Effectiveness of combined dichoptic therapy, binocular vision therapy, and part-time patching for the management of amblyopia in adults

Randomized Controlled Trial of Patching versus Dichoptic Stimulation Using Virtual Reality for Amblyopia Therapy

Purpose: To compare the outcomes of patching to dichoptic stimulation using virtual reality (VR) in moderate and severe amblyopia.Methods: This study was conducted on 86 subjects with unilateral anisometropic and mixed amblyopia. The subjects were randomized to the VR or patching group. The VR group received treatment using the Vivid Vision software (Vivid Vision Inc., San Francisco, USA) with each subject receiving weekly 2 h-sessions for 10 weeks. The patching group was prescribed patching for 10 weeks. Best-corrected visual acuity (BCVA) was measured using a single crowded letter in an ETDRS chart before, after 10 weeks of treatment, and after another 10 weeks of cessation of treatment. Near stereoacuity was measured using the TNO test.Results: Forty-two patients were randomized to the patching group and 44 to the VR group. The median age of the subjects was 12.0 (range 6.0 to 37.0) years. In the VR group, mean amblyopic eye BCVA showed statistically significant improvement by 0.89 line (95% confidence interval {CI}, 0.73 to 1.35 lines; p < 0.001) after 10 weeks of therapy, and after another 10 weeks of follow-up by 1.32 lines from baseline (95% CI, 1.15 to 1.7 lines; p < 0.001). Regarding the patching group, mean BCVA showed statistically significant improvement after 10 weeks by 1.38 lines (95% CI, 0.82 to 1.8 lines; p < 0.001), and after another 10 weeks by 1 line from baseline (95% CI, 0.06-0.147; 0.6 to 1.47 lines; p < 0.001). There was no significant difference between both groups at any time-point (p values >0.05). No serious adverse events were noted. Adults and severe amblyopes in the VR group showed more significant VA improvement than their counterparts in the patching group.Conclusions: Amblyopes treated using VR dichoptic treatment demonstrated statistically significant VA improvement after 10 and 20 weeks of follow-up that is comparable to patching.

Treatment of Anisometropic Amblyopia with a Dichoptic Digital Platform in Argentinian Children and Adults

PURPOSE

To evaluate and compare the results of dichoptic training in Argentinian children and adults with anisometropic amblyopia.

METHODS

Prospective non-comparative study enrolling 41 subjects with anisometropic amblyopia (age, 6-60 years old). Two groups were differentiated according to age, children (6-16 years, 24 subjects) and adults (>17 years, 17 subjects). All patients were treated with the Bynocs® platform (Kanohi Eye Pvt. Ltd, India) following a protocol of 30 sessions of training of 30 min daily 5 times a week for 6 weeks. Changes in corrected distance visual acuity (CDVA) and binocular function (BF) score with treatment were analyzed.

RESULTS

In the whole sample, CDVA in the amblyopic eye improved significantly, with a mean change of 0.30 logMAR (p < .001). Likewise, a significant improvement was also found in BF score (p < .001), with a mean change of 1.14 log units. The change achieved in CDVA was significantly correlated with the baseline CDVA in the amblyopic eye (r=-0.568, p < .001). Furthermore, no significant differences were found between age groups in the change achieved in CDVA (p = .431) and BF with therapy (p = .760).

CONCLUSIONS

Dichoptic training with the digital platform evaluated provides an effective improvement of visual acuity and binocular function in children and adults with anisometropic amblyopia.

Current Developments in the Management of Amblyopia with the Use of Perceptual Learning Techniques

Background and Objectives: Amblyopia is a neurodevelopmental disorder caused by interocular suppression of visual input, affecting visual acuity, stereopsis, contrast sensitivity, and other visual functions. Conventional treatment comprises occlusion of the sound eye. In recent years, novel therapies that deploy perceptual learning (PL) principles have been introduced. The purpose of this study is to assess the latest scientific data on this topic. Materials and Methods: For this purpose, we conducted a literature search for relevant studies published during the previous 4 years (2020-2023). Results: A plethora of visual perceptual learning protocols have been recently developed. Dichoptic video games, contrast rebalanced movies, and online perceptual training platforms are the main formats. Perceptual learning activates neuroplasticity, overcomes interocular suppression, and improves the visual impairments induced by amblyopia. Conclusions: This novel treatment is effective in both children and adults, as well as in patients non-responding to patching.

Feasibility of measuring eye–hand coordination in children with developmental delay using Sanet Vision Integrator

Eye–hand coordination is a visuomotor task that enables one to look, localize, and touch objects. Eye–hand coordination is known to be poor in children with developmental delay. In this study, we assessed the feasibility of measuring eye–hand coordination task in children with developmental delay using Sanet Vision Integrator (SVI), a commercially available device. Children (age: 3–16 years) with developmental delay and their age-similar typically developing peers were enrolled. White circles (5.5°) on a black background were presented on the SVI touch screen monitor. Participants popped these circles by touching it. Reaction time, accuracy, and an overall performance score were computed. Participants could perform the task from 4 years of age and with visual acuity 20/400 (6/120) or better. This resulted in 85% (17/20) of children with developmental delay and 95% (19/20) of typically developing children completing the task. Children with developmental delay were significantly ( p < .001) less accurate (56%) and took longer (2.63 s) to complete the task when compared with their peers (accuracy = 93%, reaction time = 1.46 s). The overall performance score of children with developmental delay was also lower than their peers by a factor of 3.3. Eye–hand coordination performance can be measured and quantified with SVI. The quantification of speed and accuracy is possible and a unitary measure combining speed-accuracy can be computed. The task can be performed both by typically developing children and by children with developmental delay. Thus, it is feasible to measure eye–hand coordination using SVI. Such quantification will be useful for children undergoing interdisciplinary therapies for their medical conditions.