Elbow splinting increases amblyopia patching compliance
Parents and physicians have responded with a range of measures to keep patches in place, including suturing the patch to the brow and cheek, using occlusive contact lenses, glueing the fellow eye shut, casting the patient’s arms and injecting purified botulinum A toxin into the levator muscle to induce ptosis.
Such measures can cause pain or infection, and increase the risk of the child developing amblyopia in the fellow eye, Sabri et al. note.
Some parents have rolled magazines and taped them around their children’s elbows to keep them from bending their arms to reach their eyes, and splints of a similar design are also available for sale.
This approach struck the researchers as relatively safe. Parents could remove the splints fairly easily, but children could not.
Sabri et al. wanted to see if the approach really works. So they reviewed the records of 48 children with amblyopia who were fitted for elbow splints at two tertiary paediatric ophthalmology centres between January 2008 and December 2011.
The ophthalmology centres had offered splinting because the children kept their patches in place less than half the recommended time or consistently tried to remove them over the course of three months.
Parents decided whether to splint one or both elbows, and when to remove the patches. But they got instructions to continue splinting until the child was “fully compliant.”
The researchers selected 41 children, 16 female and 25 male, with a median age of 37 months. They excluded four other patients who got their splints at the outset of the patching because of distance from the ophthalmologist, and three for being prescribed splints but not using the intervention.
Twenty-four of the patients presented with esotropia, 15 with anisometropia and two with congenital cataracts as the primary causes of their amblyopia.
The children were “very upset while wearing elbow splints” for a mean of 91 minutes, the researchers wrote. But “parents found the temporary unhappiness was an acceptable side effect in order to aid in the restoration of vision in the amblyopic eye.”