Workshop 18

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AOC-AAPOS Combined Workshop: Re-examining the Data: PEDIG Conundrums

Stephen P. Christiansen, MD; Ronald J. Biernacki, CO; Alex Christoff, CO, COT; Sean Donahue, MD, PhD; Burton J. Kushner, MD; Nina M. Palomba, CO; Michael Repka, MD; Sarah Whitecross, OC(C)
Boston University School of Medicine
Boston, MA

 

Purpose/Relevance: The best clinical care is care informed by high-quality data. The Pediatric Eye Disease Investigator Group (PEDIG), formed in 1997, is a collaborative network dedicated to facilitating multicenter clinical research in strabismus, amblyopia and other eye disorders that affect children.  The results of many PEDIG studies have changed and enlightened practice patterns.  At the same time, PEDIG studies have raised important questions that warrant further analysis and, perhaps, further study.  In this workshop, designed to enhance our understanding and interpretation of the data, questions arising out of four PEDIG studies will be addressed in a point-counterpoint discussion format.

Target Audience: Orthoptists, Pediatric Ophthalmologists

Current Practice: ATS 2A was a randomized controlled trial that compared 6 hours versus full-time daily patching as treatments for severe amblyopia in children less than 7 years of age. The study showed equivalent improvements in visual acuity in the two treatment arms. Much to the delight of children and parents alike, some providers began to recommend part-time patching for initial therapy of amblyopia. Other providers still consider full-time patching the gold standard. How does the data address either approach? This and other conundrums still exist despite well-designed and well-executed PEDIG studies. In this workshop, the data and the interpretation of the data will be re-examined to shed light on our current treatment paradigms and areas where further study may be helpful.

Best Practice: Clinical and surgical management supported by high-level evidence

Expected Outcomes: Attendees, by understanding limitations of current studies, will be prepared to more knowledgeably treat patients with conditions in which management remains in flux.

Format: Point-counterpoint discussion with audience participation.

Summary: Topics which will be addressed in this workshop include: Patching vs atropine penalization for moderate amblyopia; part-time vs full-time patching for severe amblyopia; home-based near target push-ups vs computerized vergence therapy for convergence insufficiency; and observation vs occlusion therapy for intermittent exotropia.

References: 1. Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2002;120:268-78.|2. 1. Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2002;120:268-78.
2. Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of severe amblyopia in children. Ophthalmology 2003;110:2075-87.
3. Mohney BG. A randomized trial comparing part-time patching with observation for intermittent exotropia in children 12 to 35 months of age. Ophthalmology. 2015;122:1718-25.
4. Cotter et al. A randomized trial comparing part-time patching with observation for children 3 to 10 years of age with intermittent exotropia. Ophthalmology. 2014;121:2299-310.
5. Pediatric Eye Disease Investigator Group. Home-based therapy for symptomatic convergence insufficiency in children: A randomized clinical trial. Optom Vis Sci. 2016;93:1457-1465.

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