Turkiye Klinikleri Journal of Ophthalmology

.: REVIEW
Kapama Zamanının Monitörize Edildiği Çalışmalar Işığında Ambliyopide Güncel Refraktif Adaptasyon Süreci ve Kapama Tedavisi Yaklaşımı: Geleneksel Derleme
Current Refractive Adaptation Process and Approach to Patching Treatment in Amblyopia in Light of Studies Monitoring Patching Time: Traditional Review
Deniz SOMERa, Demet YABANOĞLUb
aSağlık Bilimleri Üniversitesi Ankara Sağlık Uygulama ve Araştırma Merkezi, Göz Hastalıkları Kliniği, Ankara, Türkiye
bHacettepe Üniversitesi Tıp Fakültesi, Göz Hastalıkları ABD, Ankara, Türkiye
Turkiye Klinikleri J Ophthalmol. 2022;31(2):92-100
doi: 10.5336/ophthal.2021-86668
Article Language: TR
Full Text
ÖZET
 Derlemede, refraktif adaptasyon sürecinden (gözlük kullanımı sonrası ilk 18 hafta) sonra planlanacak kapama süresinin ne dozda ve ne kadar süreli olması gerektiği, yayın bilgilerinin değerlendirilmesi doğrultusunda önerilerle ortaya konulmuştur. Yayınlarda ortaya konulan doz-yanıt ilişkisine dair bilgilerdeki büyük farklılıkların nedenlerini anlayabilmek amacıyla, kapama doz monitörleri kullanılarak yapılan 'Monitored Occlusion Treatment of Amblyopia Study Cooperative Group (MOTAS), İngiltere Birleşik Krallık' ve 'Randomized Occlusion Treatment of Amblyopia Cooperative Group (ROTAS), İngiltere Birleşik Krallık' ve monitörizasyon kullanılmadan yapılan 'Pediatric Eye Disease Investigator Group Amblyopia Treatment Studies (PEDIG ATS), Amerika Birleşik Devletleri (ABD)' ambliyopi çalışmaları irdelenmiş ve karşılaştırılmıştır. Kapamanın monitörize edildiği (MOTAS, ROTAS) çalışmaları, doz-sonuç ilişkisi incelendiğinde, günde 3 ile 6 saat veya 6 ile12 saat kapama reçete edilen (objektif kapama süresi değil) çocuklarda, görme artışı sonuçlarının şaşırtıcı derecede benzer olduğunu ortaya koymaktadır. Bu çalışmalar farklı gruplardaki görme keskinliğindeki benzer artış sonuçlarının, daha uzun süreli olarak reçete edilen dozlara uyum eksikliğinden kaynaklanmış olduğunu düşündürmektedir. Gruplar, farklı kapama dozları önerilmiş olmasına rağmen ve hatta 'monitörize edildiklerini de bilmelerine rağmen', aile/çocuğun tedaviye uyumsuzluğu nedeniyle gerçekte benzer objektif kapama dozları almıştır. Hekimler tarafından önerilecek kapama süreleri, MOTAS ve ROTAS yayınları doğrultusunda, ailelerin, monitörize edilmeyeceklerini bildikleri güncel klinik uygulamalarda, kapama sürelerini bu yayınlarda belirlenenlerden de daha az sürelerde uygulayacakları bilgisi ışığında belirlenmelidir. Ambliyopide doz-etkinlik bağlamında yapılan söz konusu çalışmalarda, sonuçların kapama tedavisi başlanmadan sadece refraktif düzeltme ile elde edilen görme artış sonuçları ile karşılaştırılarak değerlendirilmesi de söz konusu olabildiğinden, derlemenin son bölümünde sadece refraktif düzeltme ile oluşan görme artışı dönemi (refraktif adaptasyon dönemi) ayrı bir başlık altında irdelenmiştir.

Anahtar Kelimeler: Ambliyopi; ambliyopi tedavisi; kapama; kapama tedavisi; monitörizasyon
ABSTRACT
 The review provides strategies based on an evaluation of the published data regarding the dosage and duration of the patching time to be planned following the refractive adaptation period (the first 18 weeks after the use of glasses). Amblyopia studies utilizing occlusion dose monitors 'Monitored Occlusion Treatment of Amblyopia Study Cooperative Group (MOTAS), United Kingdom' and 'Randomized Occlusion Treatment of Amblyopia Cooperative Group (ROTAS), United Kingdom' and non-monitoring 'Pediatric Eye Disease Investigator Group Amblyopia Treatment Studies (PEDIG ATS), United States of America (USA)' methods were reviewed and compared in order to ascertain the reasons for major discrepancies in dose-response information given in publications. Examining the doseoutcome relationship in monitorized occlusion studies (MOTAS, ROTAS) reveals that the results in children prescribed 3 to 6 hours or 6 to 12 hours of occlusion per day (not objective occlusion time) are surprisingly similar. These studies suggest that similar results in visual acuity improvement in different groups were due to a lack of adherence to longer duration prescribed doses. Although different occlusion doses were recommended and 'knowing being monitored', different groups actually received similar objective occlusion doses due to parent/child non-adherence to treatment. Occlusion times to be recommended by physicians should be determined in line with MOTAS and ROTAS publications, in the light of the knowledge that families will apply the occlusion times for less than the ones determined in these publications in current clinical practices, where they know that they will not be monitored. In the aforementioned studies on dose-effectiveness in amblyopia, it is also possible to compare the results to the visual increase observed with refractive correction alone prior to initiating occlusion therapy; thus, in the final section of the review, the visual increase observed with only refractive correction (refractive adaptation period) is discussed separately.

Keywords: Amblyopia; amblyopia treatment; patching; patching treatment; monitorization
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