Journal of American Association for Pediatric Ophthalmology and Strabismus
Major ArticleEvaluating the burden of amblyopia treatment from the parent and child’s perspective
Purpose
To evaluate the psychometric properties of the original Parent and new Child Amblyopia Treatment Index (ATI), questionnaires that assess the burden of amblyopia treatment in children and families, and to compare scores between children treated with atropine or patching.
Methods
Parent ATI and Child ATI were administered to 233 children 7 to <13 years old and their parents as part of a randomized trial comparing patching and atropine for amblyopia treatment. For each ATI version, construct validity was assessed using factor analysis; internal consistency reliability was assessed using Cronbach’s alpha. Data from the Parent ATI and Child ATI were correlated and scores for each version were compared between treatment groups.
Results
We analyzed the 3 subscales found in prior Parent ATI studies in younger children and confirmed subscales for adverse effects and treatment compliance, but not for social stigma, in both parent and child versions. Overall and subscale scores on the Parent ATI and Child ATI were moderately to well correlated except for the social stigma subscale. For both the Parent ATI and the Child ATI, children treated with atropine had better scores than those treated with patching, both overall and on treatment compliance and social stigma subscales (all p values ≤ 0.01).
Conclusions
When used for children 7 to <13 years old, the Parent ATI and Child ATI have similar factor structures to each other and to the Parent ATI for children 3 to <7 years old. Atropine treatment was found to have less negative impact than patching.
Section snippets
Methods
This study was conducted by the Pediatric Eye Disease Investigator Group. The respective institutional review boards approved the protocol and the Health Insurance Portability and Accountability Act–compliant informed consent forms. The parent or guardian of each participant gave written informed consent and each participant gave assent as required.
The ATI was completed as part of a randomized trial comparing atropine to patching for treatment of amblyopia in children aged 7 to <13 years. The
Statistical Analysis
Questionnaires with 3 or more missing or not-applicable responses were excluded from the analyses. For the remaining questionnaires, the missing or not-applicable responses were imputed using the average score for all completed items.
We examined the psychometric properties of the Parent ATI and Child ATI separately, using data pooled across treatment groups from the 5-week visit only because the 17-week data might have been affected by knowledge of whether visual acuity had improved at the
ATI Completion and Demographics
At the 5-week visit, of the 233 patients in the randomized trial, 188 (81%) had both parent and child questionnaires completed; 29 (12%) had only the child questionnaire completed, and 16 (7%) had neither completed. At the 17-week visit, 157 patients (67%) had both parent and child questionnaires completed, 39 (17%) had only the child questionnaire completed, and 37 (16%) had neither completed. Across both visits, for the Parent ATI and Child ATI, respectively, 246 (71%) and 280 (68%)
Discussion
Previously we had developed a parent version of the ATI and evaluated it in parents of children 3 to <7 years of age. In the current study, we administered the parent version and a new child version to patients ages 7 to <13 years old and their parents as part of a randomized trial comparing patching and atropine for the treatment of amblyopia.
For the Parent ATI, the similarity of factor structure in the present study of children 7 to <13 years old and in previous studies of of children 3 to <7
References (14)
- et al.
The amblyopia treatment index
J AAPOS
(2001) - et al.
Further validation of the amblyopia treatment index parental questionnaire
J AAPOS
(2008) Impact of patching and atropine treatment on the child and family in the amblyopia treatment study
Arch Ophthalmol
(2003)A randomized trial of atropine vs patching for treatment of moderate amblyopia in children
Arch Ophthalmol
(2002)A randomized trial of patching regimens for treatment of moderate amblyopia in children
Arch Ophthalmol
(2003)A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children
Ophthalmology
(2003)A randomized trial of atropine regimens for treatment of moderate amblyopia in children
Ophthalmology
(2004)
Cited by (0)
This work was supported through a cooperative agreement from the National Eye InstituteEY011751 and EY018810. The funding organization had no role in the design of the study. It provided external oversight through an independent data and safety monitoring committee.
The authors have no conflicts of interest to disclose.
- ∗
The members of the Pediatric Eye Disease Investigator Group (PEDIG) are listed in e-Supplement 1, available online at jaapos.org.