Chua Brian E-G, Johnson Kim, Martin Frank
Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Clin Exp Ophthalmol. 2004 Apr;32(2):175-9. doi: 10.1111/j.1442-9071.2004.00794.x.
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.
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 (CI), and Mantel-Haenszel chi2 statistic.
General practitioners and paediatricians provided most referrals. The mean presenting age was 32.9 (95% CI 29.0-36.9) months. There was no significant association between presenting age and amblyopia type (chi2 = 6.00, P = 0.11, d.f. = 3), but a trend was found with deprivation amblyopia identified earliest, and pure anisometropic amblyopia identified latest (chi2 = 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 (chi2 = 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.
Amblyopia is a preventable form of blindness. A multidisciplinary approach must be taken. 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.
回顾在一家未开展正规弱视筛查项目的典型公立医院眼科门诊就诊儿童的就诊年龄、转诊来源、弱视类型及治疗依从性。
对2001年1月至2003年5月期间在韦斯特米德儿童医院门诊接受弱视治疗的127名儿童进行回顾。使用均值、95%置信区间（CI）及曼特尔-亨泽尔卡方统计量对就诊年龄、弱视类型、转诊来源、所开治疗方法及治疗依从性进行分析。
全科医生和儿科医生提供了大部分转诊。就诊平均年龄为32.9（95%CI 29.0 - 36.9）个月。就诊年龄与弱视类型之间无显著关联（卡方 = 6.00，P = 0.11，自由度 = 3），但发现有这样一种趋势，即剥夺性弱视最早被发现，单纯屈光参差性弱视最晚被发现（卡方 = 5.65，P = 0.02，自由度 = 1）。眼罩治疗的依从性在性别之间无显著差异，男孩的计算总依从率为67.3%（95%CI：59 - 75%），女孩为66.3%（95%CI：60 - 73%）。眼罩治疗的依从性在弱视类型之间也无显著差异（卡方 = ३.६१，P = 0.3，自由度 = 3）。依从性在年龄较小和较大的儿童中最佳，在15 - 30个月龄的儿童中最差。眼罩治疗依从性与治疗持续时间之间无关联。
弱视是一种可预防的失明形式。必须采取多学科方法。资源和教育应针对最有机会进行弱视筛查的全科医生和儿科医生。教师是识别在以往非正式筛查机会中漏诊病例的重要资源。在依从性最差的15 - 30个月龄期间，必须加强弱视治疗并实现个体化。
