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Trial Comparing Patching Versus Atropine for Amblyopia in 7 to < 13 Year Olds (ATS9)

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ClinicalTrials.gov Identifier: NCT00315328
Recruitment Status : Completed
First Posted : April 18, 2006
Results First Posted : June 6, 2011
Last Update Posted : June 24, 2016
Sponsor:
Collaborator:
National Eye Institute (NEI)
Information provided by (Responsible Party):
Ray Kraker, Jaeb Center for Health Research

Brief Summary:

The purpose of this study is:

  • To compare the effectiveness of weekend atropine plus near activities and daily patching plus near activities for moderate amblyopia (20/40 to 20/100) and severe amblyopia (20/125 to 20/400) in improving vision in the amblyopic eye of 7 to <13 year olds.
  • To determine the maximum improvement in vision of the amblyopic eye with each treatment.
  • To determine whether amblyopia is associated with structural abnormalities of optic nerve fiber layer.

Condition or disease Intervention/treatment Phase
Amblyopia Drug: Atropine Device: Patching Procedure: Near activities Phase 3

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 233 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Trial Comparing Patching Versus Atropine for Amblyopia in 7 to < 13 Year Olds
Study Start Date : August 2005
Actual Primary Completion Date : December 2007
Actual Study Completion Date : January 2008

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Amblyopia

Arm Intervention/treatment
Active Comparator: Patching
Patching 2 hours per day plus near activities for one hour while patching (with increase to 4 hours per day for moderate amblyopes and >4 hours per day for severe amblyopes at 5 weeks if acuity not improved at least 5 letters)
Device: Patching
Patching 2 hours per day
Other Name: Coverlet, 3M Opticlude, Ortopad®

Procedure: Near activities
near visual activities for at least one hour per day

Active Comparator: Atropine
Atropine 1% once each weekend day in the sound eye plus near activities for at least one hour every day (with increase to daily atropine at 5 weeks if acuity not improved by at least 5 letters)
Drug: Atropine
Atropine 1% each weekend day in the sound eye

Procedure: Near activities
near visual activities for at least one hour per day




Primary Outcome Measures :
  1. Distribution of Visual Acuity in the Amblyopic Eye at 17 Weeks [ Time Frame: 17 weeks ]
    Visual acuity was measured in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best.

  2. Mean Visual Acuity in the Amblyopic Eye at 17 Weeks [ Time Frame: 17 weeks ]
    Visual acuity was measured in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best.

  3. Distribution of Change in Visual Acuity in the Amblyopic Eye From Baseline to 17 Weeks [ Time Frame: Baseline to 17 weeks ]

    Visual acuity was measured at baseline and 17 weeks in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best. A difference between the scores at baseline and 17 weeks was calculated.

    A positive difference indicates acuity was better at 17 weeks than at baseline; a negative difference indicates acuity was worse at 17 weeks.


  4. Mean Change in Visual Acuity in the Amblyopic Eye From Baseline to 17 Weeks [ Time Frame: Baseline to 17 weeks ]

    Visual acuity was measured at baseline and 17 weeks in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best. A difference between the scores at baseline and 17 weeks was calculated.

    A positive difference indicates acuity was better at 17 weeks than at baseline; a negative difference indicates acuity was worse at 17 weeks.



Secondary Outcome Measures :
  1. Stereoacuity Measured by the Randot Preschool Test at 17 or 19 Weeks- Participants With All Causes of Moderate Amblyopia [ Time Frame: 17 or 19 weeks ]
    The Randot Preschool Stereotest measures stereopsis from 800 to 40 seconds of arc on patients as young as 2 years of age. This Stereotest is designed as a matching game in which the patient matches pictures in a test booklet wearing special glasses. A subject can fail the pretest (not see any pictures) or can score >800 (the worst), 800, 400, 200, 100, 60, or 40 (the best) seconds of arc. If two shapes are identified correctly the patient progresses to the next lower stereoacuity level. A failed test occurs when the patient cannot identify any shapes.

  2. Stereoacuity Measured by the Randot Preschool Test at 17 or 19 Weeks- Anisometropic Participants With Moderate Amblyopia Only [ Time Frame: 17 or 19 weeks ]
    The Randot Preschool Stereotest measures stereopsis from 800 to 40 seconds of arc on patients as young as 2 years of age. This Stereotest is designed as a matching game in which the patient matches pictures in a test booklet wearing special glasses. A subject can fail the pretest (not see any pictures) or can score >800 (the worst), 800, 400, 200, 100, 60, or 40 (the best) seconds of arc. If two shapes are identified correctly the patient progresses to the next lower stereoacuity level. A failed test occurs when the patient cannot identify any shapes.

  3. Stereoacuity Measured by the Randot Preschool Test at 17 or 19 Weeks- Participants With Moderate Amblyopia From Strabismus Only or Combined Mechanism [ Time Frame: 17 or 19 weeks ]
    The Randot Preschool Stereotest measures stereopsis from 800 to 40 seconds of arc on patients as young as 2 years of age. This Stereotest is designed as a matching game in which the patient matches pictures in a test booklet wearing special glasses. A subject can fail the pretest (not see any pictures) or can score >800 (the worst), 800, 400, 200, 100, 60, or 40 (the best) seconds of arc. If two shapes are identified correctly the patient progresses to the next lower stereoacuity level. A failed test occurs when the patient cannot identify any shapes.

