic-Eye Visual Acuity at Best Outcome Visit(10 weeks after randomization or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Mean Amblyopic-Eye Visual Acuity at Best Outcome Visit(10 weeks after randomization or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Distribution of Change in Amblyopic-Eye Visual Acuity From Randomization to Best Outcome Visit(Randomization to 10 weeks or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Mean Change in Amblyopic-Eye Visual Acuity at Best Outcome Visit(10 weeks after randomization or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Treatment Group Comparison of the Proportion of Participants Who Have Improved by 2 or More logMAR Visual Acuity Lines Based on Visual Acuity at Best Outcome Visit(10 weeks after randomization or later (until no further VA improvement, up to maximum of 84 weeks for one subject))
- Distribution of Randot Preschool Stereoacuity Score at 12 Weeks(12 weeks after randomization)
- Distribution of Randot Preschool Stereoacuity Scores at 12 Weeks for Participants With Anisometropic Amblyopia(12 weeks after randomization)