Long-Term Efficacy of the Combination of Active Vision Therapy and Occlusion in Children with Strabismic and Anisometropic Amblyopia

Abstract

This retrospective study was conducted to evaluate the efficacy of the combined treatment of occlusion and active vision therapy in a total of 27 amblyopic children, including 14 strabismic and 13 anisometropic cases. For such purpose, changes in distance and near visual acuity as well as in the binocular function was evaluated during a two-year follow-up. In both amblyopia groups, significant improvements were found in distance and near visual acuity in the non-dominant eye (p < 0.001). In the strabismic amblyopia group, the percentage of patients with binocular function score (BF) > 3.3 decreased significantly from a baseline value of 64.3% to a two-year follow-up value of 7.1% (p < 0.001). In the anisometropic amblyopia group, this percentage also decreased significantly from a baseline value of 15.4% to a two-year follow-up value of 0.0% (p < 0.001). No recurrences were observed in the anisometropic amblyopia group, whereas recurrence occurred in two cases of the strabismic amblyopia group after finishing the vision rehabilitation process. In conclusion, the combined approach of the treatment evaluated is efficacious for providing an improvement in visual acuity and binocular function in both anisometropic and strabismic amblyopia, which was maintained over time.

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

“…Several studies investigated the efficacy of vision therapy [30,32,53,54,61]. A large retrospective study in India analyzed the data of 160 children between 4 and 13 years old who underwent vision therapy with the Bynocs training platform (Kanohi Eye Pvt., Mumbai, India) [53].…”

“…Other studies investigated the effectiveness of vision therapy combined (consequently) with occlusion in children [32,61]. They both concluded that the combination of these treatments offers a significant visual gain in both VA and stereopsis, with no regression over long follow-up periods (12 and 24 months, respectively) [32,61].…”

“…Other studies investigated the effectiveness of vision therapy combined (consequently) with occlusion in children [32,61]. They both concluded that the combination of these treatments offers a significant visual gain in both VA and stereopsis, with no regression over long follow-up periods (12 and 24 months, respectively) [32,61]. Furthermore, when comparing outcomes to occlusion solely, vision therapy provided greater benefit, and the treatment effects were achieved within a shorter time period [30,32,61].…”

“…They both concluded that the combination of these treatments offers a significant visual gain in both VA and stereopsis, with no regression over long follow-up periods (12 and 24 months, respectively) [32,61]. Furthermore, when comparing outcomes to occlusion solely, vision therapy provided greater benefit, and the treatment effects were achieved within a shorter time period [30,32,61]. Researchers also noted that strabismic amblyopia is more resistant to treatment than anisometropic and that foveal fixation in strabismus is important for visual recovery, corroborating findings from previous studies [32].…”

Amblyopia Treatment through Immersive Virtual Reality: A Preliminary Experience in Anisometropic Children

“…In contrast to patching, in which the objective is to penalize the dominant eye and to stimulate the amblyopic eye passively, the binocular treatment has the objective of balancing both eyes, leading to simultaneous vision and, consequently, to binocularity [ 9 ]. These binocular treatments are an adjuvant of patching therapies, with improvements in visual acuity when combining both active and passive treatments [ 10 , 11 , 12 ]. Some previous studies have demonstrated that the effectiveness of the binocular option can be comparable to that obtained with patching [ 13 ].…”