  4. Stereoacuity Measured by the Randot Preschool Test at 17 or 19 Weeks- Participants With All Causes of Moderate Amblyopia [ Time Frame: 17 or 19 weeks ]
    Stereoacuity is scored as seconds of arc with values of: <800, 800, 400, 200, 100, 60, 40. The lower the arc second value, the better the score (i.e. 40 arc sec is best stereoacuity; <800 is the worst). A change score was defined as the difference between baseline and outcome in score level (i.e. moving from 800 at baseline to 400 at outcome is one level change, moving from 800 to 200 is two levels, etc.) change in levels was categorized as "within one level" meaning change was -1, 0, or +1.

  5. Amblyopia Treatment Index - Social Stigma (Moderate Amblyopia Only) [ Time Frame: 17 weeks ]
    Questionnaire scores on the Social Stigma subscale of the Amblyopia Treatment Index. Questions were evaluated on a likert type scale as strongly agree (5) to strongly disagree (1), with a higher number indicating worse response.

  6. Amblyopia Treatment Index - Compliance (Moderate Amblyopia Only) [ Time Frame: 17 weeks ]
    Questionnaire scores on the compliance subscale of the Amblyopia Treatment Index. Questions were evaluated on a likert type scale as strongly agree (5) to strongly disagree (1), with a higher number indicating worse response.

  7. Amblyopia Treatment Index - Adverse Effects Scale (Moderate Amblyopia Only) [ Time Frame: 17 weeks ]
    Questionnaire scores on the adverse events subscale of the Amblyopia Treatment Index. Questions were evaluated on a likert type scale as strongly agree (5) to strongly disagree (1), with a higher number indicating worse response.

  8. Distribution of Visual Acuity in the Fellow Eye at 17 Weeks [ Time Frame: 17 weeks ]
    Visual acuity was measured in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best.

  9. Mean Visual Acuity in the Fellow Eye at 17 Weeks [ Time Frame: 17 weeks ]
    Visual acuity was measured in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best.

  10. Distribution of Change in Visual Acuity in the Fellow Eye From Baseline to 17 Weeks [ Time Frame: Baseline to 17 weeks ]

    Visual acuity was measured at baseline and 17 weeks in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best. A difference between the scores at baseline and 17 weeks was calculated.

    A positive difference indicates acuity was better at 17 weeks than at baseline; a negative difference indicates acuity was worse at 17 weeks.


  11. Mean Change in Visual Acuity in the Fellow Eye From Baseline to 17 Weeks [ Time Frame: Baseline to 17 weeks ]

    Visual acuity was measured at baseline and 17 weeks in each eye using the electronic early treatment diabetic retinopathy study (E-ETDRS) method which resulted in a letter score that could range from 0 to 97 letters, with 0 being the worst and 97 being the best. A difference between the scores at baseline and 17 weeks was calculated.

    A positive difference indicates acuity was better at 17 weeks than at baseline; a negative difference indicates acuity was worse at 17 weeks.




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Ages Eligible for Study:   7 Years to 12 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 7 to 12 years old (inclusive)
  • Amblyopia associated with strabismus, anisometropia, or both
  • Visual acuity in the amblyopic eye 19 to 71 letters on Electronic Early Treatment Diabetic Retinopathy Study (E-ETDRS©) (20/40 to 20/400 inclusive)
  • Visual acuity in the sound eye 79 letters or better on E-ETDRS© (20/25 or better)
  • Interocular difference >=15 letters (3 lines)
  • Spectacles, if needed, worn for at least 16 weeks or visual acuity documented to be stable

Inclusion Criteria for Optional Ancillary Study:

  • Enrolled into the main study
  • Refractive error in both eyes between -0.25 and +5.00D, inclusive (to avoid the need to adjust for refractive error)
  • Birth weight >1500 grams
  • No history of Central Nervous System (CNS) disease (e.g. intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), meningitis, developmental abnormalities of the brain, hydrocephalus, cerebral palsy, hypoxic ischemic encephalopathy

Exclusion Criteria:

  • Amblyopia treatment (other than spectacles) in the last 6 months
  • Myopia (more than -0.25D spherical equivalent) in either eye

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00315328


Locations
United States, Pennsylvania
Pennsylvania College of Optometry
Philadelphia, Pennsylvania, United States, 19141
Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States, 15213
Sponsors and Collaborators
Jaeb Center for Health Research
National Eye Institute (NEI)
Investigators
Study Chair: Richard W. Hertle, M.D. University of Pittsburgh
Study Chair: Mitchell M. Scheiman, O.D. Pennsylvania College of Optometry

Additional Information:
Publications of Results:
Other Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Ray Kraker, Director, PEDIG Coordinating Center, Jaeb Center for Health Research
ClinicalTrials.gov Identifier: NCT00315328     History of Changes
Other Study ID Numbers: NEI-119
2U10EY011751 ( U.S. NIH Grant/Contract )
First Posted: April 18, 2006    Key Record Dates
Results First Posted: June 6, 2011
Last Update Posted: June 24, 2016
Last Verified: May 2016

Keywords provided by Ray Kraker, Jaeb Center for Health Research:
Amblyopia
Atropine
Patching

Additional relevant MeSH terms:
Amblyopia
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vision Disorders
Sensation Disorders
Neurologic Manifestations
Eye Diseases
Signs and Symptoms
Atropine
Adjuvants, Anesthesia
Anti-Arrhythmia Agents
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Mydriatics
Parasympatholytics
Muscarinic Antagonists
Cholinergic Antagonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action