Treatment of Amblyopia Using Personalized Dosing Strategies: Statistical Modelling and Clinical Implementation
- 1 October 2016
- journal article
- research article
- Published by Taylor & Francis Ltd in Strabismus
- Vol. 24 (4), 161-168
- https://doi.org/10.1080/09273972.2016.1242638
Abstract
Purpose: To generate a statistical model for personalizing a patient’s occlusion therapy regimen. Methods: Statistical modelling was undertaken on a combined data set of the Monitored Occlusion Treatment of Amblyopia Study (MOTAS) and the Randomized Occlusion Treatment of Amblyopia Study (ROTAS). This exercise permits the calculation of future patients’ total effective dose (TED)—that predicted to achieve their best attainable visual acuity. Daily patching regimens (hours/day) can be calculated from the TED. Results: Occlusion data for 149 study participants with amblyopia (anisometropic in 50, strabismic in 43, and mixed in 56) were analyzed. Median time to best observed visual acuity was 63 days (25% and 75% quartiles; 28 and 91 days). Median visual acuity in the amblyopic eye at start of occlusion was 0.40 logMAR (quartiles 0.22 and 0.68 logMAR) and at end of occlusion was 0.12 (quartiles 0.025 and 0.32 logMAR). Median lower and upper estimates of TED were 120 hours (quartiles 34 and 242 hours), and 176 hours (quartiles 84 and 316 hours). The data suggest a piecewise linear relationship (P = 0.008) between patching dose-rate (hours/day) and TED with a single breakpoint estimated at 2.16 (standard error 0.51) hours/day, suggesting doses below 2.16 hours/day are less effective. Conclusion: We introduce the concept of TED of occlusion. Predictors for TED are visual acuity deficit, amblyopia type, and age at start of occlusion therapy. Dose-rates prescribed within the model range from 2.5 to 12 hours/day and can be revised dynamically throughout treatment in response to recorded patient compliance: a personalized dosing strategy.Keywords
Funding Information
- National Institute for Health Research (PB-PG-0808-16087)
This publication has 21 references indexed in Scilit:
- Randomized Trial to Evaluate Combined Patching and Atropine for Residual AmblyopiaJAMA Ophthalmology, 2011
- Treatment of severe amblyopia with weekend atropine: Results from 2 randomized clinical trialsJournal of American Association for Pediatric Ophthalmology and Strabismus, 2009
- Patching vs Atropine to Treat Amblyopia in Children Aged 7 to 12 YearsJAMA Ophthalmology, 2008
- Objectively monitored patching regimens for treatment of amblyopia: randomised trialBMJ, 2007
- Modeling Dose-Response in Amblyopia: Toward a Child-Specific Treatment PlanInvestigative Ophthalmology & Visual Science, 2007
- Treatment of Unilateral Amblyopia: Factors Influencing Visual OutcomeInvestigative Ophthalmology & Visual Science, 2005
- Refractive adaptation in amblyopia: quantification of effect and implications for practiceBritish Journal of Ophthalmology, 2004
- Treatment Dose-Response in Amblyopia Therapy: The Monitored Occlusion Treatment of Amblyopia Study (MOTAS)Investigative Ophthalmology & Visual Science, 2004
- Compliance in amblyopia therapy: objective monitoring of occlusion.British Journal of Ophthalmology, 1995
- A new look at the statistical model identificationIEEE Transactions on Automatic Control, 1974