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Original Investigation
December 2016

Association Between Adherence to Glasses Wearing During Amblyopia Treatment and Improvement in Visual Acuity

Author Affiliations
  • 1Ulverscroft Eye Unit, University of Leicester, Leicester, England
  • 2Orthoptics Department, Bradford Teaching Hospitals, Bradford, England
  • 3Medical Physics, University Hospitals of Leicester, Leicester, England
JAMA Ophthalmol. 2016;134(12):1347-1353. doi:10.1001/jamaophthalmol.2016.3793
Key Points

Question  Can monitoring adherence to glasses wearing objectively help understand patient outcomes during amblyopia treatment?

Findings  In this observational cohort study, objective monitoring of adherence to glasses wearing was reliable and feasible. Adherence to glasses wearing in children was highly variable but, along with age and type of amblyopia, was associated with visual outcome at the end of the optical treatment.

Meaning  This study supports the importance of encouraging good adherence to glasses wearing in addition to other forms of treatment for some cases of amblyopia.


Importance  Occlusion dose monitors have helped establish that better adherence to occlusion is associated with improved visual outcomes in patients undergoing amblyopia treatment. However, the role of adherence to glasses wearing is unknown.

Objectives  To establish the feasibility and reliability of objectively monitoring adherence to glasses wearing using age-based norms, establish the association between adherence to glasses wearing and improvement in visual acuity (VA) after optical treatment and occlusion therapy, and analyze the effect of age, sex, refractive errors, type of amblyopia, and adherence to glasses wearing on improvement in VA.

Design, Setting, and Participants  A prospective, observational, nonmasked, cohort study was conducted between June 8, 2008, and June 30, 2013, among patients at a pediatric ophthalmology clinic of a tertiary care hospital who were newly diagnosed with anisometropic and/or strabismic amblyopia and had not undergone previous treatment. The study consisted of a glasses phase (18 weeks) and a patching phase (glasses and occlusion for 10 hours per day for 12 weeks). Reliability of the glasses monitors was assessed by comparing diary entries and monitor recordings in adults.

Interventions  Objective monitoring of glasses wearing and occlusion.

Main Outcomes and Measures  Adherence to glasses wearing (hours per day) and effect on VA.

Results  Among 20 children with anisometropia (mean [SD] age, 6.20 [2.16] years; 11 boys and 9 girls) and 20 with strabismic or mixed amblyopia (mean [SD] age, 4.90 [1.36] years; 10 boys and 10 girls), adherence to glasses wearing was successfully monitored in all but 1 patient. Agreement between diaries and monitored times wearing glasses in adults was high (intraclass correlation coefficient, 1.00; 95% CI, 0.999-1.00). Median (SD) adherence to glasses wearing was 70% (25.3%). A moderate correlation was observed between adherence to glasses wearing and percentage improvement in VA during the glasses phase (r = 0.462; P = .003). Multiple regression revealed that age (β = –0.535; P = .001), type of amblyopia (β = –0.347; P = .02), and adherence to glasses wearing (β = 0.287; P = .04) were independently associated with improvement in VA after the glasses phase and explained 42% of the variability (F3,35 = 8.457; P < .001). A strong correlation between glasses wearing and occlusion adherence was observed (r = 0.719; P < .001).

Conclusions and Relevance  The results suggest that adherence to glasses wearing is less than optimal and highly variable but is important in achieving good VA. This study emphasizes the importance of encouraging children to not only have good adherence to occlusion therapy but also to glasses wearing.