***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aim : To analyse psychological causes for low compliance with occlusion therapy for amblyopia . Method : In a r and omised trial , the effect of an educational programme on electronically measured compliance had been assessed . 149 families who participated in this trial completed a question naire based on the Protection Motivation Theory after 8 months of treatment . Families with compliance less than 20 % of prescribed occlusion hours were interviewed to better underst and their cause for non-compliance . Results : Poor compliance was most strongly associated with a high degree of distress ( p<0.001 ) , followed by low perception of vulnerability ( p = 0.014 ) , increased stigma ( p = 0.017 ) and logistical problems with treatment ( p = 0.044 ) . Of 44 families with electronically measured compliance less than 20 % , 28 could be interviewed . The interviews confirmed that lack of knowledge , distress and logistical problems result ed in non-compliance . Conclusion : Poor parental knowledge , distress and difficulties implementing treatment seemed to be associated with non-compliance . For the same domains , the scores were more favourable for families who had received the  educational programme  than for those who had not OBJECTIVE To develop a question naire to assess the acceptability of  amblyopia treatment  and its effect on the child and family . METHODS A 20-item parental survey was developed and pilot tested on 64 subjects , aged 3 to 6 years , participating in the Amblyopia Treatment Study , a r and omized trial comparing patching and atropine as treatments for moderate amblyopia . The survey was administered after 4 weeks of treatment . A descriptive item analysis and an internal consistency reliability analysis were performed . RESULTS Nineteen of the 20 items demonstrated adequate variability as evidence d by the frequency distributions for item responses . Only 4 ( < 1 % ) of 1280 possible item responses were missing , one each by 4 different respondents . Factor analysis identified 3 treatment-related factors--"adverse effects , " " compliance , " and " social stigma "-- among 11 of the 20 items . The internal-consistency reliability alpha for the 5-item adverse effects subscale was 0.82 , the 4-item compliance subscale alpha was 0.81 , and the 2-item social stigma subscale alpha was 0.84 . CONCLUSIONS The Amblyopia Treatment Index appears to be a useful instrument for assessing the impact of amblyopia treatment in 3- to 6-year-old children Purpose . The purpose s of this study were to evaluate self-esteem over 3 years in the 469 myopic children participating in the Correction of Myopia Evaluation Trial ( COMET ) , and to examine its relationship with lens assignment ( progressive addition lenses [ PALs ] vs. single-vision lenses [ SVLs ] ) , myopia progression , and several other ocular and demographic characteristics . Methods . Data collection included refractive error measurements , child-reported  visual symptoms , attitude toward glasses , adherence , and  self-esteem  as measured by the Self-Perception Profile for Children ( SPPC ) . A two-way analysis of variance ( treatment group × time ) was performed to examine whether PAL and SVL wearers differed in self-esteem over time . Multiple regression analyses were used to evaluate associations between self-esteem at follow-up and relevant factors identified by univariate analyses . Results . Regardless of lens assignment or myopia progression , COMET children reported moderate to high levels of self-esteem at follow-up in the areas of scholastic and athletic competence , physical appearance , social acceptance , behavioral conduct , and global self-worth . Mean scores ranged from 2.87 ( ± 0.68 ) on athletic competence to 3.40 ( ± 0.56 ) on global self-worth . Self-esteem changed significantly ( p < 0.05 ) over 3 years in the domains of scholastic competence , social acceptance , and physical appearance . Self-esteem at follow-up was associated with visual symptoms , attitude toward glasses , age , gender , and ethnicity . Conclusions . Lens assignment and myopia progression were not associated with self-esteem in the COMET cohort . These children had high levels of self-esteem , suggesting that having myopia does not negatively impact self-esteem . Follow-up reports will monitor self-esteem and related factors in this cohort of myopic children over the course of adolescence and early adulthood Aim : To evaluate if functionally relevant deficits in reading performance exist in children with essential microstrabismic amblyopia by comparing the monocular and binocular reading performance with the reading performance of normal sighted children with full visual acuity in both eyes . Methods : The reading performance of 40 children ( mean age 11.6 ( SD 1.4 ) years ) was evaluated monocularly and binocularly in r and omised order , using st and ardised reading charts for the simultaneous determination of reading acuity and speed . 