H J Simonsz

Erasmus Universiteit Rotterdam, Rotterdam, South Holland, Netherlands

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Publications (99)154.79 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: PurposeTo investigate omission of population-based eye screening at age 6–9 months in the Netherlands.Methods Prospective population-based consecutive birth cohort study was used. In two consecutive birth cohorts, children were eye screened at 1–2 and 3–4 months, but at general-health screening at 6–9 months, the second cohort was not eye screened, unless anything conspicuous was noted or in case of positive family history. Data were collected from screening records and anonymous questionnaires. Semi-structured daylong observations were made of physicians examining children aged 0–4 years, including children from the cohorts, by two orthoptic students.Results58 of 6059 children (0.96%), in the screened, and 48 of 5482 children (0.88%) in the unscreened group were referred to orthoptist or ophthalmologist, mostly for observed strabismus. Amblyopia, all combined with strabismus, was diagnosed in ten screened (0.17%) versus six unscreened children (0.11%). Most physicians found preverbal examinations and decisions to refer difficult. The observations by orthoptic students revealed that cover test, pupillary reflexes, pursuit movements and eye motility were frequently performed inadequately, contrary to the Hirschberg test, at this age.Conclusion The screened and unscreened group differed little regarding the number of children referred and found to have amblyopia. Referral was mostly based on observed strabismus.
    Acta ophthalmologica 09/2014; · 2.44 Impact Factor
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    Journal of Pediatrics 05/2014; 165(2):410. · 4.04 Impact Factor
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    ABSTRACT: Provide insight in natural history, screening and treatment policy of retinopathy of prematurity (ROP) in The Netherlands. A multicentre, prospective, population-based study (NEDROP) included all preterm infants born in 2009 in The Netherlands fulfilling the inclusion criteria for ROP screening. Anonymised data from ophthalmologists, neonatologists and paediatricians were merged on identification number. Of 2033 reported infants, 1688 (83%) were screened for ROP. ROP stage was reported in 100%, zone in 94.4% and plus disease in 83%. ROP developed in 324 (19.2%), mild ROP (stage 1-2) in 294 (17.4%), severe ROP (stage 3 or more) in 30 (1.8%) and 17 (1%) were treated. The initial screening examination was not performed within the required 42 days in 641 (38%). Date for follow-up was recorded 1973 times and accomplished within 3 days from the planned date in 1957 (99.2%). The chance of not being screened increased from 12.9% without transfer to another hospital to 23.5, 18.5 and 25% after 1, 2, or 3 transfers, respectively. The incidence of severe ROP and infants treated was low. NEDROP emphasises that timing of initial examination and transfer to another hospital are issues of concern within the screening process.
    The British journal of ophthalmology 03/2014; · 2.92 Impact Factor
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    ABSTRACT: To study the incidence and risk factors for retinopathy of prematurity (ROP) in the Netherlands. Prospective, approximating population-based study that included infants with gestational age (GA) <32 weeks and/or birth weight (BW) <1500 g born in 2009. Pediatricians and ophthalmologists of all hospitals involved in care for premature infants reported data that were matched with the national perinatal database for risk factor analysis. Of 1380 infants, median GA 29.8 weeks (IQR 28.1-31.1) and median BW 1260 g (IQR 1020-1500), ROP developed in 21.9%. Logistic regression identified GA and BW as risk factors for ROP (P < .001). After adjustment for GA and BW, additional risk factors were inhaled nitric oxide (iNO; OR 2.6, 95% CI 1.1-6.2, P = .03), stay at a neonatal intensive care unit >28 days (OR 1.6, 95% CI 1.1-2.6, P = .03), and artificial ventilation >7 days (OR 1.6, 95% CI 1.1-2.5, P = .02). Prenatal glucocorticoids (OR 0.6, 95% CI 0.4-0.8, P < .001) and female sex (OR 0.7, 95% CI 0.5-0.99, P = .04) showed a lesser incidence of ROP. iNO remained significant after correction for all significant factors (OR 2.6, 95% CI 1.1-6.2, P = .03). In addition to established risk factors (GA, BW, stay at a neonatal intensive care unit >28 days, and artificial ventilation >7 days), treatment with iNO as risk factor for ROP is a novel finding.
