Department of Ophthalmology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Ophthalmology. 2012 Nov;119(11):2393-401. doi: 10.1016/j.ophtha.2012.05.035. Epub 2012 Aug 21.
We showed previously that an educational cartoon that explains without words why amblyopic children should wear their eye patch improves compliance, especially in children of immigrant parents who speak Dutch poorly. We now implemented this cartoon in clinics in low socioeconomic status (SES) areas with a large proportion of immigrants and clinics elsewhere in the Netherlands.
Clinical, prospective, nonrandomized, preimplementation, and postimplementation study.
Amblyopic children aged 3 to 6 years who started occlusion therapy.
Preimplementation, children received standard orthoptic care. Postimplementation, children starting occlusion therapy received the cartoon in addition. At implementation, treating orthoptists followed a course on compliance. In low SES areas, compliance was measured electronically during 1 week.
The clinical effects of the cartoon-electronically measured compliance, outpatient attendance rate, and speed of reduction in interocular-acuity difference (SRIAD)-averaged over 15 months of observation.
In low SES areas, 114 children were included preimplementation versus 65 children postimplementation; elsewhere in the Netherlands, 335 versus 249 children were included. In low SES areas, mean electronically measured compliance was 52.0% preimplementation versus 62.3% postimplementation (P=0.146); 41.8% versus 21.6% (P=0.043) of children occluded less than 30% of prescribed occlusion time. Attendance rates in low SES areas were 60.3% preimplementation versus 76.0% postimplementation (P=0.141), and 82.7% versus 84.5%, respectively, elsewhere in the Netherlands. In low SES areas, the SRIAD was 0.215 log/year preimplementation versus 0.316 log/year postimplementation (P=0.025), whereas elsewhere in the Netherlands, these were 0.244 versus 0.292 log/year, respectively (P=0.005; the SRIAD's improvement was significantly better in low SES areas than elsewhere, P=0.0203). This advantage remained after adjustment for confounding factors. Overall, 25.1% versus 30.1% (P=0.038) had completed occlusion therapy after 15 months.
After implementation of the cartoon, electronically measured compliance improved, attendance improved, acuity increased more rapidly, and treatment was shorter. This may be due, in part, to additional measures such as the course on compliance. However, that these advantages were especially pronounced in children in low SES areas with a large proportion of immigrants who spoke Dutch poorly supports its use in such areas.
我们之前曾展示过，一个用图片解释弱视儿童为何应戴眼罩的教育漫画可提高依从性，尤其是对荷兰语讲得不好的移民父母的孩子效果更好。我们现在将该漫画应用于有大量移民的低社会经济地位（SES）地区的诊所和荷兰其他地区的诊所。
临床、前瞻性、非随机、实施前和实施后研究。
开始遮盖治疗的 3 至 6 岁弱视儿童。
实施前，儿童接受标准的斜视矫正治疗。实施后，开始遮盖治疗的儿童除了接受常规治疗外，还接受该漫画的治疗。在实施时，治疗斜视的视轴矫形师接受了依从性课程培训。在 SES 较低的地区，在为期 1 周的时间内通过电子方式测量依从性。
实施后通过电子方式测量的依从性、门诊就诊率和 15 个月观察期间双眼视力差异（SRIAD）的平均降低速度。
SES 较低地区实施前纳入 114 例患儿，实施后纳入 65 例；荷兰其他地区实施前纳入 335 例，实施后纳入 249 例。SES 较低地区实施前电子测量的依从性平均为 52.0%，实施后为 62.3%（P=0.146）；分别有 41.8%和 21.6%的儿童未按规定时间（<30%）进行遮盖（P=0.043）。SES 较低地区实施前的门诊就诊率为 60.3%，实施后为 76.0%（P=0.141）；荷兰其他地区分别为 82.7%和 84.5%。SES 较低地区的 SRIAD 为 0.215 对数/年，实施后为 0.316 对数/年（P=0.025）；荷兰其他地区分别为 0.244 对数/年和 0.292 对数/年（P=0.005；SRIAD 的改善在 SES 较低地区明显优于其他地区，P=0.0203）。调整混杂因素后，这种优势仍然存在。15 个月后，分别有 25.1%和 30.1%（P=0.038）的儿童完成了遮盖治疗。
实施漫画后，电子测量的依从性提高，就诊率提高，视力提高速度加快，治疗时间缩短。这可能部分归因于依从性课程等额外措施。然而，在 SES 较低地区和荷兰语讲得不好的移民较多的地区，这些优势更为明显，这支持在这些地区使用该漫画。