20 of the tested children were under treatment for unilateral microstrabismic amblyopia  ( visual acuity in the amblyopic eyes : logMAR 0.19 ( 0.15 ) ; fellow eyes −0.1 ( 0.07 ) ) ; the others were normal sighted controls  ( visual acuity in the right eyes −0.04 ( 0.15 ) ; left eyes −0.08 ( 0.07 ) ) . Results : In respect of the binocular maximum reading speed ( MRS ) , significant differences were found between the children with microstrabismic amblyopia and the normal controls ( p = 0.03 ) : whereas the controls achieved a binocular MRS of 200.4 ( 11 ) wpm ( words per minute ) , the children with unilateral amblyopia achieved only a binocular MRS of 172.9 ( 43.9 ) wpm . No significant differences between the two groups were found in respect of the binocular logMAR visual acuity and reading acuity ( p>0.05 ) . For the monocular reading performance , significant impairment was found in the amblyopic eyes , whereas no significant differences were found between the sound fellow eyes of the amblyopic children and the control group . Conclusion : In binocular MRS , significant differences could be found between children with microstrabismic amblyopia and normal controls . This result indicates the presence of a functionally relevant reading impairment , even though the binocular visual acuity and reading acuity were both comparable with the control group The research reported is an experimental study on the effects of intensified education of parents of children with amblyopia on their underst and ing of the nature of the defect , its origins and treatment . Parents in the control group were exposed to the ordinary information provided at two departments of paediatric ophthalmology , whereas parents in the experimental group , attending the same clinics , were asked to read a booklet aim ing at enhancing their underst and ing of amblyopia and its treatment . Experimental as well as control subjects were thereafter interviewed about their underst and ing of the meaning of amblyopia and amblyopia-related phenomena . Data were generated in single subject , semi-structured , in-depth interviews which were taped and transcribed in extenso . The interviews were analyzed according to the phenomenographic approach : i.e. the outcome is a description of the various conceptions that emerged in the interviews . In almost all cases the categories of meaning could be hierarchically ordered with regard to the level of underst and ing implied . Parallel to the interviews the subjects had also filled out a question naire assessing general and specific attitudes towards disease and treatment ( the Health Belief Model , HBM ) . The results reveal a superior underst and ing among parents in the experimental group . The experimental group had also changed attitudes towards disease and treatment in a direction that would favour compliance , more than could be observed in the control group . The outcome is discussed in terms of the role of underst and ing for a compliant behaviour . It is also emphasised that health care personnel would profit from being aware of the nature of common misconceptions of diseases and their treatment , in the sense that they would be better prepared for entering instructional dialogues with patients or , as in this case , other persons responsible for the management of prescriptions provided OBJECTIVE To determine whether visual acuity improvement with Bangerter filters is similar to improvement with patching as initial therapy for children with moderate amblyopia . DESIGN R and omized , clinical trial . PARTICIPANTS We enrolled 186 children , 3 to < 10 years old , with moderate amblyopia ( 20/40 - 20/80 ) . METHODS Children were r and omly assigned to receive either daily patching or to use a Bangerter filter on the spectacle lens in front of the fellow eye . Study visits were scheduled at 6 , 12 , 18 , and 24 weeks . MAIN OUTCOME MEASURES Visual acuity in amblyopic eyes at 24 weeks . RESULTS At 24 weeks , amblyopic eye improvement averaged 1.9 lines in the Bangerter group and 2.3 lines in the patching group ( difference in mean visual acuities between groups adjusted for baseline acuity = 0.38 line ) . The upper limit of a 1-sided 95 % confidence interval was 0.76 line , which slightly exceeded a prespecified noninferiority limit of < 0.75 line . Similar percentages of subjects in each group improved > or =3 lines  ( Bangerter group 38 % vs patching group 35 % ; P = 0.61 ) or had > or = 20/25 amblyopic