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Increasing Patching for Amblyopia in Children 3 to < 8 Years Old (ATS15)

This study has been completed.
Sponsor:
Collaborator:
National Eye Institute (NEI)
Information provided by (Responsible Party):
Jaeb Center for Health Research
ClinicalTrials.gov Identifier:
NCT00945100
First received: July 21, 2009
Last updated: July 12, 2016
Last verified: July 2016
Results First Received: September 6, 2013  
Study Type: Interventional
Study Design: Allocation: Randomized;   Endpoint Classification: Efficacy Study;   Intervention Model: Parallel Assignment;   Masking: Open Label;   Primary Purpose: Treatment
Condition: Amblyopia
Intervention: Device: Eye Patch

  Participant Flow
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Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
Between September 2009 and December 2012, 45 sites randomized 169 participants to either increase patching time to an average of 6 hours per day (n=86) or continue 2 hours daily patching (n=83).

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
Prior to being considered for the randomized trial, participants who had not already completed at least 12 weeks of 2 hours of daily patching were enrolled into a run-in phase and treated with 2 hours of daily patching (and spectacles if needed) with follow-up every 6 weeks until no improvement.

Reporting Groups
  Description
Control 2 hours daily patching
Intensified Treatment 42 hours per week of patching (averaging 6 hours daily)

Participant Flow for 2 periods

Period 1:   10-week Primary Outcome
    Control   Intensified Treatment
STARTED   83   86 
Completed, Eligible   55 [1]   63 [1] 
Completed, Not Eligible   27 [2]   20 [2] 
COMPLETED   82   83 
NOT COMPLETED   1   3 
[1] Eligible for Post-10 week phase
[2] Not Eligible for Post-10 week phase

Period 2:   Post-10 Week Primary Outcome
    Control   Intensified Treatment
STARTED   55 [1]   63 [2] 
COMPLETED   51   56 
NOT COMPLETED   4   7 
[1] 27 participants were not eligible for Post 10 week Primary Outcome phase
[2] 20 participants were not eligible for Post 10 week Primary Outcome phase



  Baseline Characteristics
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Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
Control 2 hours daily patching
Intensified Treatment 42 hours per week of patching (averaging 6 hours daily)
Total Total of all reporting groups

Baseline Measures
   Control   Intensified Treatment   Total 
Overall Participants Analyzed 
[Units: Participants]
 83   86   169 
Age 
[Units: Participants]
     
<=18 years   83   86   169 
Between 18 and 65 years   0   0   0 
>=65 years   0   0   0 
Age 
[Units: Years]
Mean (Standard Deviation)
 5.9  (1.3)   5.9  (1.2)   5.9  (1.3) 
Age, Customized [1] 
[Units: Participants]
     
3 to <4 years   5   8   13 
4 to <5 years   15   15   30 
5 to <6 years   27   19   46 
6 to <7 years   17   25   42 
7 to 8 years   19   19   38 
[1]

Baseline age reflects age at randomization.

The age eligibility requirement at enrollment was 3 to <8 years old, however, there were 7 participants who were enrolled into the run-in phase that were 8 years old by the time they were randomized.

Gender 
[Units: Participants]
     
Female   43   43   86 
Male   40   43   83 
Race/Ethnicity, Customized 
[Units: Participants]
     
White   57   66   123 
Black/African American   8   2   10 
Hispanic   14   14   28 
Asian   2   3   5 
More than one race   2   1   3 
Region of Enrollment 
[Units: Participants]
     
United States   80   82   162 
United Kingdom   3   3   6 
Canada   0   1   1 
Enrollment Disposition [1] 
[Units: Participants]
     
No current treatment   48   49   97 
On treatment   18   18   36 
Ready for randomization   17   19   36 
[1] Participants were classified into 3 groups (no current treatment, on treatment, ready for randomization) according to their treatment disposition at enrollment.
Duration of patching prior to randomization (weeks) 
[Units: Participants]
     
12 to <16 weeks   14   21   35 
16 to <25 weeks   39   31   70 
25 weeks or more   30   34   64 
Duration of patching prior to randomization (weeks) 
[Units: Weeks]
Mean (Standard Deviation)
 24.5  (10.7)   24.4  (11.9)   24.4  (11.3) 
Amblyopia Cause [1] 
[Units: Participants]
     
Strabismus   16   16   32 
Anisometropia   41   34   75 
Strabismus and Anisometropia   26   36   62 
[1]

Amblyopia associated with strabismus (comitant or incomitant), anisometropia, or both:

Criteria for strabismus: At least one of the following:

  1. Heterotropia at distance and/or near fixation on examination (with or without spectacles)
  2. History of strabismus surgery
  3. Documented history which is no longer present (which in the judgement of the investigator could have caused amblyopia)

Criteria for anisometropia: At least one of the following:

  1. At least 0.50 D difference between eyes in spherical equivalent
  2. At least 1.50 D different between eyes in astigmatism in any meridian
Best distance visual acuity in the amblyopic eye at randomization [1] 
[Units: Participants]
     
20/160   2   3   5 
20/125   3   1   4 
20/100   2   7   9 
20/80   6   6   12 
20/63   17   21   38 
20/50   26   24   50 
20/40   21   18   39 
20/32   6   6   12 
[1]

Visual acuity was measured without cycloplegia using the participant's optimal spectacle correction (if applicable) by a study-certified tester using the ATS-HOTV protocol on the Electronic Visual Acuity Tester.

