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New behavioral training methods for amblyopia show stronger results with better initial acuity
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Dichoptic training, perceptual learning and video gaming improve visual acuity in adults with both mild and severe amblyopia, according to a meta-analysis published in Investigative Ophthalmology & Visual Science.
Tsirlin and colleagues conducted a meta-analysis of these new behavioral treatment methods to determine their efficacy in improving visual function in adult amblyopia and the factors involved in amblyopia recovery.
The researchers identified 24 relevant studies using PubMed, Google Scholar and published reviews.
On average, the researchers found that 56% of the participants showed visual acuity improvements at or above mean test-retest reliability of 0.15 logMAR, and 32% improved by 0.2 logMAR or more.
Stereo sensitivity improved for 42% of participants at or above test-retest reliability of 2 octaves.
“This finding should be interpreted with caution, because participants with gross stereopsis could sometimes show nil results on one visit and be able to pass the first level of the test on the next visit without any treatment intervention whatsoever,” the researchers wrote.
They found that better initial visual acuity was associated with greater improvement in stereo sensitivity. Additionally, better initial stereo sensitivity correlated with greater improvements in stereo sensitivity, suggesting that better initial visual acuity correlates with better initial stereo sensitivity.
Regardless of treatment method, age has no significant effect on visual and stereo sensitivity outcomes in adults, the authors said, because the visual cortex maintains its plasticity into adulthood.
While the underlying causes might differ between anisometropic and strabismic amblyopia, the ability for change is similar across types, they said. Improvement results as long as the amblyopic eye is given the ability to work effectively either alone or with the fellow eye.
The authors recommend using several tests to assess binocularity before and post-treatment. The first step in any treatment protocol should be performing refractive correction adaptation, they said.
They concluded: “These treatments appear to be especially beneficial for individuals with more severe amblyopia, as these participants showed the greatest improvement in visual acuity. Individuals with mild amblyopia could also benefit, as they showed the greatest improvement in stereopsis.” – by Abigail Sutton
Disclosure: The researchers reported no relevant financial disclosures.
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