1. In a large retrospective database study, Black children with amblyopia were significantly less likely to be successfully treated based on visual acuity outcomes than White children.
2. Children aged 3-7 with Medicaid coverage were 35% less likely to have successful amblyopia therapy than children with private insurance.
Evidence Rating Level: 2 (Good)
Study Rundown: Amblyopia is poorer vision in one eye caused by abnormalities during visual development, which can include uneven refractive error or strabismus. It is treated by regular occlusion of the unaffected eye using dilating drops or patching. This study aimed to analyze demographic factors affecting outcomes in amblyopia treatment. Among nearly 19,000 children, amblyopia treatment was successful in 77.3% of those aged 3-7 and 55.5% of those aged 8-12. Black children aged 3-7 were 29% less likely to be successfully treated than White children. For children aged 8-12, Black race was also significantly associated with lower treatment success rate, but Hispanic/Latino ethnicity was associated with increased treatment success. Medicaid coverage was independently, significantly associated with lower rates of treatment success. Successful amblyopia treatment requires not only presentation and prompt initiation of therapy before neuroplasticity decreases, but also regular follow-up to assess treatment efficacy and explore treatment of underlying conditions such as strabismus or refractive error. The relative role of age at presentation compared to differences in care, such as follow-up frequency, adherence, or provider bias, are unclear from this data. Nonetheless, these disparities are highly troubling, as untreated and unsuccessfully treated amblyopia have lifelong consequences for vision and quality and life.
Relevant Reading: Amblyopia and quality of life: A systematic review
In-Depth [retrospective cohort]: Children who were 3-12 years old at the time of enrollment in the national Intelligent Research in Sight (IRIS) database between 2013-2019 were included. The primary outcome, IRIS-50, has been previously studied and reflects unilateral amblyopia associated with strabismus, refractive error, or both in children with at least one follow-up visit recorded. Treatment success is defined by IRIS-50 as best corrected visual acuity difference between eyes less than 0.23 logMAR units, acuity improvement of at least 3 Snellen chart lines in the affected eye, and/or acuity of 20/30 or better in the affected eye. Multiple logistic regression models were adjusted for sex, race, ethnicity, and insurance type. For children 3-7 years old, the odds ratio for treatment success in female compared to male children was 1.01 [95% confidence interval (CI) 0.94-1.08]. The odds ratios for 3-7-year-old Black, Hispanic, and Asian children compared to White children were 0.71 (95% CI 0.62-0.83), 0.93 (0.83-1.04), and 0.97 (0.77-1.23). The odds ratio for children with Medicaid compared to private insurance was 0.65 (95% CI 0.60-0.71).
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