Best amblyopic eye visual acuity was computed as the better of the initial test and retest visual acuities at randomization.

Best distance visual acuity in the amblyopic eye at randomization [1] 
[Units: logMAR]
Mean (Standard Deviation)
 0.43  (0.15)   0.45  (0.16)   0.44  (0.16) 
[1]

Visual acuity was measured without cycloplegia using the participant's optimal spectacle correction (if applicable) by a study-certified tester using the ATS-HOTV protocol on the Electronic Visual Acuity Tester.

Best amblyopic eye visual acuity was computed as the better of the initial test and retest visual acuities at randomization.

Best distance visual acuity in the fellow eye at randomization [1] 
[Units: Participants]
     
20/32   5   5   10 
20/25   17   21   38 
20/20   27   26   53 
20/16   34   34   68 
[1]

Visual acuity was measured without cycloplegia using the participant's optimal spectacle correction (if applicable) by a study-certified tester using the ATS-HOTV protocol on the Electronic Visual Acuity Tester.

Best fellow eye visual acuity was computed as the better of the initial test and retest visual acuities at randomization.

Best distance visual acuity in the fellow eye at randomization [1] 
[Units: logMAR]
Mean (Standard Deviation)
 -0.01  (0.09)   0.00  (0.09)   -0.01  (0.09) 
[1]

Visual acuity was measured without cycloplegia using the participant's optimal spectacle correction (if applicable) by a study-certified tester using the ATS-HOTV protocol on the Electronic Visual Acuity Tester.

Best fellow eye visual acuity was computed as the better of the initial test and retest visual acuities at randomization.

Best interocular eye visual acuity difference at randomization [1] 
[Units: logMAR lines]
Mean (Standard Deviation)
 4.4  (1.6)   4.5  (1.7)   4.5  (1.7) 
[1] Best interocular eye visual acuity difference was computed as difference between the best amblyopic eye visual acuity and the best fellow eye visual acuity at randomization.
Refractive error in amblyopic eye at enrollment 
[Units: Participants]
     
0 to <+1.00D   9   3   12 
+1.00 D to <+2.00 D   5   3   8 
+2.00 D to <+3.00 D   2   4   6 
+3.00 D to <+4.00 D   13   6   19 
+4.00 D or more   54   70   124 
Refractive error in amblyopic eye at enrollment 
[Units: Diopters]
Mean (Standard Deviation)
 4.58  (2.26)   5.27  (1.94)   4.93  (2.12) 
Refractive error in fellow eye at enrollment 
[Units: Participants]
     
<0 D   1   1   2 
0 to <+1.00D   22   14   36 
+1.00 D to <+2.00 D   30   19   49 
+2.00 D to <+3.00 D   10   14   24 
+3.00 D to <+4.00 D   4   12   16 
+4.00 D or more   16   26   42 
Refractive error in fellow eye at enrollment 
[Units: Diopters]
Mean (Standard Deviation)
 2.10  (1.86)   2.89  (2.06)   2.50  (2.00) 


  Outcome Measures
  Show All Outcome Measures

1.  Primary:   Distribution of 10-week Amblyopic Eye Visual Acuity   [ Time Frame: 10 weeks after randomization ]

2.  Primary:   Mean 10-week Amblyopic Eye Visual Acuity   [ Time Frame: 10 weeks after randomization ]

3.  Primary:   Distribution of the Change in Amblyopic Eye Visual Acuity at 10 Weeks From Randomization   [ Time Frame: Randomization to 10 weeks ]

4.  Primary:   Mean Change in Amblyopic Eye Visual Acuity at 10 Weeks From Randomization   [ Time Frame: Randomization to 10 weeks ]

5.  Secondary:   Compliance With Prescribed Patching by Treatment Group at 10 Weeks   [ Time Frame: 10 weeks after randomization ]

6.  Secondary:   Average Compliance With Prescribed Patching by Treatment Group   [ Time Frame: 10 weeks after randomization or later ]

7.  Secondary:   Treatment Group Comparison of the Proportion of Participants Who Have Improved by 2 or More logMAR Visual Acuity Lines at 10 Weeks Since Randomization   [ Time Frame: 10 weeks after randomization ]

