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  • Demographics Affect Outcomes of Amblyopia Treatment

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
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    Journal Highlights

    Ophthalmology, February 2023

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    Using data from the IRIS Registry, Repka et al. previously reported on the residual VA deficits caused by amblyopia. In a follow-up study, they performed multivariable analysis of their findings to explore success rates for amblyopia treatment, adjusted for age, race/eth­nicity, and type of health insurance. Although treatment was successful in more than 77% of young children and 55% of older children, the success rates were disproportionately lower for Black patients and for those covered by Medicaid.

    For this work, the authors gathered IRIS Registry data for 3- to 12-year-old children who were new to the registry from 2013 through 2019. The main outcome was IRIS-50, a composite endpoint representing the effectiveness of amblyopia treatment. The IRIS-50 measure helps to capture denser am­blyopia at baseline and accounts for unilateral amblyopia associated with strabismus and/or refractive error. Although it was designed for younger children, the authors also utilized it for 8- to 12-year-olds. Types of insurance were categorized as private, military, or Medicaid.

    Prior to analysis, VA was converted to logMAR units. IRIS-50 success was defined as satisfying at least one of three criteria: 1) corrected interocular VA difference of <.23 logMAR within three to 12 months of initial amblyopia diagnosis; 2) corrected VA improve­ment of at least 3 lines (≥.30 logMAR) in the amblyopic eye in the same period; or 3) final VA of 20/30 or better (£.18 logMAR) in the amblyopic eye.

    Among the younger cohort (n = 18,841), amblyopia was treated success­fully in 77.3%. Outcomes were success­ful in 55.5% of the 8- to 12-year-olds (n = 9,762). Multivariable analyses of the younger cohort showed that, rel­ative to White patients, the likelihood of treatment success was substantially lower for Black children (OR, .71). The ORs for Hispanic/Latino and Asian children were .93 and .97, respectively. Compared with private insurance, Medicaid con­ferred significant­ly lower odds of treatment success (OR, .65). Among 8- to 12-year-olds, the odds of treatment success were lower for Blacks (OR, .81) and higher for Hispanics (OR, 1.16) than for Whites. As in the younger cohort, older children with Medicaid were less likely to have a successful outcome (OR, .84). For both cohorts, military insurance was comparable to private insurance with respect to treatment outcomes.

    The insurance-related disparity is noteworthy given that nearly 50% of U.S. children are covered by Medicaid, said the authors. They recommend developing strategies to improve the success of amblyopia treatment, espe­cially for children who are Black and/or covered by Medicaid.

    The original article can be found here.