Vision, conventional therapy together yield better outcomes in amblyopic children
Children with unilateral refractive amblyopia showed greater improvement when vision therapy was combined with conventional treatment, according to a retrospective study published in BMC Ophthalmology.
“In this study, we evaluated the efficacy of vision therapy as treatment for amblyopia and compared this binocular approach with conventional treatments in amblyopic children aged 7 to 10 years,” Yi-Ching Hsieh, BM, attending physician in the department of ophthalmology at China Medical University Hospital in Taiwan, and colleagues wrote.
From April 2016 to November 2019, researchers enrolled 36 children with unilateral refractive amblyopia and divided them into two groups to assess vision therapy as a treatment option.
Nineteen children were assigned to the case group, and their treatment included receiving binocular vision therapy for 1 hour per week for 3 months, wearing glasses and using an eye patch on their weaker eye for 4 to 6 hours a day. The control group included 17 children who received the same treatment without vision therapy.
The 1-hour vision therapy sessions included anti-suppression, training based on binocular vision skill and behavior training. Researchers measured visual acuity at baseline, every 3 months for 9 months and 3 months after ending treatment.
The mean visual acuity of the case group at baseline was 0.39 ± 0.24 logMAR, which improved to 0.10 ± 0.23 logMAR by the end of treatment (P < 0.001). Conversely, measurements in the control group were 0.64 ± 0.30 logMAR at baseline and 0.52 ± 0.27 logMAR at the end of treatment (P = .015).
Eight children in the control group measured no improvement, compared with only one child in the case group. Three months after concluding treatment, children in the case group experienced no visual acuity regression.
Hsieh and colleagues also found that the combined treatment of vision therapy, optical correction and patching led to a shorter treatment period: an average of 3.63 months to reach best visual acuity for the case group compared with 4.41 months for the control group.
“Vision therapy combined with optical correction and patching is a more effective treatment than optical correction and patching alone in children from 7 to 10 years of age with unilateral amblyopia,” researchers wrote. “The treatment results not only in greater vision gain but also in a shorter duration of treatment under the mechanism of binocular vision and perceptual learning.”
Perspective
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Although this was a retrospective study, and the authors admit that the design was not without fault, the results are important for several reasons. The main takeaway is the authors’ conclusion. They recognize that amblyopia is a binocular phenomenon and that using a binocular treatment approach creates a better overall outcome for a patient. They found that when vision therapy and conventional treatments (patching and glasses) are combined for at least 3 months, the improvements in acuity are statistically better and are achieved more quickly than from conventional treatments alone. The authors also mention that stereoacuity must be measured during the initial evaluation (after all, amblyopia is a binocular disorder) and it can be used to monitor improvement throughout treatment. Overall, this study advances the growing body of research supporting optometric vision therapy as a treatment option for a variety of conditions.
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Hsieh YC, et al. BMC Ophthalmol. 2022;doi:10.1186/s12886-022-02246-9.