Randomised trial of three treatments for amblyopia: Vision therapy and patching, perceptual learning and patching alone.

Publisher: Blackwell Publishers Country of Publication: England NLM ID: 8208839 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-1313 (Electronic) Linking ISSN: 02755408 NLM ISO Abbreviation: Ophthalmic Physiol Opt Subsets: MEDLINE

Publication: 2002- : Oxford : Blackwell Publishers
Original Publication: Oxford ; New York : Pergamon Press, c1981-

Amblyopia*/therapy ; Amblyopia*/physiopathology ; Visual Acuity*/physiology ; Sensory Deprivation*; Humans ; Child ; Female ; Male ; Child, Preschool ; Learning ; Video Games ; Treatment Outcome ; Vision, Binocular/physiology ; Visual Perception/physiology ; Depth Perception/physiology

Background: Active vision therapy for amblyopia shows good results, but there is no standard vision therapy protocol. This study compared the results of three treatments, two combining patching with active therapy and one with patching alone, in a sample of children with amblyopia.
Methods: Two protocols have been developed: (a) perceptual learning with a computer game designed to favour the medium-to-high spatial frequency-tuned achromatic mechanisms of parvocellular origin and (b) vision therapy with a specific protocol and 2-h patching. The third treatment group used patching only. Fifty-two amblyopic children (aged 4-12 years), were randomly assigned to three monocular treatment groups: 2-h patching (n = 18), monocular perceptual learning (n = 17) and 2-h patching plus vision therapy (n = 17). Visual outcomes were analysed after 3 months and compared with a control group (n = 36) of subjects with normal vision.
Results: Visual acuity (VA) and stereoacuity (STA) improved significantly after treatment for the three groups with the best results for patching plus vision therapy, followed by monocular perceptual learning, with patching only least effective. Change in the interocular difference in VA was significant for monocular perceptual learning, followed by patching. Differences in STA between groups were not significant. For VA and interocular differences, the final outcomes were influenced by the baseline VA and interocular difference, respectively, with greater improvements in subjects with poorer initial values.
Conclusions: Visual acuity and STA improved with the two most active treatments, that is, vision therapy followed by perceptual learning. Patching alone showed the worst outcome. These results suggest that vision therapy should include monocular accommodative exercises, ocular motility and central fixation exercises where the fovea is more active.
(© 2024 The Author(s). Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Graefes Arch Clin Exp Ophthalmol. 2011 Dec;249(12):1893-9. (PMID: 21399941)
Eye (Lond). 2002 Mar;16(2):150-5. (PMID: 11988815)
J Ophthalmol. 2020 Mar 23;2020:4282316. (PMID: 32733699)
Vision Res. 2012 May 15;61:15-24. (PMID: 22227159)
Invest Ophthalmol Vis Sci. 2018 Apr 1;59(5):2187-2196. (PMID: 29801152)
Optom Vis Sci. 2014 Mar;91(3):351-8. (PMID: 24463769)
Vision Res. 2015 Sep;114:17-30. (PMID: 25637854)
Vision Res. 2009 Oct;49(21):2535-49. (PMID: 19250947)
J AAPOS. 2015 Feb;19(1):6-11. (PMID: 25727578)
J AAPOS. 2008 Feb;12(1):23-6. (PMID: 17720573)
Invest Ophthalmol Vis Sci. 2012 Feb 21;53(2):817-24. (PMID: 22169103)
Am J Optom Physiol Opt. 1987 Jun;64(6):393-404. (PMID: 3307436)
Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4393-400. (PMID: 17003431)
Ophthalmology. 1993 Mar;100(3):323-7. (PMID: 8460000)
Nat Neurosci. 2011 May;14(5):642-8. (PMID: 21460833)
Ophthalmic Physiol Opt. 2025 Jan;45(1):31-42. (PMID: 39396111)
JAMA Ophthalmol. 2016 Dec 01;134(12):1391-1400. (PMID: 27812703)
Optom Vis Sci. 2013 May;90(5):475-81. (PMID: 23563444)
Sci Rep. 2016 Oct 18;6:35702. (PMID: 27752122)
Invest Ophthalmol Vis Sci. 1984 Nov;25(11):1307-15. (PMID: 6490332)
Front Psychol. 2014 Nov 03;5:1210. (PMID: 25404922)
Ophthalmology. 2010 May;117(5):998-1004.e6. (PMID: 20163869)
Ophthalmology. 2006 Nov;113(11):2097-100. (PMID: 17074568)
Eye (Lond). 2011 Apr;25(4):403-13. (PMID: 21274010)
Children (Basel). 2022 Feb 05;9(2):. (PMID: 35204925)
Optom Vis Sci. 2008 Nov;85(11):1074-81. (PMID: 18981922)
Invest Ophthalmol Vis Sci. 2007 Nov;48(11):5046-51. (PMID: 17962456)
J Ophthalmol. 2014;2014:615213. (PMID: 25580280)
Front Psychol. 2012 Jul 05;3:226. (PMID: 22783220)
J Pediatr Ophthalmol Strabismus. 2005 Mar-Apr;42(2):82-8. (PMID: 15825744)
J Vis. 2006 Aug 22;6(9):966-73. (PMID: 17083288)
J AAPOS. 2013 Apr;17(2):166-73. (PMID: 23622448)
Lancet. 2006 Apr 22;367(9519):1343-51. (PMID: 16631913)
Behav Res Methods. 2007 May;39(2):175-91. (PMID: 17695343)
Vision Res. 2015 Sep;114:31-40. (PMID: 25743080)
Doc Ophthalmol. 1984 Feb 29;56(4):303-26. (PMID: 6714069)
Arch Ophthalmol. 2005 Apr;123(4):437-47. (PMID: 15824215)
Invest Ophthalmol Vis Sci. 2005 Sep;46(9):3161-8. (PMID: 16123415)
Graefes Arch Clin Exp Ophthalmol. 2021 Oct;259(10):3149-3157. (PMID: 34057550)
Invest Ophthalmol Vis Sci. 2015 Jan 27;56(2):1193-207. (PMID: 25626970)
J AAPOS. 2005 Apr;9(2):129-36. (PMID: 15838439)
Cochrane Database Syst Rev. 2003;(4):CD003716. (PMID: 14583990)
Strabismus. 2014 Mar;22(1):1-6. (PMID: 24564723)
Vision Res. 2013 Aug 30;89:65-71. (PMID: 23891704)
Optom Vis Sci. 1997 Jun;74(6):367-75. (PMID: 9255814)
Clin Exp Ophthalmol. 2006 Nov;34(8):743-50. (PMID: 17073896)
Ophthalmic Physiol Opt. 2008 Sep;28(5):422-8. (PMID: 18761479)
Vision Res. 2015 Sep;114:161-72. (PMID: 25676883)
Invest Ophthalmol Vis Sci. 2014 Apr 15;55(4):2384-91. (PMID: 24508791)
Invest Ophthalmol Vis Sci. 2015 Jun;56(6):4061-75. (PMID: 26114483)
J AAPOS. 2004 Oct;8(5):420-8. (PMID: 15492733)

Keywords: amblyopia; monocular perceptual learning; patching; stereoacuity; vision therapy; visual acuity

Date Created: 20241013 Date Completed: 20241210 Latest Revision: 20241212

20241212

PMC11629843

10.1111/opo.13395

39396111