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The treatment protocol in this study¹ consisted of 1 hour of supervised near visual activities, including reading and drawing, while the patch was worn for 2 or 6 hours. The reported visual acuity improvement is consistent with the Hawthorne effect. This term is used to describe behavioral changes due to an awareness of being observed or active compliance with the supposed wishes of researchers because of special attention received.² The Hawthorne effect is known to bias outcome prevalence estimates.³

Likewise, the lack of a difference in outcome between the 2 modes of treatment in this article confirms the observation of Flynn et al⁴ that "success was not related to the duration of occlusion therapy, type of occlusion used, accompanying refractive error, patient's sex, or eye." In patients with refractive amblyopia, optical correction without occlusion produced substantial gains in visual acuity.⁵

The authors state that they "did not believe that we . . . [Full Text of this Article]

Philip Lempert, MD
Ithaca, NY

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The Effectiveness of Patching for Amblyopia Should Be Tested With Untreated Control Subjects—Reply
Michael X. Repka, Roy W. Beck, Danielle L. Chandler, Raymond T. Kraker, Pamela S. Moke, Jonathan M. Holmes, Eileen E. Birch, Susan A. Cotter, Richard W. Hertle, Graham E. Quinn, and Mitchell M. Scheiman
Arch Ophthalmol. 2004;122(3):424-425.
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