8.  Secondary:   Treatment Group Comparison of 10-week Interocular Difference   [ Time Frame: 10 weeks after randomization ]

9.  Secondary:   Distribution of Baseline Characteristics at the 10-week Outcome   [ Time Frame: 10 weeks after randomization ]

10.  Secondary:   Mean Amblyopic Eye Visual at Randomization According to Baseline Characteristics for 10-week Outcome   [ Time Frame: 10 weeks after randomization ]

11.  Secondary:   Treatment Comparison of Mean Amblyopic Eye Visual Acuity Change at 10-weeks According to Baseline Characteristics   [ Time Frame: 10 weeks after randomization ]

12.  Secondary:   Distribution of Amblyopic Eye Visual Acuity at Visit of Best Post-randomization Visual Acuity   [ Time Frame: 10 weeks after randomization or later ]

13.  Secondary:   Mean Amblyopic Eye Visual Acuity at Visit of Best Post-randomization Visual Acuity   [ Time Frame: 10 weeks after randomization or later ]

14.  Secondary:   Distribution of the Change in Best Post-randomization Visual Acuity in the Amblyopic Eye   [ Time Frame: Randomization to 10 weeks or later ]

15.  Secondary:   Mean Change in Amblyopic Eye Visual Acuity Since Randomization at Visit of Best Post-randomization Visual Acuity   [ Time Frame: 10 weeks after randomization or later ]

16.  Secondary:   Treatment Group Comparison of the Proportion of Participants Who Have Improved by 2 or More logMAR Visual Acuity Lines Based on Visual Acuity at Best Post-randomization Visit   [ Time Frame: 10 weeks after randomization or later ]

17.  Secondary:   Distribution of Best Fellow Eye Visual Acuity at 10-week Outcome   [ Time Frame: 10 weeks after randomization ]

18.  Secondary:   Mean Best Fellow Eye Visual Acuity at 10-week Outcome   [ Time Frame: 10 weeks after randomization ]

19.  Secondary:   Distribution of Best Fellow Eye Visual Acuity at Final Visit   [ Time Frame: 10 weeks after randomization or later ]

20.  Secondary:   Mean Best Fellow Eye Visual Acuity at Final Visit   [ Time Frame: 10 weeks after randomization or later ]

21.  Secondary:   Distribution of Change in Best Fellow Eye Visual Acuity Since Randomization at 10 Weeks   [ Time Frame: 10 weeks after randomization ]

22.  Secondary:   Mean Change in Best Fellow Eye Visual Acuity Since Randomization at 10 Weeks   [ Time Frame: 10 weeks after randomization ]

23.  Secondary:   Distribution of Change in Best Fellow Eye Visual Acuity Since Randomization at Final Visit   [ Time Frame: 10 weeks after randomization or later ]

24.  Secondary:   Mean Change in Best Fellow Eye Visual Acuity Since Randomization at Final Visit   [ Time Frame: 10 weeks after randomization or later ]

25.  Secondary:   Distribution of Randot Preschool Stereoacuity Scores at Randomization   [ Time Frame: Randomization ]

26.  Secondary:   Distribution of Randot Preschool Stereoacuity Scores at 10 Weeks   [ Time Frame: 10 weeks after randomization ]

27.  Secondary:   Change in Randot Preschool Stereoacuity Level at 10-week Outcome Since Randomization   [ Time Frame: 10 weeks after randomization ]

28.  Secondary:   Distribution of Randot Preschool Stereoacuity Scores at Randomization for Participants With Anisometropic Amblyopia   [ Time Frame: Randomization ]

29.  Secondary:   Distribution of Randot Preschool Stereoacuity Scores at 10 Weeks for Participants With Anisometropic Amblyopia   [ Time Frame: 10 weeks after randomization ]

30.  Secondary:   Change in Randot Preschool Stereoacuity Level at 10-week Outcome Since Randomization for Participants With Anisometropic Amblyopia   [ Time Frame: 10 weeks after randomization ]


  Serious Adverse Events


  Other Adverse Events
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Additional Description No text entered.

Frequency Threshold
Threshold above which other adverse events are reported   5  

Reporting Groups
  Description
Control 2 hours daily patching
Intensified Treatment 42 hours per week of patching (averaging 6 hours daily)

Other Adverse Events
    Control   Intensified Treatment
Total, other (not including serious) adverse events     
# participants affected / at risk   6/83 (7.23%)   4/86 (4.65%) 
Eye disorders     
New ocular deviation or worsening of preexisting deviation by at least 10 pd     
# participants affected / at risk   6/83 (7.23%)   4/86 (4.65%) 
# events   7   7 
* Events were collected by non-systematic assessment



  Limitations and Caveats
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Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
A potential study limitation is that compliance with patching was based on discussions with the parent and by reviewing study calendars maintained by the parent, which not an objective measure of compliance.


  More Information