Effectiveness of Video-Based Dichoptic Therapy vs. Patching in Children with Amblyopia: A Meta-Analysis of Randomized...

To compare the effectiveness of video-based dichoptic therapy versus patching in improving vision of children with amblyopia.

Amblyopia remains an important cause of monocular vision loss in children and young adults.

This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and its protocol was registered in the International Prospective Register of Systematic Reviews (CRD420251031242). A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted to identify randomized controlled trials comparing video-based dichoptic therapy vs. patching in children with anisometropic or strabismic amblyopia. The primary outcome was change in best-corrected visual acuity (BCVA) in the amblyopic eye. The secondary outcomes included change in stereoacuity and adverse events. Subgroup analyses were conducted for children with high adherence to treatment. Data were pooled using a random-effects model. A meta-regression using a mixed-effects model evaluated the relationship between treatment adherence and effect size. Analyses were performed using R software.

Fourteen studies, including 1110 participants, were analyzed. No significant differences were found between dichoptic therapy and patching for change in BCVA (standardized mean difference [SMD] -0.24, 95% confidence interval [CI] -0.53 to 0.05; P = 0.11; I² = 79%; very low certainty), stereoacuity (SMD -0.19, 95% CI -0.47 to 0.08; P = 0.17; I² = 54%; very low certainty), or overall adverse events (risk ratio 1.24, 95% CI 0.86-1.80; P = 0.25; I² = 0%; moderate certainty). However, there was a significant improvement in vision among children with high adherence to dichoptic therapy compared to patching (SMD -0.59, 95% CI -0.98 to -0.20; P < 0.01; I² = 73%; very low certainty). Higher adherence to dichoptic therapy significantly predicted greater improvement in BCVA (I² = 63.40%; estimate -0.0125, P = 0.0014).

Video-based dichoptic therapy and patching are similarly effective for improving vision in amblyopic children. However, high adherence to dichoptic therapy may be associated with greater visual improvement. Given the low certainty of evidence, further studies are needed to establish optimal treatment protocols.

The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.