Comparison between Amblyopia Treatment with Glasses Only and Combination of Glasses and Open-Type Binocular “Occlu-Pad” Device

Abstract

We evaluated amblyopia treatment, comparing training with glasses only and training with glasses and the Occlu-pad, a binocular open-type amblyopia training device. Forty-six children (4.8 ± 1.1 years) diagnosed with anisometropic amblyopia, all wearing complete correction glasses, were treated either with glasses only, or with glasses in combination with the Occlu-pad (training time: 2 days a week, 30 minutes per day). We compared visual acuity scores at 3 and 6 months after treatment had started, and examined the compliance rate for the Occlu-pad training. Three months as well as 6 months after amblyopia treatment started, the “Occlu-pad treatment group” showed significantly improved visual acuity, compared to the “Glasses treatment group” (at both 3 and 6 months: p < 0.0001). The compliance rate for using the Occlu-pad was 88.4 ± 18.7% after 3 months and 69.6 ± 19.5%, after 6 months. There was no significant correlation between the training time using the Occlu-pad and improvement in visual acuity (3 months: p = 0.97; 6 months: p = 0.55). The compliance rate for months 4 to 6 was significantly lower than that for months 1 to 3 (p = 0.003). Amblyopia treatment using the Occlu-pad device in combination with glasses led to a better effect than treatment with glasses alone.

Active Vision Therapy for Anisometropic Amblyopia in Children: A Systematic Review

“…For instance, Singh et al reported significant differences in their RCT, since the group that received dichoptic therapy and patching improved 2.4 lines in VA, while the patching group enhanced 1.8 lines [23]. In addition, good treatment compliance (mean of 69% or more) with visual therapy was reported by many authors [24][25][26][27][28], except a rate of 50% of compliance reported by Birch et al [21]. is is an important advantage compared to patching, as its compliance ranges from 44% to 57% [31].…”

“…According to the results of this systematic review, three main aspects should be analyzed in studies evaluating the effect of active vision therapy in amblyopia due to its importance in daily practice: visual acuity improvement, dose-response ratio, and adherence to treatment. Active visual therapy with dichoptic therapy, perceptual learning, anaglyph glasses, or some specific video games is effective in the treatment of anisometropic amblyopia to improve visual acuity [21][22][23][24][25][26][27][28] when it is compared with only glasses [24,26], patching [23,28], or placebo [21]. According to some authors, this improvement seems to be similar to patching [24,26,27], without a clear evidence confirming that vision therapy is more or less effective than patching for the treatment of anisometropic amblyopia in children.…”

“…For example, Singh et al [ 23 ] and Totsuka et al [ 28 ] prescribed 1 hour of training per day, Deshpande et al [ 25 ] up to 2 hours per day, and Kuruca et al [ 22 ] 15 minutes per day 6 times a week. While Birch et al [ 21 ] prescribed 4 hours per week, Iwata et al [ 24 , 26 ] prescribed 2 sessions per week (30 minutes per day), and Gambacorta et al prescribed 20 hours of training with no specific time per day [ 27 ]. Furthermore, some authors also combined vision therapy with near task and patching, but not all of them.…”

Stimuli Characteristics and Psychophysical Requirements for Visual Training in Amblyopia: A Narrative Review

“…Despite the fact that they seem to be effective, they also have some features which could be a limitation. Some of these treatments are based on dichoptic training or monocular stimulation, and use eye–hand coordination games [ 12 , 14 , 46 ] and popular films [ 47 ] which are not specifically designed for treating amblyopia, or do not adjust the difficulty of the training to the patient’s progress. However, there are four types of stimuli which have shown to be effective in clinical research that can be easily added to the amblyopia training software, with the possibility of modification according to the patient’s evolution, and these are letter optotypes [ 48 , 49 ], Gabor’s patches [ 9 , 48 , 49 , 50 , 51 , 52 ], Vernier’s stimuli [ 53 ] and random-dot stereograms [ 16 , 54 ] ( Table 1 ).…”

“…Over the last few years, vision therapy has been suggested to be an effective option to promote visual rehabilitation and even to accelerate recovery when combined with patching [ 8 ]. New trends in computer-based active vision therapy have been developed for amblyopia treatment, such as the use of perceptual learning environments [ 9 , 10 , 11 ], dichoptic stimulation [ 12 , 13 , 14 ] and binocular training [ 15 , 16 ]. These video games use visual and perceptual tasks, such as orientation discrimination or letter recognition, among others, to cause a response in neuro-modulatory pathways and the enhancement of attentional skills, according to neurophysiological studies [ 17 , 18 ].…”