    The Journal of pediatrics 12/2013; · 4.02 Impact Factor
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    ABSTRACT: To establish whether the current vision screening practice in the Netherlands is effective in preventing permanent visual loss and to estimate the sensitivity of the programme. In the Netherlands, all children are invited for preverbal (1, 3, 69 and 1424 months) and preschool (36, 45, and 6072 months) vision screening. Screening attendance is high, but the effectiveness in reducing amblyopia is unknown. In a 7-year cohort study, 4624 children born in the city of Rotterdam between 16 September 1996 and 15 May 1997 were followed through all routine vision screening examinations. At age seven, visual acuity (VA) of children still living in Rotterdam was assessed by study orthoptists. In case of VA > 0.1 logMAR in one or both eyes, two or more logMAR lines of interocular difference or eye disorders like strabismus, children underwent a more intensive eye examination. Attendance at the 9-month screening was 89, decreasing to about 75 at later examinations.Of preverbal tests, 2.5 were positive, and of preschool tests, 10. In total, 19 of children had a positive vision screening test at least once. Amblyopia prevalence was 3.4. Sensitivity of the vision screening programme was 73 and specificity 83. At age seven, 0.71.2 (confirmed vs final exam) of the children had a VA > 0.3 logMAR in the worse eye compared with 23.9 (in literature) reported prevalence in non-screening situations. Children who were less frequently screened had a higher chance of poor vision (>0.3 logMAR) at age seven. The Dutch child vision screening programme may reduce the risk of persistent amblyopia (VA > 0.3 logMAR) at age seven by more than half.
    Journal of Medical Screening 07/2013; · 2.35 Impact Factor
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    ABSTRACT: To develop a new national screening guideline for retinopathy of prematurity (ROP). Included were infants of the 2009 prospective ROP inventory in The Netherlands with gestational age (GA) <32 weeks and/or birth weight (BW) <1500 g. Five models were studied, based on GA and BW in combination with no, one or a set of five risk factors for ROP. Risk factors were determined by logistic regression. In MEDLINE and EMBASE, additional risk factors were searched. A precondition was that no infants with severe ROP would be missed. Receiver operating characteristic curves or classical measures were used to determine diagnostic accuracy. The model including all infants with severe ROP comprised screening of infants with GA <30 weeks and/or BW <1250 g and a selection of infants with GA 30-32 weeks and/or BW 1250-1500 g, with at least one of the following risk factors: artificial ventilation (AV), sepsis, necrotising enterocolitis (NEC), postnatal glucocorticoids or cardiotonica. This model would not detect 4.8% (95% CI 2.5% to 8.0%) of infants with mild ROP and would reduce infants eligible for screening by 29%. In The Netherlands, screening may be safely reduced using a new guideline based on GA, BW, AV, sepsis, NEC, postnatal glucocorticoids and cardiotonica.
    The British journal of ophthalmology 07/2013; · 2.92 Impact Factor
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    ABSTRACT: We present the Delft Assessment Instrument for Strabismus in Young children (DAISY) a device designed to measure angles of strabismus in young children fast and accurately. Daisy allows for unrestrained head movements by the mean of a triple camera vision system that simultaneously estimates the head rotation and the eye pose. The device combines two different methods to record bilateral eye position: corneal reflections (Purkinje images) and pupillary images. Detailed results are provided on three orthotropic subjects (age 25-27). Three different conditions were tested: (i) gaze ahead, (ii) gaze ahead with different head rotations and (iii) fixed head with different eye positions. Systematic errors occurred between subjects that need further study. The system reached sufficient accuracy to be applied for the measurement of angles of strabismus, almost independent from the head pose.
    IEEE transactions on bio-medical engineering 02/2013; · 2.15 Impact Factor
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    ABSTRACT: PURPOSE: We showed previously that an educational cartoon that explains without words why amblyopic children should wear their eye patch improves compliance, especially in children of immigrant parents who speak Dutch poorly. We now implemented this cartoon in clinics in low socioeconomic status (SES) areas with a large proportion of immigrants and clinics elsewhere in the Netherlands. DESIGN: Clinical, prospective, nonrandomized, preimplementation, and postimplementation study. PARTICIPANTS: Amblyopic children aged 3 to 6 years who started occlusion therapy. METHODS: Preimplementation, children received standard orthoptic care. Postimplementation, children starting occlusion therapy received the cartoon in addition. At implementation, treating orthoptists followed a course on compliance. In low SES areas, compliance was measured electronically during 1 week. MAIN OUTCOME MEASURES: The clinical effects of the cartoon-electronically measured compliance, outpatient attendance rate, and speed of reduction in interocular-acuity difference (SRIAD)-averaged over 15 months of observation. RESULTS: In low SES areas, 114 children were included preimplementation versus 65 children postimplementation; elsewhere in the Netherlands, 335 versus 249 children were included. In low SES areas, mean electronically measured compliance was 52.0% preimplementation versus 62.3% postimplementation (P=0.146); 41.8% versus 21.6% (P=0.043) of children occluded less than 30% of prescribed occlusion time. Attendance rates in low SES areas were 60.3% preimplementation versus 76.0% postimplementation (P=0.141), and 82.7% versus 84.5%, respectively, elsewhere in the Netherlands. In low SES areas, the SRIAD was 0.215 log/year preimplementation versus 0.316 log/year postimplementation (P=0.025), whereas elsewhere in the Netherlands, these were 0.244 versus 0.292 log/year, respectively (P=0.005; the SRIAD's improvement was significantly better in low SES areas than elsewhere, P=0.0203). This advantage remained after adjustment for confounding factors. Overall, 25.1% versus 30.1% (P=0.038) had completed occlusion therapy after 15 months. CONCLUSIONS: After implementation of the cartoon, electronically measured compliance improved, attendance improved, acuity increased more rapidly, and treatment was shorter. This may be due, in part, to additional measures such as the course on compliance. However, that these advantages were especially pronounced in children in low SES areas with a large proportion of immigrants who spoke Dutch poorly supports its use in such areas. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    Ophthalmology 08/2012; · 5.56 Impact Factor
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    ABSTRACT: BACKGROUND: We previously demonstrated that compliance with occlusion therapy for amblyopia was improved by the use of an educational programme, especially in children of parents of foreign origin and who spoke Dutch poorly. The programme consisted of: (i) a cartoon story for amblyopic children that explained without words why they should patch, (ii) a calendar with reward stickers, and (iii) an information leaflet for parents. In the current study, we assessed the individual effect of each component on compliance. METHODS: We recruited 120 3- to 6-year-old children who lived in a low socio-economic status (SES) area in The Hague and were starting occlusion therapy for the first time. They were randomised to receive one of the components (three intervention groups), or a picture to colour (control group). The randomisation was blinded for treating orthoptist and researcher. Compliance was measured electronically using the Occlusion Dose Monitor (ODM). Primary outcome was percentage of compliance (actual/prescribed occlusion time). Secondary outcome was absolute occlusion hours per day. Parental fluency in Dutch was rated on a five-point scale. RESULTS: Compliance could be measured electronically in 88 of the 120 children; in 32 others, it failed for various reasons. Parental fluency in Dutch was moderate or worse in 36.4 % (p = 0.327). Average compliance was 55 % standard deviation (SD) 40 (n = 18) in the control group, 89 % SD 25 in the group receiving the educational cartoon (n = 25, P = 0.002 compared with control group), 67 % SD 33 (n = 24, P = 0.301) in the reward-calendar group and 73 % SD 40 (n = 21, P = 0.119) in the parent-information-leaflet group. On average, children in the control group occluded 1:46 SD1:19 hours/day, 2:33 SD 1:18 hours/day in the group receiving the educational cartoon, 1:59 SD 1:13 hours/day in the reward-calendar group and 2:18 SD 1:13 hours/day in the parent-information-leaflet group. No child who received the cartoon story occluded less than 1 hour per day, against seven in the reward-calendar group, five in the parent-information-leaflet group and five in the control group. CONCLUSIONS: Although all three components of the programme improved compliance with occlusion therapy in children in low-SES areas, the educational cartoon had the strongest effect, as it explained without words to a 4- to 5-year-old child why it should wear the eye patch.
    Albrecht von Graæes Archiv für Ophthalmologie 07/2012; · 1.93 Impact Factor
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    ABSTRACT: To quantify manual fraction of inspired oxygen (FiO(2)) adjustments performed by caregivers in extremely low birth weight (ELBW; ≤1000 g) infants, in relation to oxygen saturation (SpO(2)) and bedside care. In a single-centre study, FiO(2) , SpO(2) and alarm limits of ELBW infants were collected for 3 days continuously, while caregivers were filmed. A descriptive analysis, focused on manual FiO(2) adjustments, was performed. Twelve ELWB infants were included. Total recording time was 726 h. FiO(2) was increased 851 times and decreased 1309 times; median (range) step size was 5% (1% to 65%) and -3% (-1% to -65%), respectively. Wide variation of FiO(2) adjustments for equal levels of SpO(2) was observed in all included infants. One hundred and twenty-six of 136 FiO(2) adjustments with a step size ≥15% and 111 of 171 desaturations <70% were associated with medical or nursing procedures. When FiO(2) was >21%, alarm limits for SpO(2) were set according to protocol (88-94%) in 64% of the time. Within these periods, SpO(2) was >94% for 30% and <88% for 16% of the time. Manual FiO(2) adjustments varied widely in frequency and step size. Deep desaturations and large FiO(2) adjustments were associated with medical or nursing procedures. When large adjustments are really necessary, it will be challenging to implement them in an automatic adjustment device.
    Acta Paediatrica 03/2012; 101(3):e97-104. · 1.97 Impact Factor
  • H J Simonsz
    Strabismus 03/2012; 20(1):42.
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    ABSTRACT: Occlusion therapy for amblyopia has been the mainstay of treatment for centuries, however, acceptance of the patch is often lacking. This study evaluated comfort of wear of the eye patch and assessed the mechanical properties in order to achieve a more individualized prescription. For 8 consecutive days, parents used each of the four main brands of patches for 2 consecutive days in a randomized fashion. After 2 days a 21-item questionnaire was completed to evaluate comfort of wear for each patch. Compliance was measured electronically using the Occlusion Dose Monitor (ODM). In addition, breathing capacity at 23°C and 33°C, resistance to water penetration, opacity, and strength of adhesion to the skin were measured. Twenty-four children participated. Overall, satisfaction was moderate: large differences in discomfort when removing the patch, skin reaction, and cosmetic appearance were found. In the material measurements large differences were found in opacity and strength of adhesion to the skin. In all brands breathing capability was minimal. Answers given by the parents matched the physical properties of the eye patch. There was no difference in electronically measured compliance between patches. We found large differences in comfort of wear and mechanical properties. Therefore, when prescribing a certain brand of patch, the wide variety needs to be taken into account. Further study into these properties seems warranted; especially breathing capability requires improvement since children often wear the patch for a longer period of time. This could contribute to increasing satisfaction and consequently may improve compliance.
    Strabismus 03/2012; 20(1):3-10.
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    ABSTRACT: Complete congenital stationary night blindness (cCSNB) is a clinically and genetically heterogeneous group of retinal disorders characterized by nonprogressive impairment of night vision, absence of the electroretinogram (ERG) b-wave, and variable degrees of involvement of other visual functions. We report here that mutations in GPR179, encoding an orphan G protein receptor, underlie a form of autosomal-recessive cCSNB. The Gpr179(nob5/nob5) mouse model was initially discovered by the absence of the ERG b-wave, a component that reflects depolarizing bipolar cell (DBC) function. We performed genetic mapping, followed by next-generation sequencing of the critical region and detected a large transposon-like DNA insertion in Gpr179. The involvement of GPR179 in DBC function was confirmed in zebrafish and humans. Functional knockdown of gpr179 in zebrafish led to a marked reduction in the amplitude of the ERG b-wave. Candidate gene analysis of GPR179 in DNA extracted from patients with cCSNB identified GPR179-inactivating mutations in two patients. We developed an antibody against mouse GPR179, which robustly labeled DBC dendritic terminals in wild-type mice. This labeling colocalized with the expression of GRM6 and was absent in Gpr179(nob5/nob5) mutant mice. Our results demonstrate that GPR179 plays a critical role in DBC signal transduction and expands our understanding of the mechanisms that mediate normal rod vision.
    The American Journal of Human Genetics 02/2012; 90(2):331-9. · 11.20 Impact Factor
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    ABSTRACT: The efficacy of population-based vision screening is hampered by unsuccessful referral after a positive screening test. We studied the nature and causes of unsuccessful referral in a 7-year birth cohort study of vision screening in Rotterdam, the Netherlands. All parents of children who had been unsuccessfully referred were asked whether they recalled the referral. Reasons for noncompliance, if any, were identified using semi-structured interviews. Screening records were checked for written evidence of the referral. The parents' fluency in Dutch and their socioeconomic status were also assessed. Of the 561 screen-positive children, 129 (23%) had not been referred successfully. For the current study, 97 parents were successfully contacted. Of these, 14 parents had been willingly noncompliant and 83 said they were unaware of the referral, with 47% having poor to moderate fluency in Dutch. In 53 cases, the screening charts contained no written evidence of any referral. Amblyopia was identified in 3 of the unsuccessful referrals. In this population-based screening program, 1 of 4 positively screened children was not successfully referred. Apart from parental noncompliance, the unsuccessful referrals can be explained by miscommunication, deficient documentation, and physician noncompliance with screening guidelines. An effective monitoring feedback system may improve the efficacy of child vision screening.
    Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 06/2011; 15(3):256-62. · 1.07 Impact Factor
  • H J Simonsz, G H Kolling
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    ABSTRACT: Infantile esotropia (IE) is defined as an esotropia before the age of 6 months, with a large angle, latent nystagmus, dissociated vertical deviation, limitation of abduction, and reduced binocular vision, without neurological disorder. Prematurity, low birth weight, and low Apgar scores are significant risk factors for IE. US standard age of first surgery is 12-18 months, in Europe 2-3 years. The only study to date with prospectively assigned early- and late-surgery groups and evaluation according to intention-to-treat, was the European Early vs. Late Infantile Strabismus Surgery Study (ELISSS). In that study 13.5% of children operated around 20 months vs. 3.9% (P = 0.001) of those operated around 49 months had gross stereopsis (Titmus Housefly) at age 6. The reoperation rate was 28.7% in children operated early vs. 24.6% in those operated late. Unexpectedly, 8% in the early group vs. 20% in the late group had not been operated at age 6, although all had been eligible for surgery at baseline at 11 SD 3.7 months. In most of these children the angle of strabismus decreased spontaneously. In a meta-regression analysis of the ELISSS and 12 other studies we found that reoperation rates were 60-80% for children first operated around age 1 and 25% for children operated around age 4. Based on these findings, the endpoints to consider when contemplating best age for surgery in an individual child with IE should be: (1) degree of binocular vision restored or retained, (2) postoperative angle and long-term stability of the angle and (3) number of operations needed or chance of spontaneous regression. IE is characterized by lack of binocular connections in the visual cortex that cannot develop, e.g. because the eyes squint, or do not develop, e.g. after perinatal hypoxia. As the cause of IE, whether motor or sensory, is a determinant of surgical outcome, a subdivision of IE according to cause is needed. As similarities exist between IE and cerebral palsy we propose to adapt the working definition formulated by the Surveillance of Cerebral Palsy in Europe and define IE as "a group of permanent, but not unchanging, disorders with strabismus and disability of fusional vergence and binocular vision, due to a nonprogressive interference, lesion, or maldevelopment of the immature brain, the orbit, the eyes, or its muscles, that can be differentiated according to location, extent, and timing of the period of development."
    European journal of paediatric neurology: EJPN: official journal of the European Paediatric Neurology Society 05/2011; 15(3):205-8. · 2.01 Impact Factor
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    ABSTRACT: Compliance with occlusion therapy for amblyopia in children is low when their parents have a low level of education, speak Dutch poorly, or originate from another country. We determined how sociocultural and psychological determinants affect compliance. Included were amblyopic children between the ages of 3 and 6, living in low socio-economic status (SES) areas. Compliance with occlusion therapy was measured electronically. Their parents completed an oral questionnaire, based on the "Social Position & Use of Social Services by Migrants and Natives" questionnaire that included demographics and questions on issues like education, employment, religion and social contacts. Parental fluency in Dutch was rated on a five-point scale. Regression analysis was used to describe the relationship between the level of compliance and sociocultural and psychological determinants. Data from 45 children and their parents were analyzed. Mean electronically measured compliance was 56 ± 44 percent. Children whose parents had close contact with their neighbors or who were highly dependent on their family demonstrated low levels of compliance. Children of parents who were members of a club and who had positive conceptualizations of Dutch society showed high levels of compliance. Poor compliance was also associated with low income, depression, and when patching interfered with the child's outdoor activity. Religion was not associated with compliance. Poor compliance with occlusion therapy seems correlated with indicators of social cohesion. High social cohesion at micro level, i.e., family, neighbors and friends, and low social cohesion on macro level, i.e., Dutch society, are associated with noncompliance. However, such parents tend to speak Dutch poorly, so it is difficult to determine its actual cause.
    Albrecht von Graæes Archiv für Ophthalmologie 03/2011; 249(12):1893-9. · 1.93 Impact Factor
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    ABSTRACT: To determine the existence of a correlation between the vertical angle of strabismus and the vertical angle between the orbital axes in nonsyndromic plagiocephaly in childhood. Patients were included when diagnosed with plagiocephaly. Orthoptic measurements showed a vertical strabismus and three-dimensional computed tomographic (CT) imaging of the skull was available. Patients were excluded if plagiocephaly was part of a syndrome or if any surgical intervention had taken place before our measurements. Three-dimensional CT imaging was used to calculate the vertical angle between the orbital axes in 3 reference planes (VAO) perpendicular to a line of reference through the lower borders of the maxilla (VAOmax), both auditory canals (VAOaud), and the lower points of the external occipital protuberances (VAOocc). Fourteen patients were included (mean age, 14 mo). Three-dimensional CT measurements showed a mean (SD) VAOmax of 1.70 (2.31) degrees, VAOaud of -1.54 (1.46) degrees, and VAOocc of -2.06 (4.29) degrees (a negative value indicates that the eye on the affected side was situated lower in the head). The mean vertical angle of strabismus was -2.39 (4.69) degrees in gaze toward the affected side, 3.66 (3.77) degrees in gaze ahead, and 8.14 (5.63) degrees in gaze toward the nonaffected side. The Pearson test showed no significant correlations. The clinical observation that vertical strabismus in adult plagiocephaly is correlated with the vertical angle of the orbital axes could not be confirmed in young children.
    The Journal of craniofacial surgery 01/2011; 22(1):135-8. · 0.81 Impact Factor
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    Elizabeth S van de Graaf, Huibert J Simonsz
    Investigative ophthalmology & visual science 12/2010; 51(12):6898; author reply 6899-900. · 3.43 Impact Factor
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    ABSTRACT: We previously found that compliance with occlusion therapy for amblyopia is poor, especially among children of non-native parents who spoke Dutch poorly and who were low educated. We investigated conception, awareness, attitude, and actions to deal with noncompliance among Dutch orthoptists. Orthoptists working in non-native, low socioeconomic status (SES) areas and a selection of orthoptists working elsewhere in the Netherlands were studied. They were observed in their practice, received a structured questionnaire, and underwent a semi-structured interview. Finally, a short survey was sent to all working orthoptists in the Netherlands. Nine orthoptists working in non-native, low-SES areas and 23 working elsewhere in the Netherlands participated. One hundred and fifty-one orthoptists returned the short survey. Major discrepancies existed in conception, awareness, and attitude. Opinions differed on what should be defined as noncompliance and on what causes noncompliance. Some orthoptists found noncompliance annoying, unpleasant, and hard to imagine, others were more understanding. Many pitied the noncompliant child. Almost all thought that the success of occlusion therapy lies both with the parents and the orthoptist, but one third thought that noncompliance was not solely their responsibility. Patients' compliance was estimated at 69.3% in non-native, low-SES areas (electronically, 52% had been measured), at 74.1% by the other 23 orthoptists, and at 73.8% in the short survey. Actions to improve compliance were diverse; some increased occlusion hours whereas others decreased them. In non-native, low-SES areas, 22% spoke Dutch moderately to none; the allotted time for a patient's first visit was 21'; the time spent on explaining to the parents was 2'30" and to the child 10". In practices of the other 23 orthoptists, 6% spoke Dutch moderately to none (P<0.0001), the time for a patient's first visit was 27'24" (P=0.47), and the periods spent explaining were 2'51" (P=0.59) and 26" (P=0.17), respectively. Conception, awareness, attitude, and actions to deal with noncompliance varied among orthoptists. In non-native, low-SES areas, time spent on explanation was shorter, despite a lower fluency in Dutch among the parents.
    Strabismus 12/2010; 18(4):146-66.
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    ABSTRACT: According to the ROTAS study most of the improvement in visual acuity (VA) during amblyopia therapy of children aged 3 to 8 years occurs during the first 6 to 8 weeks . Sattler reported a VA gain in 11-year olds even during the second year of treatment . So far there are no standards concerning the intensity and duration of the treatment of patients older than 7 years of age. After a report on electronic monitoring of occlusion treatment in patients aged 7 to 16 years for 4 months , we now analyse whether this age group benefits from a longer-lasting treatment. In this pilot study the progression of VA was analysed in 11 patients (age range 7.18 to 15.76 years; median 11.42 years) during 12 months of occlusion therapy (types of amblyopia: 5 anisometropic, 1 strabismic, 5 combined). The daily occlusion times were recorded using the occlusion dose monitor (ODM) . At the beginning of treatment the prescription of the occlusion regime (median) was 6 h/d (range 4 to 7 h/d), the (decimal) VA 0.2 (range 0.02 to 0.63) for single and 0.16 (range 0.02 to 0.8) for crowded optotypes. The recorded occlusion time (median) was 4.4 h/d during the 12 months of treatment, the VA gain (median) was 0.4 log units for single (range 0.2 to 0.7 log units) and 0.3 for crowded optotypes (range--0.1 to 0.6). During the period of 4 to 12 months of treatment (received occlusion 4.12 h/d) the VA gain was 0.1 log units for single and for crowded optotypes. The maximum VA gain during the interval of 4 to 12 months of treatment was 0.2 log units, both single and crowded. The interocular difference for crowded VA (median) decreased from 0.9 to 0.6 log units during treatment, however only one patient achieved an interocular difference of < 0.2 log units. The patients presented here were able to integrate daily occlusion lasting several hours and the electronic monitoring of occlusion treatment into their daily routine over a period of 12 months. During this period the VA of all included types of amblyopia improved significantly, both from a clinical and statistical point of view. Further long-term studies using ODMs with larger groups of patients may identify factors for success of treatment, reveal the long-term stability of the improvement and contribute to a standardised treatment in this age group.
    Klinische Monatsblätter für Augenheilkunde 10/2010; 227(10):774-81. · 0.70 Impact Factor

Publication Stats

680 Citations
154.79 Total Impact Points

Institutions

  • 2000–2014
    • Erasmus Universiteit Rotterdam
      • • Department of Ophthalmology
      • • Erasmus Medical Center (MC)
      Rotterdam, South Holland, Netherlands
  • 2003–2013
    • Erasmus MC
      • • Department of Ophthalmology
      • • Research Group for Public Health
      Rotterdam, South Holland, Netherlands
  • 2009
    • Netherlands Institute for Neuroscience
      Amsterdamo, North Holland, Netherlands
  • 2007
    • Retina Foundation of the Southwest
      Dallas, Texas, United States
  • 2005–2006
    • Delft University Of Technology
      • Department of Biomechanical Engineering
      Delft, South Holland, Netherlands
  • 1998
    • Universität Heidelberg
      • Department of Medical Biometry
      Heidelberg, Baden-Wuerttemberg, Germany
  • 1991–1993
    • Kantonsspital St. Gallen
      San Gallo, Saint Gallen, Switzerland
  • 1989
    • University of Amsterdam
      Amsterdamo, North Holland, Netherlands
  • 1988
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany