Comparison of the efficacy of unilateral amblyopia treatments: A systematic review and network meta-analysis

Amblyopia, a disorder that impairs visual acuity, encompasses a spectrum of clinical interventions. The true efficacy of these treatments, however, remains elusive. Consequently, we elucidate the effectiveness of each intervention, providing critical insights into optimal therapeutic strategies. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials up to August 12, 2024, including amblyopic patients without residual amblyopia. Interventions included spectacles alone, 2-hour patching, 6-hour patching, full-time patching (FTP), atropine eye drops (daily or weekly), optical penalization, and Bangerter filters, among others. Change in best-corrected visual acuity was the primary outcome. Study quality was assessed using the Cochrane risk-of-bias tool. A frequentist network meta-analysis was performed using a multivariate random-effects model. Twenty-two studies were included in this network meta-analysis. Compared to spectacles, both FTP combined with video games (MD = 0.27; 95 % CI [0.06, 0.48]) and combined atropine with patching therapy (MD = 0.25; 95 % CI [0.06, 0.45]) demonstrated significantly better effectiveness. No statistically significant differences were observed in the effectiveness of other treatments. FTP combined with video games and combined atropine with patching therapy showed significantly better therapeutic effects compared to spectacles alone, providing valuable insights for amblyopia treatment. SYSTEMATIC REVIEW REGISTRATION: CRD42024607532.