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
REFERENCES:
  1. Birch EE. Amblyopia and binocular vision. Prog Retin Eye Res. 2013;33:67-84. [Crossref]  [PubMed]  [PMC] 
  2. Repka MX, Beck RW, Holmes JM, Birch EE, Chandler DL, Cotter SA, et al; Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol. 2003;121(5):603-11. [Crossref]  [PubMed] 
  3. Holmes JM, Kraker RT, Beck RW, Birch EE, Cotter SA, Everett DF, et al; Pediatric Eye Disease Investigator Group. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology. 2003;110(11):2075-87. [Crossref]  [PubMed] 
  4. von Noorden GK, Campos EC. Patching regimens. Ophthalmology. 2004;111(5):1063; author reply 1064-6. [Crossref]  [PubMed] 
  5. Kushner BJ. Patching regimens for amblyopia. Ophthalmology. 2005;112(4):736-7; author reply 737. [Crossref]  [PubMed] 
  6. Stewart CE, Fielder AR, Stephens DA, Moseley MJ. Design of the Monitored Occlusion Treatment of Amblyopia Study (MOTAS). Br J Ophthalmol. 2002;86(8):915-9. [Crossref]  [PubMed]  [PMC] 
  7. Stewart CE, Moseley MJ, Fielder AR, Stephens DA; MOTAS Cooperative. Refractive adaptation in amblyopia: quantification of effect and implications for practice. Br J Ophthalmol. 2004;88(12):1552-6. [Crossref]  [PubMed]  [PMC] 
  8. Stewart CE, Moseley MJ, Stephens DA, Fielder AR. Treatment dose-response in amblyopia therapy: the Monitored Occlusion Treatment of Amblyopia Study (MOTAS). Invest Ophthalmol Vis Sci. 2004;45(9):3048-54. [Crossref]  [PubMed] 
  9. Stewart CE, Stephens DA, Fielder AR, Moseley MJ; MOTAS Cooperative. Modeling dose-response in amblyopia: toward a child-specific treatment plan. Invest Ophthalmol Vis Sci. 2007;48(6):2589-94. [Crossref]  [PubMed] 
  10. Stewart CE, Stephens DA, Fielder AR, Moseley MJ; ROTAS Cooperative. Objectively monitored patching regimens for treatment of amblyopia: randomised trial. BMJ. 2007;335(7622):707. [Crossref]  [PubMed]  [PMC] 
  11. Hrisos S, Clarke MP, Wright CM. The emotional impact of amblyopia treatment in preschool children: randomized controlled trial. Ophthalmology. 2004;111(8):1550-6. [Crossref]  [PubMed] 
  12. Searle A, Norman P, Harrad R, Vedhara K. Psychosocial and clinical determinants of compliance with occlusion therapy for amblyopic children. Eye (Lond). 2002;16(2):150-5. [Crossref]  [PubMed] 
  13. Newsham D. A randomised controlled trial of written information: the effect on parental non-concordance with occlusion therapy. Br J Ophthalmol. 2002;86(7):787-91. [Crossref]  [PubMed]  [PMC] 
  14. Hiscox F, Strong N, Thompson JR, Minshull C, Woodruff G. Occlusion for amblyopia: a comprehensive survey of outcome. Eye (Lond). 1992;6 ( Pt 3):300-4. [Crossref]  [PubMed] 
  15. Awan M, Proudlock FA, Gottlob I. A randomized controlled trial of unilateral strabismic and mixed amblyopia using occlusion dose monitors to record compliance. Invest Ophthalmol Vis Sci. 2005;46(4):1435-9. [Crossref]  [PubMed] 
  16. Maconachie GD, Gottlob I. The challenges of amblyopia treatment. Biomed J. 2015;38(6):510-6. [Crossref]  [PubMed]  [PMC] 
  17. Holmes JM, Edwards AR, Beck RW, Arnold RW, Johnson DA, Klimek DL, et al; Pediatric Eye Disease Investigator Group. A randomized pilot study of near activities versus non-near activities during patching therapy for amblyopia. J AAPOS. 2005;9(2):129-36. [Crossref]  [PubMed] 
  18. Papageorgiou E, Asproudis I, Maconachie G, Tsironi EE, Gottlob I. The treatment of amblyopia: current practice and emerging trends. Graefes Arch Clin Exp Ophthalmol. 2019;257(6):1061-78. [Crossref]  [PubMed] 
  19. Pediatric Eye Disease Investigator Group. A randomized trial of near versus distance activities while patching for amblyopia in children aged 3 to less than 7 years. Ophthalmology. 2008;115(11):2071-8. [Crossref]  [PubMed]  [PMC] 
  20. Alotaibi AG, Fawazi SM, Alenazy BR, Abu-Amero KK. Outcomes of 3 hours part-time occlusion treatment combined with near activities among children with unilateral amblyopia. Saudi Med J. 2012;33(4):395-8. [PubMed] 
  21. Bloch D, Wick B. Differences between strabismic and anisometropic amblyopia: research findings and impact on management. In: Rutstein Rp, ed. Amblyopia. Problems in Optometry. Vol. 3. Philadelphia: Lippin­cott; 1991. p.276-92. ISSN: 1043-6278.
  22. Cotter SA; Pediatric Eye Disease Investigator Group, Edwards AR, Wallace DK, Beck RW, Arnold RW, Astle WF, Barnhardt CN, et al. Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology. 2006;113(6):895-903. [Crossref]  [PubMed]  [PMC] 
  23. Writing Committee for the Pediatric Eye Disease Investigator Group, Cotter SA, Foster NC, Holmes JM, Melia BM, Wallace DK, Repka MX, et al. Optical treatment of strabismic and combined strabismic-anisometropic amblyopia. Ophthalmology. 2012;119(1):150-8. [Crossref]  [PubMed]  [PMC] 
  24. Chen PL, Chen JT, Tai MC, Fu JJ, Chang CC, Lu DW. Anisometropic amblyopia treated with spectacle correction alone: possible factors predicting success and time to start patching. Am J Ophthalmol. 2007;143(1):54-60. [Crossref]  [PubMed] 
  25. Stewart CE, Moseley MJ, Fielder AR. Amblyopia therapy: an update. Strabismus. 2011;19(3):91-8. [Crossref]  [PubMed] 
  26. Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA, et al; Pediatric Eye Disease Investigator Group. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005;123(4):437-47. [Crossref]  [PubMed] 
  27. Wallace DK, Chandler DL, Beck RW, Arnold RW, Bacal DA, Birch EE, et al; Pediatric Eye Disease Investigator Group. Treatment of bilateral refractive amblyopia in children three to less than 10 years of age. Am J Ophthalmol. 2007;144(4):487-96. [Crossref]  [PubMed]  [PMC] 
  28. Clarke MP, Wright CM, Hrisos S, Anderson JD, Henderson J,Richardson SR. Randomised controlled trial of treatment of unilateral visual impairment detected at preschool vision screening. BMJ. 2003;327(7426):1251. [Crossref]  [PubMed]  [PMC] 
  29. Moseley MJ, Neufeld M, McCarry B, Charnock A, McNamara R, Rice T, et al. Remediation of refractive amblyopia by optical correction alone. Ophthalmic Physiol Opt. 2002;22(4):296-9. [Crossref]  [PubMed] 
  30. Maconachie G, Farooq S, Bush G, Proudlock FA, Gottlob I. Effect of compliance to glasses wear on the outcome of visual acuity after refractive adaptation. Invest Ophthalmol Vis Sci. 2012;53(14):5609. [Link] 
  31. Norris JH, Pilling RF, Hook J. An audit of the Royal College of Ophthalmologists strabismic amblyopia treatment protocol: a departmental review. Strabismus. 2009;17(2):78-81. [Crossref]  [PubMed] 

.: Up To Date

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com