title: Clinical translation of recommendations from randomized clinical trials on patching regimen for amblyopia.
abstract: OBJECTIVE
  To investigate whether the evidence-based recommendations by the Pediatric Eye Disease Investigator Group (PEDIG) as initial treatment of amblyopia have been implemented into clinical practice and to discuss the necessary steps in translating evidence-based knowledge to inform clinical decision making.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Children with amblyopia seen from 2007 through 2009 by academic and community ophthalmologists in a large urban center in North America that serves a population of more than 8 million. Using PEDIG criteria, moderate amblyopia was defined as visual acuity between 20/40 and 20/80 and severe amblyopia was defined as visual acuity between 20/100 and 20/400.
  
  
  METHODS
  Patching of the sound eye.
  
  
  METHODS
  The number of prescribed patching hours daily and the amblyopic eye visual acuity expressed as logarithm of the minimum angle of resolution (logMAR).
  
  
  RESULTS
  For moderate amblyopia, the cohort (n = 71) was prescribed a mean of 3.2 hours of daily patching (95% confidence interval [CI]: 2.8-3.6 hours), which is significantly greater than the recommended 2 hours of daily patching for initial treatment. Only 24% (95% CI, 16%-35%) of them were prescribed the recommended initial patching hours. The amblyopic eye acuity on the 3- to 6-month visit in the cohort (0.23 logMAR) was similar to that of the 4-month visit in the PEDIG cohort (0.24 logMAR; P = 0.74). For severe amblyopia, the cohort (n = 52) was prescribed a mean of 3.9 hours of daily patching (95% CI, 3.5-4.3 hours), which is significantly lower than the recommended 6 hours of daily patching for initial treatment. Only 12% (95% CI, 5%-23%) of them were prescribed the recommended initial patching hours. The amblyopic eye acuity at the 7- to 12-month visit in the cohort (0.44 logMAR) was comparable with that of the 4-month visit in the PEDIG cohort (0.40 logMAR; P = 0.35).
  
  
  CONCLUSIONS
  The evidence-based recommendations for amblyopia management have not been translated widely into changes in clinical practice in a large urban center in North America, although there is a general move from full-time to part-time patching since the PEDIG results were published. Using a well-established framework for knowledge translation, the Knowledge-to-Action Cycle, the necessary steps required to implement new knowledge into actual clinical practice are discussed.
authors: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada. Yaping.Jin@utoronto.ca
authors: Ya-Ping
authors: YP
authors: Jin
authors: Amy H Y
authors: AH
authors: Chow
authors: Linda
authors: L
authors: Colpa
authors: Agnes M F
authors: AM
authors: Wong
mesh_terms: D000550:Amblyopia / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009864:Ontario; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012683:Sensory Deprivation; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity