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家长对儿童弱视治疗的影响
Acta Clin Croat 2009; 48:427-431 Professional Paper
PARENTS' INFLUENCE ON THE TREATMENT OF AMBLYOPIA IN CHILDREN
家长对儿童弱视治疗的影响
Dobrila Karlica, Svjetlana Matijevic, Davor Galetovic and Ljubo Znaor
University Department of Ophthalmology,
Dobrila Karlica、 Svjetlana Matijevic、 Davor Galetovic Ljubo Znaor
SUMMARY - Amblyopia in children is a great problem that has to be identified on time and treatment initiated as early as possible to achieve optimal therapeutic result. Therapeutic success depends greatly on the children's parents' collaboration. It was the reason for us to embark upon this study to evaluate the parents' role in amblyopia treatment and their influence on the final therapeutic result. The aim of the study was to assess compliance with therapy prescribed, the degree to which the parents understood their children's health condition, and whether they were satisfied with their child's ophthalmologist. The study included 105 parents divided into three groups of 35 persons according to their educational level. All study parents filled out a questionnaire. The children's visual acuity measured before and after prescribed therapy was compared with the parents' answers to the questions. Among 105 children, post-therapeutic improvement in visual acuity was recorded in 66 (62.8%) children, whereas the rest of39 (37.1%) children showed no therapeutic success.
摘要-儿童弱视是必须及时确诊并尽早启动治疗以达到最佳治疗效果的一个大问题。治疗的成功极大地取决于孩子们家长的合作。这就是我们着手这项研究来评估家长在弱视治疗中的作用及对最终的治疗结果影响的原因。该研究的目的是评估遵守治疗的规定、家长了解孩子健康状况的程度以及他们是否满意他们孩子的眼科医师。该项研究包括 105 家长，根据他们的受教育水平分为三个组，每个组 35 人。所有家长都填写了调查表。儿童纠正治疗之前和之后的视力会与家长对该问卷的答案进行对比。在105名儿童中，录得66名(62.8%)取得了后期视力治疗改善，而其余39名儿童 (37.1%)没有显示出治疗是成功的。
Statistical analysis yielded no significant difference in the rate of therapeutic success according to parent's educational level (P=0.61). The best results were obtained in children with highest therapy compliance. It is of utmost importance for the ophthalmologist to gain parents' trust, which then leads them to better compliance with the therapeutic measures prescribed. This mode of approach requires more time, which, unfortunately, may not always be possible due to the great number of visits the ophthalmologist has to cover during working hours. Frequent ophthalmologic follow ups are mandatory to be sure that therapy is performed correctly and to prevent the possible unfavorable effects of noncompliance.
统计分析还没有显示出家长的受教育程度对治疗成功率产生的显著差异 (P = 0.61)。最依从治疗的儿童获得了最佳结果。眼科医师获得家长信任是至关重要的，这将导致他们更好地遵从指定的治疗措施。这种模式的治疗方法需要更多的时间，遗憾的是，这是不大可行的，因为眼科医师在工作时间内要应付大量诊断。频繁的眼科追踪是强制性的，以确保治疗正确执行，防止可能的不利影响。
Key words: Amblyopia -prevention and control,' Amblyopia - diagnosis; Vision screening - methods; Health knowledge attitudes - practice; Parents psychology; Patient compliance
关键词：弱视的预防和控制，'弱视 - 诊断;视力筛查 - 方法;健康知识态度 - 行为;家长的心理，病人依从
Introduction
Amblyopia in children poses a great problem that has to be identified on time and treatment initiated as early as possible to achieve optimal therapeutic result.
Therapeutic success depends greatly on the children's parents' collaboration. It was the reason for us to embark upon this study to evaluate the parents' role in amblyopia treatment and their influence on the final therapeutic result.
导入
儿童弱视是必须及时确诊并尽早启动治疗以达到最佳治疗效果的一个大问题。治疗的成功极大地取决于孩子们家长的合作。这就是我们着手这项研究来评估家长在弱视治疗中的作用及对最终的治疗结果影响的原因。
Correspondence to:
Spinciceva 1, HR-21000
E-mail: ante.utrobicic1@st.t-com.hr
Received August 3, 2009, accepted October 9, 2009
多布里拉卡尔利察，博士，大学眼科，斯普利特大学医疗中心，
Spinciceva 1，人力资源- 21000斯普利特，克罗地亚
电子邮箱：ante.utrobicic1 @ st.t - com.hr
The diagnosis of amblyopia is confirmed when the loss of visual acuity cannot be explained by visible abnormalities, or when there are some history or other data on a previous illness or state that might have caused amblyopia.
One therapeutic option for amblyopia is to promote the use of the amblyopic eye by restricting the function of the better eye (occlusions that can last from a few hours to throughout the day), demonstrated to be the best way to treat amblyopia. The duration of occlusion therapy depends on the degree of amblyopia. Parents' collaboration and motivation is crucial because the treatment is long lasting and a certain degree of worsening may occur if it is prematurely interrupted.
当视力丧失无法解释为视觉异常或有一些历史记录或其他以前病的数据可能导致弱视时，可以确诊为弱视。一种治疗弱视的疗法是通过限制调节功能较好的眼 （可以持续的从几个小时至全天的阻塞) 来促进弱视眼的使用，这被证实是治疗弱视的最佳方法。阻塞治疗的时间长短取决于弱视的程度。家长的合作和动机是关键，因为治疗是长期持久的，如果它过早地中断，可能会出现某种程度的恶化。
Dobrila Karlica d aL
The aim of the study was to detennine the percentage to which the parents complied with performing prescribed exercises with their children, how often the children were wearing the glasses prescribed, the degree to which the parents understood their children's health state, and whether they were satisfied with their child's ophthalmologist.
研究目的旨在确定家长与子女遵守规定的行为练习、孩子们如何佩戴规定的眼镜、在何种程度上家长了解子女的健康状况以及他们是否对孩子的眼科医生感到满意的百分比。
Subjects and Methods主题与方法
The parents whose children were treated at the pediatric ophthalmology outpatient clinic for amblyopia, being caused either by strabismus or anisometropia, were asked to fill out a questionnaire. We selected parents whose children had amblyopia of comparable grade and received approximately the same treatment.
The parents were divided into three groups of 35 persons according to their educational level. Group 1 consisted of parents with university education, group 2 included parents with high school education, and group 3 included parents with less than high school education.
由于斜视或屈光参差导致弱视并通过小儿眼科门诊治疗弱视的子女的家长，被要求填写一份问卷。我们选择弱视级别相近的并且接受大约相同的治疗的子女的家长。家长根据他们的受教育水平被分成三个组，每组 35 人。第一组包括接受过大学教育的家长，第二组包括高中教育的家长，第三组包括低于高中教育的家长。
Their questionnaire answers were compared with ophthalmologic findings of their children. 他们调查表的回答与他们子女的眼科研究结果进行了比较。
Fig. 1. Distribution if parents' questionnaire answers.
Values are expressed as percentage.
图 1。家长问卷回答的分布。
值表示为百分比。
The study included 105 parents accompanying their children to the pediatric ophthalmology outpatient clinic or outpatient orthopleoptic clinic, University Department of Ophthalmology,
The questionnaire asked the following questions:
1. To what extent are you familiar with your child's diagnosis?
2. Does your child wear prescribed glasses?
3. Does your child perform occlusive therapy regularly?
4. Are you satisfied with your child's ophthalmologist?
该项研究包括105名陪同子女到儿科眼科门诊或Split大学医院中心大学眼科门诊临床orthopleoptic的家长。
调查问卷包括下列问题：
1.在何等程度上你熟悉您孩子的诊断？
2.你孩子佩戴指定的眼镜吗？
3.你的孩子定期执行阻塞治疗吗？
4.你满意你孩子的眼科医师吗？
The children's visual acuity measured before and after prescribed therapy was compared with the parents' answers.
Statistical analysis was done by use of the Statistica 6.0 software (StatSoft Inc.). Between-group differences were analyzed by Student's t -test and i-test.
Statistical significance was set at P<0.05.
儿童治疗之前和之后的测量视力与家长的答案进行了对比。
统计分析是通过使用 Statistica 6.0 软件 (StatSoft Inc.)完成的。组之间的差异由学生 t-测试和X2-测试进行分析。
统计有效性设置为P<0.05。
Results结果
The study included 105 parents, 35 with university education, high school education and less than high school education each. General distribution of parents' questionnaire answers according to these three groups is presented in Figure 1. Amblyopia was caused by strabismus in 65 (61.9%) and by anisometropia in 40 (38.1%) children. Study results showed group 3 parents to be less familiar with their children's medical condition and they did not know what the aim of therapy prescribed was. Nevertheless, their children seemed to be most compliant with prescribed therapy, either occlusive therapy or wearing glasses, and they were most satisfied with the work of their children's ophthalmologist. Among 105 children, post-therapeutic improvement in visual acuity was recorded in 66 (62.8%) children, whereas the rest of 39 (37.1%) children showed no improvement. In group 1 parents, 22 (62.8%) children showed post-therapeutic improvement in visual amity, whereas 13 (37.1%) children showed no improvement. In group 2 parents, post-therapeutic improvement in visual acuity was recorded in 24 (68.5%) and no improvement in 11 (31.4%) children. In group 3 parents, post-therapeutic improvement was found in 20 (57.1%) and no improvement in 15 (42.8%) children. Distribution of parents' answers to particular questions is presented in Figures 2-6. The success of treatment for amblyopia according to three levels of parents' education is shown in Fig. 7.
该项研究涉及到105名家长，3个组，大学教育学历、高中教育和低于高中教育学历的各35名。这三个组的家长的问卷答案一般分布如图 1 中所示。65名儿童由(619%) 斜视造成弱视，40名 (381%) 儿童由屈光参差造成弱视。显示结果表明，第三组家长对子女的医疗条件不太熟悉，他们并不知道所指定的治疗目标是什么。不过，他们的孩子似乎最遵守指定的阻塞治疗或配戴眼镜治疗，并且他们对子女的眼科医师的工作感到最满意的。105 儿童中，录得 66 名(62.8%) 小儿视力得到后期治疗改善，而其余 39 名(37.1%) 孩子则没有表现出改善。第一组家长的孩子中有22名（62.8％）表现出良好视觉改善，而13名（37.1％）儿童无明显改善。第二组家长的孩子中录得24名（68.5％）有后期治疗视力改善，11名（31.4％）无改善。第三组家长的孩子中录得20名（57.1％）有后期治疗视力改善，15名（42.8％）无改善。家长对特定问题的回答分布如图2-6所示。基于家长受教育三种水平的弱视的治疗成功率如图7。
Statistical analysis showed that there was no statistically significant difference in the rate of therapeutic success according to the parents' educational level
(Pearson X2=0.98; df=2; P=0.61).
统计分析显示，家长的受教育水平对治疗成功率没有统计学上的显著差异
(Pearson X2=0.98; df = 2 ； P = 0.61)。
Fig. 2. Frequency of different answers to question 1 (How much do you know about your child's medical condition?) according to parents' educational leve.(P<0.005)
图2。基于家长的受教育水平，问题1不同答案的频率比照（你对你的孩子的医疗条件了解多少？）（P<0.005）
Fig. 3, Frequency of different answers to question 2 (Does your child wear prescribed glasses regularly?) according to parents' educational level.(p=0. 72).
图 3，基于家长受教育水平的问题2的不同答案的频率（你的孩子有规律地佩戴指定的眼镜吗？）。(p = 0.72)。
Fig. 4, Frequency of different answers to question 3 (Does your child comply with occlusive therapy?) according to parents' educational level (P<0.005).
图 4，基于家长受教育程度的问题 3 的不同答案的频率 （您的孩子是否遵守闭塞治疗？） (P P<
Fig. 5. Frequency of different answers to question 4 (Do you know what is occlusive therapy for?) according to parents' educational level (P<0.001).
图5基于家长的受教育程度的问题 4的不同答案的频率（你知道什么是闭塞治疗？）（P<0.001).
Fig. 6. Frequency of different answers to question 5 {Are you satisfied with your physician's work?} according to parents' educational level (p=0.26).
图 6。 基于家长受教育程度的问题 5 {您对你的医生的工作满意吗？}的不同答案的频率(p = 0.26)。
Fig. 7. Success of treatment for amblyopia according to three levels of parents' education. Values are expressed as percentage.
图7。基于家长受教育的三个级别的弱视治疗的成功率。值表示为百分比。
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Discussion讨论
We decided to embark upon this study because we had often faced a situation where the child's parents did not understand what their child was treated for, or did not understand at all the terms like strabismus or astigmatism. We also noticed that parents usually passed the control of occlusive therapy to their child's will. It usually results in poor therapy compliance because the child finds it annoying, or does not like to cover the leading eye, crying or struggling to avoid the occlusion. This confirms poor understanding of the importance of occlusive therapy among parents.
我们决定着手这项研究，因为我们经常遇见这样的家长，他们不懂他们的孩子接受的是什么样的治疗，或根本不明白斜视或散光等事项。我们也注意到家长往往根据他们孩子的意愿忽视了对阻塞治疗的控制。它通常会导致较差的治疗依从，因为孩子觉得这令其讨厌，他们不喜欢遮蔽着眼睛，于是哭或挣扎逃避。这证实了家长对阻塞治疗重要性的理解较差。
Occlusive therapy done at the hospital, under medical staff surveillance, is reported to be significantly more successful than when done at home. The reason for this might be poor or incomplete compliance with amblyopia treatment at home. It is also important to note that our study demonstrated that the parents' educational level had no influence on the rate of amblyopia treatment success.
在医院医务人员监督下进行的阻塞治疗成功率大大超过在家里进行的。这可能是较差的或不完整的家庭弱视治疗依从性的原因。同样重要的是，要注意我们的研究表明家长的教育水平并没有对弱视治疗成功率产生影响。
Conclusion结论
We may say that great parents' efforts and collaboration with their children's ophthalmologists are needed to achieve optimal therapeutic results. Our Parents and treatment of amblyopia study showed that best results were obtained in children with high therapy compliance. Statistical analysis showed no correlation between the parents' educationallevel and rate of therapeutic success. It is of utmost importance that the ophthalmologist gains the parents' trust, which will then result in better compliance with the therapy prescribed. In order to gain their trust, the ophthalmologist should inform the parents about their child's medical condition, prognosis and treatment plan. This information has to be delivered in an appropriate way. It is crucial for the ophthalmologist to evaluate the extent to which the parents can understand their child's condition and to adjust the explaining process accordingly. This approach requires more time, which, unfortunately, may not always be possible due to the great number of visits the ophthalmologist has to cover during his working hours. Frequent ophthalmologic follow ups are mandatory to be sure that therapy is being performed correctly and to avoid the possible unfavorable effects of noncompliance.
我们可以说，家长的努力和与子女眼科医生的合作才能取得最佳的治疗效果。我们研究中的家长和弱视治疗的研究结果表明，最好的结果伴随着高度治疗顺从。统计分析表明，家长受教育水平和治疗成功率之间没有相关性。最重要的是眼科医生能得到家长的信任，这将导致更好地遵守规定治疗的结果。为了赢得他们的信任，眼科医生应告知他们孩子的健康状况、预后和治疗计划。此信息必须以适当的方式送达。它对眼科医师评估家长对孩子情况的了解程度并对此进行相应的调整具有决定性作用。。这种方法需要更多的时间，遗憾的是，这往往不可行，因为眼科医师在其工作时间内要应付大量诊断。频繁的眼科追踪是强制性的，以确保治疗正在正确执行并避免可能的不利影响。
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Acta Clin Croat, Vol. 48, No.4, 2009
Dobrila Karlica et al Parents and treatment of amblyopia
Saietak
ULOGA RODITELJA U LIJECENJU SLABOVIDNOSTI KOD DJECE
D. Karlica, S. MatiJevii, D. Galetovid Lj. Znaor
Lijecenje slabovidnosti u djece predstavlja velik problem koji treba sto ranije dijagnosticirati i poceti s lijecenjem kako birezultati bili sto bolji. U lijecenju slabovidnosti suradnja s roditeljima je jedan od najvainijih preduvjeta za njenu uspjdnost.
Zbog tog razloga smo proveli ispitivanje roditelja i njihove uloge u lijecenju. Cilj ove studije je bio utvrditi u kojem postotku
roditelji kod djece provode zadane vjeibe u svrhu lijecenja slabovidnosti, nose li djeca propisane naoeale, kao i razumiju li
djetetovu dijagnozu i koliko su zadovoljni radom lijecnika. Anketirali smo 105 roditelja koji svoju djecu dovode u djecju
opeu ambulantu ili ambulantu za ortopleoptiku Klinike za ocne bolesti KBC Split. Dobivene odgovore usporedili smo snalazima u djece usporedivsi vidnu ostrinu prije terapije okluzijom i nakon preporucene terapije. Medu djecom koja su selijecila opeu ambulantu ili ambulantu za ortopleoptiku Klinike za ocne bolesti KBC Split. Dobivene odgovore usporedili smo snalazima u djece usporedivsi vidnu ostrinu prije terapije okluzijom i nakon preporucene terapije. Medu djecom koja su se
zbog slabovidnosti uzrok slabovidnosti je u 65 (61,9%) djece bio strabizam, a kod 40 (38,1%) djece anizometropija.
U studiju je bilo ukljucene ukupno 105 roditelja od kojih je 35 bilo s visokom i visom strucnom spremom, 35 sa srednjom
strucnom spremom i 35 s niiom strucnom spremom. Rezultati su pokazali kako su roditelji iz treee skupine bili najmanje
upoznati s djetetovom dijagnozom, u najveeem postotku nisu znali zbog cega se provodi zatvaranje oka, ali njihova djeca u
najveeem postotku
analiza podataka 0 uspjdnosti lijecenja ambliopije u odnosu na strucnu spremu roditelja nije pokazala znaeajnu razliku
(;(=0,98, df=2, P=0,61). Kako bi lijecenje slabovidnosti bilo sto ucinkovitije potrebna je suradnja roditelja i lijecnika, sto
podrazumijeva velik angaiman roditelja u provodenju vjeibi. Najvainije je da roditelji vjeruju lijecniku koji lijeci njihovo
dijete, jer se tada pridriavaju uputa koje im se daju u vezi s lijecenjem. Roditelji trebaju biti dobro obavijeSteni 0 bolesti,
prognozi i nacinu lijecenja. Takav pristup iziskuje vrijeme koje treba provesti s roditeljima, sto naialost katkad nije moguee
zbog velikog broja pregleda. Ceste kontrole su potrebne kako bismo bili sigurni u ispravno provodenje terapije te da bi se
izbjegli negativni ucinci nepridriavanja uputa za provodenje terapije.
Kljucne rijeci: AmbliopiJa - prevenciJa i kontrola; AmbliopiJa - diJagnostika; Ispitivanje vida - metode; Stavovi prema poznavanju
zdravlja - praksa; Psihologija roditelja; Swadljivost bolesnika
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