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AmblyopiaPhase 3ATS15NCT00945100

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

A Phase 3 study testing Eye Patch in people with Amblyopia, run by Jaeb Center for Health Research at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study is designed to evaluate the effectiveness of increasing prescribed patching treatment from 2 to 6 daily hours after visual acuity has stabilized with initial treatment and amblyopia is still present. Read more about this study

Who is it for?
Ages 3 to 7 years
Conditions the study is for
Amblyopia
What is being tested?
Eye Patch
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
169 participants
Where
2 sitesUnited States
Study dates
Aug 2009to Mar 2013
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 3 to 7 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Major Eligibility Criteria for Run-in Phase
  • Age 3 to < 8 years
  • Amblyopia associated with strabismus, anisometropia, or both
  • Visual acuity in the amblyopic eye between 20/50 and 20/400 inclusive
  • Visual acuity in the sound eye 20/32 or better and inter-eye acuity difference >3 logMAR lines
  • Amblyopia treatment within the past 6 months subject to the following stipulations:
Show all 16Show fewer
  • No more than 6 weeks of any amblyopia treatment other than spectacles (except for patients being treated with 2 hours of patching per day who are entering the study on treatment)
  • No simultaneous treatment with patching and atropine
  • No use of atropine in combination with the sound eye spectacle lens reduced by more than 1.50 D
  • Maximum level of treatment within the past 6 months:
  • Patching: up to 2 hours daily
  • Atropine: up to once daily
  • Wearing spectacles with optimal correction (if applicable); if amblyopic eye acuity is 20/80 or better, then VA must be stable in glasses. If amblyopic eye acuity is 20/100 or worse, then spectacles and patching can be initiated simultaneously.
  • Eligibility Criteria for Randomization:
  • Amblyopic eye acuity of 20/40 to 20/160 with an inter-ocular difference of >2 lines, or amblyopic eye acuity of 20/32 with 3 lines of IOD.
  • Reasonable compliance with prescribed treatment, defined as wearing the patch at least 10 hours per week.

Who cannot join

  • Currently using vision therapy or orthoptics
  • Ocular cause for reduced visual acuity (nystagmus per se does not exclude the patient if the above visual acuity criteria are met)
  • Prior intraocular or refractive surgery
  • Known skin reaction to patch or bandage adhesives

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Duke University Eye Center

    Durham, North Carolina, 27710

  • Southern California College of Optometry

    Fullerton, California, 92831

Other trials in United States

About this study

This study is designed to evaluate the effectiveness of increasing prescribed patching treatment from 2 to 6 daily hours after visual acuity has stabilized with initial treatment and amblyopia is still present. Children ages 3 to <8 years with visual acuity of 20/50 to 20/400 in the amblyopic eye will be enrolled in a run-in phase with 2 hours daily patching until no improvement, followed by randomization of eligible patients to patching 2 hours daily versus an average of 6 hours daily (42 hours per week). The primary objective is to determine if increasing patching dosage will improve visual acuity in patients with amblyopia still present after visual acuity has stabilized with initial treatment.

Read the detailed description

Amblyopia is the most common cause of monocular visual impairment in both children and young and middle-aged adults. Both patching and atropine are accepted treatment modalities for the management of moderate amblyopia in children.1 Many practitioners prescribe 2 hours daily patching as initial therapy for amblyopia. However, many children fail to achieve normal visual acuity in the amblyopic eye with this regimen. In a randomized trial conducted by PEDIG comparing patching regimens, 71 of 92 patients with moderate amblyopia (77%) had amblyopic eye visual acuity of 20/32 or worse after 4 months of patching 2 hours daily.2 In another PEDIG randomized trial comparing patching to spectacles alone after a period of refractive adaptation, patients were treated with 2 hours daily patching and followed every 5 weeks until there was no improvement in amblyopic eye acuity. Fifty-five of 70 patients with moderate amblyopia (79%) and 14 of 14 patients with severe amblyopia (100%) had best-measured amblyopic eye visual acuity of 20/32 or worse after a median treatment period of 10 weeks.3 When improvement with initial therapy stops and amblyopia is still present, treatment options include increasing the dosage of current treatment, switching to another treatment, maintaining the same treatment and dosage for additional months, or combining treatments. Many clinicians will choose to increase the dosage of the current treatment, in part because families have become comfortable with that particular mode of treatment. However, it is unknown whether increasing occlusion dosage will improve amblyopic eye visual acuity in these patients. We are unaware of any reports of response to intensified treatment of amblyopia.

Conditions
Amblyopia
Being tested
Eye Patch
Keywords
Amblyopia, patching, occlusion
Medical subject headings
Amblyopia, Bites and Stings

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Eye PatchDevice

    Also called Coverlet, 3M Opticlude, Ortopad

    42 hours patching per week (averaging 6 hours patching daily)

  • Eye PatchDevice

    Also called Coverlet, 3M Opticlude, Ortopad

    2 hours patching daily

Study groups in NCT00945100
Study groupRoleWhat they receive
ControlActive comparator2 hours daily patching
Receives: Device: Eye Patch
Intensified treatmentActive comparator42 hours per week of patching (averaging 6 hours daily)
Receives: Device: Eye Patch

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Distribution of 10-week Amblyopic Eye Visual Acuity

    The masked 10-week amblyopic eye visual acuity scores were tabulated for both treatment groups, and included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data.

    The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.

    Measured: 10 weeks after randomization

  2. Mean 10-week Amblyopic Eye Visual Acuity

    The primary outcome analysis was a treatment group comparison of the masked 10-week amblyopic eye visual acuity using an analysis of covariance (ANCOVA) model, adjusting for visual acuity at randomization. The analysis included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data.

    The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.

    Measured: 10 weeks after randomization

  3. Distribution of the Change in Amblyopic Eye Visual Acuity at 10 Weeks From Randomization

    The change in 10-week amblyopic eye visual acuity scores since randomization was tabulated for both treatment groups, and included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data.

    The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.

    Measured: Randomization to 10 weeks

  4. Mean Change in Amblyopic Eye Visual Acuity at 10 Weeks From Randomization

    The change in 10-week amblyopic eye visual acuity was computed for both treatment groups and included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) with no imputation for missing data.

    The primary outcome analysis followed the "intent-to-treat" principle. Therefore, data from randomized participants were included in the analysis regardless of whether the assigned treatment was actually received or whether they deviated from treatment against protocol. In addition, randomized participants who were found to be ineligible upon subsequent review of enrollment data were included in the primary outcome analysis.

    Measured: Randomization to 10 weeks

Secondary outcomes (26)
  1. Compliance With Prescribed Patching by Treatment Group at 10 Weeks

    The distribution of compliance with prescribed treatment was tabulated for the 10-week outcome and as averaged scores across all study follow-up visits. Compliance was evaluated as excellent (>75%), good (51%-75%), fair (26%-50%), or poor (<26%) based on discussions with the parent and by reviewing study calendars maintained by the parent, who recorded the number of hours the child patched each day.

    Measured: 10 weeks after randomization

  2. Average Compliance With Prescribed Patching by Treatment Group

    The distribution of compliance with prescribed treatment was tabulated for the 10-week outcome and as averaged scores across all study follow-up visits. Compliance was evaluated as excellent (>75%), good (51%-75%), fair (26%-50%), or poor (<26%) based on discussions with the parent and by reviewing study calendars maintained by the parent, who recorded the number of hours the child patched each day.

    Measured: 10 weeks after randomization or later

  3. Treatment Group Comparison of the Proportion of Participants Who Have Improved by 2 or More logMAR Visual Acuity Lines at 10 Weeks Since Randomization

    The proportion of participants who improved at least 2 logMAR lines since randomization was computed at the 10-week outcome.

    The secondary outcome analysis was a treatment group comparison of the proportion of participants whose 10-week masked amblyopic eye visual acuity improved at least 2 logMAR lines since randomization using logistic regression, adjusting for visual acuity at randomization. The analysis included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) according to the principles specified in the primary outcome analysis.

    Measured: 10 weeks after randomization

  4. Treatment Group Comparison of 10-week Interocular Difference

    The secondary outcome analysis was a treatment group comparison of the 10-week interocular difference (IOD), computed as the difference between the masked amblyopic and fellow eye visual acuities, using an analysis of covariance (ANCOVA) model, adjusting for IOD at randomization. The analysis included data from 10-week visual acuity exams completed between 8 to 15 weeks (inclusive) according to the principles specified in the primary outcome analysis.

    Measured: 10 weeks after randomization

  5. Distribution of Baseline Characteristics at the 10-week Outcome

    The number of participants was tabulated by treatment group within categorical levels of prespecified baseline subgroup factors for participants with 10-week visual acuity exams completed between 8 to 15 weeks (inclusive)according to principles specified in the primary outcome analysis.

    Measured: 10 weeks after randomization

  6. Mean Amblyopic Eye Visual at Randomization According to Baseline Characteristics for 10-week Outcome

    Mean amblyopic eye visual acuity at randomization was computed by treatment group within categorical levels of prespecified baseline subgroup factors. The analysis included data from participants with 10-week exams completed between 8 to 15 weeks (inclusive) according to the principles specified in the primary outcome analysis.

    Measured: 10 weeks after randomization

  7. Treatment Comparison of Mean Amblyopic Eye Visual Acuity Change at 10-weeks According to Baseline Characteristics

    A treatment comparison of mean amblyopic eye visual acuity change since randomization was performed at the 10-week outcome according to categorical levels of prespecified baseline subgroup factors. The analysis included data from participants with 10-week exams completed between 8 to 15 weeks (inclusive) according to the principles specified in the primary outcome analysis.

    Measured: 10 weeks after randomization

  8. Distribution of Amblyopic Eye Visual Acuity at Visit of Best Post-randomization Visual Acuity

    Participants in both groups who have improved by one or more lines from randomization to the 10-week outcome exam will continue in the study and visits will occur every 10 weeks until no improvement of one or more lines from the previous visit. The distribution of best post-randomization (10 weeks or later) visual acuity scores in the amblyopic eye was tabulated for both treatment groups using the initial visual acuity score (if a retest was obtained.)

    Measured: 10 weeks after randomization or later

  9. Mean Amblyopic Eye Visual Acuity at Visit of Best Post-randomization Visual Acuity

    Participants in both groups who have improved by one or more lines from randomization to the 10-week outcome exam will continue in the study and visits will occur every 10 weeks until no improvement of one or more lines from the previous visit. A treatment comparison of mean amblyopic eye visual acuity at the visit of best post-randomization visual acuity (10 weeks or later) was performed using an analysis of covariance, adjusting for amblyopic eye visual acuity at randomization.

    Measured: 10 weeks after randomization or later

  10. Distribution of the Change in Best Post-randomization Visual Acuity in the Amblyopic Eye

    Participants in both groups who have improved by one or more lines from randomization to the 10-week outcome exam will continue in the study and visits will occur every 10 weeks until no improvement of one or more lines from the previous visit. The distribution of change in best post-randomization (10 weeks or later) visual acuity in the amblyopic eye since randomization was tabulated for both treatment groups using the initial visual acuity score (if a retest was obtained.)

    Measured: Randomization to 10 weeks or later

  11. Mean Change in Amblyopic Eye Visual Acuity Since Randomization at Visit of Best Post-randomization Visual Acuity

    Participants in both groups who have improved by one or more lines from randomization to the 10-week outcome exam will continue in the study and visits will occur every 10 weeks until no improvement of one or more lines from the previous visit. The mean change in amblyopic eye visual acuity since randomization was computed for both treatment groups based on the visit of best post-randomization visual acuity (10 weeks or later) using the initial visual acuity score (if a retest was obtained.)

    Measured: 10 weeks after randomization or later

  12. 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

    Participants in both groups who have improved by one or more lines from randomization to the 10-week outcome exam will continue in the study and visits will occur every 10 weeks until no improvement of one or more lines from the previous visit. The proportion of participants who improved at least 2 logMAR lines since randomization was computed based on the best post-randomization visual acuity in the amblyopic eye. The initial visual acuity score was used if a retest was obtained.