eye acuity ( 36 % vs 31 % , respectively ; P = 0.86 ) . There was a lower treatment burden in the Bangerter group as measured with the Amblyopia Treatment Index . With Bangerter filters , neither a fixation switch to the amblyopic eye nor induced blurring in the fellow eye to worse than that of the amblyopic eye was required for visual acuity improvement . CONCLUSIONS Because the average difference in visual acuity improvement between Bangerter filters and patching was less than half a line , and there was lower burden of treatment on the child and family , Bangerter filter treatment is a reasonable option to consider for initial treatment of moderate amblyopia BACKGROUND The Amblyopia Treatment Index ( ATI ) is a parental question naire that has been used to assess the impact of patching or atropine treatment on the child and family in several amblyopia treatment studies . The 18-item parental question naire was design ed with versions for treatment with patching or atropine . We pooled data across studies to further evaluate the validity of the ATI , to further assess the presence or absence of factors ( subscales ) . METHODS A parent or guardian completed the ATI for 794 children who participated in 1 of 4 r and omized clinical trials . Internal consistency reliability was assessed with Cronbach 's alpha , and factor analysis was performed . RESULTS The ATI demonstrated high internal consistency reliability , with a Cronbach 's alpha of 0.88 ( 95 % CL = 0.87 , 0.89 ) . Factor analysis revealed the same 3 minimally overlapping factors found in the original validation study , which were again labeled " adverse effects , " " treatment compliance , " and " social stigma . " Two of the 18 items did not load with any factor and could reasonably be omitted from future ATI administrations . CONCLUSIONS The ATI is a useful instrument for assessing the impact of patching or atropine treatment on the child and family Background / aims : It is well documented that non-concordance with occlusion therapy is both substantial and a major factor leading to treatment failure . Parental underst and ing in previous work has been found to be poor in key areas such as the critical period and effect of age on prognosis . Research in other areas of medicine has shown that the level of underst and ing can have a direct effect on the level of concordance . The aims of this study were to assess the ability of educational material in the form of a leaflet , to improve parental underst and ing of amblyopia and occlusion , and subsequently increase concordance . Methods : Parents of children aged between 1 and 7 years receiving a minimum of 1 hour of occlusion for amblyopia were recruited . A r and omised controlled trial was undertaken where , on inclusion , the patients were r and omised into a leaflet group , whose parents were issued with written educational material , and a control group whose parents did not receive the written information .  Patients were paired and matched for age ( < 2 years difference ) and amount of prescribed occlusion ( no more than 1 hour difference ) . Concordance was monitored by a parental diary and knowledge and parental reasons for non-concordance were assessed by a question naire . Concordance was analysed by means of a concordance index and by calculating the proportion of non-concordant parents by setting a threshold of concordance at 80 % . Results : Parental knowledge was significantly greater in the leaflet group ( 88 % had complete knowledge ) compared to the control group ( 49 % had complete knowledge ) ( p < 0.001 ) . There were also differences between the groups in the area of the treatment regimen , with errors only occurring in the control group ( three patients occluded the incorrect eye ) , but this did not reach statistical significance . Concordance was significantly greater in the leaflet group ( mean concordance index 0.85 ) compared to the non-leaflet group ( mean concordance index ( 0.71 ) ( p < 0.001 ) . Comparison of the proportion of non-concordant parents was also statistically different ( p < 0.005 ) at 0.23 ( 95 % CI 0.13 to 0.35 ) for the leaflet group compared to 0.54 ( 95 % CI 0.41 to 0.67 ) for the control group . Conclusion : A large proportion of patients would benefit by increasing parental knowledge in key areas such as the critical period , importance of occlusion , and potential negative consequences of not treating amblyopia . Written information is a simple , inexpensive , 
    Output:
    
The HRQoL implication s of amblyopia related specifically to amblyopia treatment , rather than to the condition itself .
The reported findings of the HRQoL implication s are of importance when considering the management of cases of amblyopia .