Binocular Treatment of Amblyopia

Abstract

Purpose: To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.Methods: Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.Results: Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.Conclusions: There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future. Ophthalmology 2020;127:261-272 ª 2019 by the American Academy of OphthalmologyThe American Academy of Ophthalmology prepares Ophthalmic Technology Assessments to evaluate new and existing procedures, drugs, and diagnostic and screening tests. The goal of an Ophthalmic Technology Assessment is to systematically review the available research for clinical efficacy, effectiveness, and safety. After review by members of the Ophthalmic Technology Assessment Committee, other assessments by Academy committees, relevant subspecialty societies, and legal counsel are submitted to the Academy's Board of Trustees for consideration as official Academy statements. The purpose of this assessment by the Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel was to review the publis...

Barriers to successful dichoptic treatment for amblyopia in young children

“…Age turned out to be a key factor in determining eligibility and success of dichoptic treatment in practice. In the literature, the age of children undergoing these therapies mostly range from 4 to 17 years [10]. We note that the subjects from the study of Gambacorta et al, which used the same gaming principles, had older subjects with an age range of 7 to 17 years [17].…”

“…A number of studies have reported favourable results not only in children but also in adults with on average 1 to 2 logMAR lines of improvement [9,10]. However, studies comparing the effectiveness of behavioural training with patching were incomplete because the actual gaming time was compared to prescribed or reported patching time [11][12][13].…”

Efficacy of vision-based treatments for children and teens with amblyopia: a systematic review and meta-analysis of randomised controlled trials

“…36 Several literature reviews have specifically compared the efficacy of binocular treatments to patching. A review by Pineles et al did not recommend the use of binocular treatments, 33 while other systematic literature reviews concluded that more research was required before making any conclusions about binocular treatments. 34 51 More RCTs were available at the time of our literature search than these studies, but the overall strength of evidence for this comparison was low, which implies that further research is still required.…”

“…Comparisons of vision-based treatments for patients with amblyopia have been examined in systematic reviews comparing patching against atropine [29][30][31] or binocular treatments against patching. [32][33][34] Only one review 35 included a meta-analysis, which was limited to two studies and two treatments. In general, published systematic reviews and meta-analyses found no significant differences between the various vision-based amblyopia treatments.…”

Patching and Suppression in Amblyopia: One Mechanism or Two?

“…It improves not only binocular vision Hess and Thompson, 2015;Webber et al, 2016;Kelly et al, 2018) but also monocular acuity (Hess et al, 2010bTo et al, 2011;Li et al, 2013Li et al, , 2014Mansouri et al, 2014;Birch et al, 2015). Despite ongoing debate concerning which therapeutic approach is more effective (Holmes et al, 2016;Kelly et al, 2016;Gao et al, 2018;Manh et al, 2018;Pineles et al, 2019), one should bear in mind the possibility that the visual improvements from both approaches might involve the same mechanisms in the brain. If both approaches involve similar neural mechanisms, convenience and efficacy might determine which one to use.…”