    Measured: 10 weeks after randomization or later

  13. Distribution of Best Fellow Eye Visual Acuity at 10-week Outcome

    Measured: 10 weeks after randomization

  14. Mean Best Fellow Eye Visual Acuity at 10-week Outcome

    Measured: 10 weeks after randomization

  15. Distribution of Best Fellow Eye Visual Acuity at Final Visit

    Measured: 10 weeks after randomization or later

  16. Mean Best Fellow Eye Visual Acuity at Final Visit

    Measured: 10 weeks after randomization or later

  17. Distribution of Change in Best Fellow Eye Visual Acuity Since Randomization at 10 Weeks

    Measured: 10 weeks after randomization

  18. Mean Change in Best Fellow Eye Visual Acuity Since Randomization at 10 Weeks

    Measured: 10 weeks after randomization

  19. Distribution of Change in Best Fellow Eye Visual Acuity Since Randomization at Final Visit

    Measured: 10 weeks after randomization or later

  20. Mean Change in Best Fellow Eye Visual Acuity Since Randomization at Final Visit

    Measured: 10 weeks after randomization or later

  21. Distribution of Randot Preschool Stereoacuity Scores at Randomization

    The Preschool Randot test measures random dot stereoacuity from 800 to 40 arc seconds (800, 400, 200, 100, 60, 40). Lower scores indicate better stereoacuity and subjects who fail the first level (800 seconds of arc) are assigned a score of >800.

    We administer a pretest, and those with a failed or uninterpretable score do not proceed with the Randot testing.

    The Preschool Randot test consists of 3 booklets each with 2 sets of 4 random dot shapes (one is blank, 3 are actual figures), which can be matched to non-stereo shapes on the opposite side of the booklets. There are six levels (seconds of arc) in the test with two levels in each book. Each level has 4 rectangles that contain 3 shapes and one blank.

    Measured: Randomization

  22. Distribution of Randot Preschool Stereoacuity Scores at 10 Weeks

    Measured: 10 weeks after randomization

  23. Change in Randot Preschool Stereoacuity Level at 10-week Outcome Since Randomization

    Measured: 10 weeks after randomization

  24. Distribution of Randot Preschool Stereoacuity Scores at Randomization for Participants With Anisometropic Amblyopia

    Measured: Randomization

  25. Distribution of Randot Preschool Stereoacuity Scores at 10 Weeks for Participants With Anisometropic Amblyopia

    Measured: 10 weeks after randomization

  26. Change in Randot Preschool Stereoacuity Level at 10-week Outcome Since Randomization for Participants With Anisometropic Amblyopia

    Measured: 10 weeks after randomization

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jul 2009 (estimated)
  2. Study startAug 2009
  3. Primary completionMar 2013
  4. Study completionMar 2013

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
169 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00945100
Sponsor's protocol ID
NEI-143
Other IDs
2U10EY011751
Acronym
ATS15
Status last verified
Jul 2016
First submitted
21 Jul 2009
Last updated
13 Jul 2016
Data monitoring committee
Yes
Individual data sharing
Yes: In accordance with the NIH data sharing policy, a de-identified database is placed in the public domain on the PEDIG public website at http://pedig.jaeb.org/Studies.aspx?RecID=29

Publications

  • Wallace DK, Lazar EL, Crouch ER 3rd, Hoover DL, Kraker RT, Tamkins SM; Pediatric Eye Disease Investigator Group. Time course and predictors of amblyopia improvement with 2 hours of daily patching. JAMA Ophthalmol. 2015 May;133(5):606-9. doi: 10.1001/jamaophthalmol.2015.6. No abstract available.

    PubMed 25695355
  • Pediatric Eye Disease Investigator Group; Wallace DK, Lazar EL, Holmes JM, Repka MX, Cotter SA, Chen AM, Kraker RT, Beck RW, Clarke MP, Lorenzana IJ, Petersen DB, Roberts JT, Suh DW. A randomized trial of increasing patching for amblyopia. Ophthalmology. 2013 Nov;120(11):2270-7. doi: 10.1016/j.ophtha.2013.04.008. Epub 2013 Jun 4.

    PubMed 23755872

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Eye Patch in people with Amblyopia, run by Jaeb Center for Health Research at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 16 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Jul 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Nov 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Distribution of 10-week Amblyopic Eye Visual Acuity (time frame: 10 weeks after randomization). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00945100, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jul 2016.

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