This prospective study found that the use of a cartoon explaining without words why amblyopic children should wear their eye patches resulted in improved compliance, improved attendance, a more rapid increase in visual acuity and a shorter treatment period. This was especially true in clinics in low socioeconomic status areas with a large proportion of immigrants.
The authors assessed the clinical effectiveness of using an education cartoon among amblyopic children aged 3 to 6 years. They included clinics in low socioeconomic status suburban areas of Amsterdam, Rotterdam, The Hague and Utrecht with a large proportion of immigrants and, for comparison, other areas in the Netherlands. They used the speed of reduction in interocular-acuity difference to measure the cartoon's clinical effectiveness averaged over 15 months of observation.
The study was broken down into two one-year phases. During the "preimplementation" phase, the newly diagnosed patients began receiving standard orthoptic care and the treating orthoptists explained amblyopia and its treatment to patients and their parents as usual. In the "postimplementation" phase, the treating orthoptists took a course on compliance with amblyopia treatment, showed pediatric patients the educational cartoon, and continued providing standard care. In each phase of the study, each child's compliance with occlusion therapy was measured electronically over an entire week with an occlusion dose monitor.
In areas of low socioeconomic status, mean compliance was 52 percent during preimplementation versus 62.3 percent postimplementation (P = 0.146); 41.8 percent occluded less than 30 percent of the prescribed occlusion time during the preimplantation phase, compared to 21.6 percent during the postimplantation phase.
Attendance of scheduled visits in low socioeconomic status areas was 60.3 percent preimplementation versus 76 percent postimplementation (P = 0.141), and 82.7 percent versus 84.5 percent, respectively, elsewhere in the Netherlands.
In low socioeconomic areas, the speed of reduction in interocular-acuity difference showed that the difference between acuity of the amblyopic eye and acuity in the healthy eye decreased, on average, 2.2 lines per year preimplementation, compared with 3.2 lines per year, on average, postimplementation, versus 2.4 and 2.9 lines, respectively, elsewhere in the Netherlands. This advantage remained after adjustment for confounding factors.