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Acupuncture for Amblyopia: Study Design Considerations—Reply

Acupuncture for Amblyopia: Study Design Considerations—Reply In reply We thank Dr Wallace for his interest in our article.1 We agree that factors such as new or recent change in spectacle prescription might lead to visual improvement. However, this is less likely in our study, as children were eligible only if they had worn optimal spectacles for at least 16 weeks (washout period) prior to enrollment. During the washout period, we measured the visual acuity of all children every 5 (±1) weeks. Spectacle prescriptions were changed, if needed, according to standard clinical practice. The new spectacles must have been worn for at least 5 weeks prior to the screening visit. If the visual acuity was 1 line (or more) better than that of the previous visit, another screening visit would be scheduled. This process was repeated until no significant visual acuity improvement was detected between 2 consecutive visits. We acknowledge the concern of Dr Wallace that the disparate frequency of office visits may have affected the primary outcome. Indeed, we had arranged different rooms on different floors of the hospital for follow-up clinic visits that included visual acuity testing and acupuncture treatment respectively. The number of clinic follow-up visits was the same (1 visit per 5 weeks) for both study groups. Moreover, visual improvement should be the main motivator for good compliance with assigned treatments and/or trying one's best to perform during visual acuity testing. Because the treatment effect was equivalent between acupuncture and patching in our study, such a confounding effect, even if present, would be relatively mild. Finally, we agree that selection of the patching method is crucial. However, it is also important to make sure that there is optimal training of the amblyopic eye during patching of the sound eye. In our study, we requested that parents monitor their children and encourage them to use the nonpatched eye during the occlusion therapy.1 Moreover, the visual acuity outcomes in the patching group of our study were comparable with previous studies using other patching methods.2 Lastly, other occlusion methods and regimens can always be considered in future studies. Back to top Article Information Correspondence: Dr Lam, Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong 515041, China (dennislam_pub@jsiec.org). Financial Disclosure: None reported. References 1. Zhao J, Lam DS, Chen LJ, et al. Randomized controlled trial of patching vs acupuncture for anisometropic amblyopia in children aged 7 to 12 years. Arch Ophthalmol. 2010;128(12):1510-151721149771PubMedGoogle ScholarCrossref 2. Scheiman MM, Hertle RW, Kraker RT, et al; Pediatric Eye Disease Investigator Group. Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial. Arch Ophthalmol. 2008;126(12):1634-164219064841PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Acupuncture for Amblyopia: Study Design Considerations—Reply

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References (2)

Publisher
American Medical Association
Copyright
Copyright © 2011 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archophthalmol.2011.240
Publisher site
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Abstract

In reply We thank Dr Wallace for his interest in our article.1 We agree that factors such as new or recent change in spectacle prescription might lead to visual improvement. However, this is less likely in our study, as children were eligible only if they had worn optimal spectacles for at least 16 weeks (washout period) prior to enrollment. During the washout period, we measured the visual acuity of all children every 5 (±1) weeks. Spectacle prescriptions were changed, if needed, according to standard clinical practice. The new spectacles must have been worn for at least 5 weeks prior to the screening visit. If the visual acuity was 1 line (or more) better than that of the previous visit, another screening visit would be scheduled. This process was repeated until no significant visual acuity improvement was detected between 2 consecutive visits. We acknowledge the concern of Dr Wallace that the disparate frequency of office visits may have affected the primary outcome. Indeed, we had arranged different rooms on different floors of the hospital for follow-up clinic visits that included visual acuity testing and acupuncture treatment respectively. The number of clinic follow-up visits was the same (1 visit per 5 weeks) for both study groups. Moreover, visual improvement should be the main motivator for good compliance with assigned treatments and/or trying one's best to perform during visual acuity testing. Because the treatment effect was equivalent between acupuncture and patching in our study, such a confounding effect, even if present, would be relatively mild. Finally, we agree that selection of the patching method is crucial. However, it is also important to make sure that there is optimal training of the amblyopic eye during patching of the sound eye. In our study, we requested that parents monitor their children and encourage them to use the nonpatched eye during the occlusion therapy.1 Moreover, the visual acuity outcomes in the patching group of our study were comparable with previous studies using other patching methods.2 Lastly, other occlusion methods and regimens can always be considered in future studies. Back to top Article Information Correspondence: Dr Lam, Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong 515041, China (dennislam_pub@jsiec.org). Financial Disclosure: None reported. References 1. Zhao J, Lam DS, Chen LJ, et al. Randomized controlled trial of patching vs acupuncture for anisometropic amblyopia in children aged 7 to 12 years. Arch Ophthalmol. 2010;128(12):1510-151721149771PubMedGoogle ScholarCrossref 2. Scheiman MM, Hertle RW, Kraker RT, et al; Pediatric Eye Disease Investigator Group. Patching vs atropine to treat amblyopia in children aged 7 to 12 years: a randomized trial. Arch Ophthalmol. 2008;126(12):1634-164219064841PubMedGoogle ScholarCrossref

Journal

Archives of Ophthalmology – American Medical Association

Published: Sep 12, 2011

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