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Monocular and binocular vision function following patching alone versus combined patching and active vision therapy
Santosh Chhetri1, Aashish Kant Shah2, Umesh Belbase3,4
1Department of Pediatric Ophthalmology, Lumbini Eye Institute and Research Centre, Bhairahawa, Nepal.
Purpose:
To evaluate binocular visual function in amblyopic patients who achieved optimal visual acuity following treatment with either conventional patching alone or combined patching and structured Active vision therapy (AVT).
Methods:
This retrospective chart review included 67 patients with non strabismic refractive amblyopia (31 patching; 36 combined treatment) who achieved best-corrected visual acuity (BCVA) ≤0.17 logMAR in both eyes after treatment. The combined treatment consisted of patching with structured active vision therapy incorporating anti-suppression, accommodative, vergence, and visuomotor exercises. Post-treatment assessment included stereoacuity (log seconds of arc), vergence parameters (phoria, near point of convergence, fusional vergence), accommodative lag, accommodative facility (monocular and binocular), and binocular sensory status. Within-group changes were analyzed using Wilcoxon signed-rank tests; between-group comparisons were performed using Mann-Whitney U tests. Effect sizes (r) were calculated for intergroup comparisons.
Results:
Both groups demonstrated significant reduction in accommodative lag (p < .001). Post-treatment stereoacuity was significantly better in the combined treatment group (p < .001; r = 0.724). The combined treatment group also showed superior vergence function, with larger positive fusional vergence amplitudes (r = 0.60) and improved near point of convergence (r = 0.488). Monocular and binocular accommodative facility were significantly higher in the combined treatment group (r = 0.656 and r = 0.690, respectively). Treatment duration was significantly shorter in the combined treatment group (p < .001).
Conclusions:
Combined patching and structured AVT group was associated with superior binocular vision function outcomes and reduced treatment duration. However, due to the non-randomized, retrospective design of the study, findings should be interpreted with caution. AVT is a more intensive treatment requiring greater motivation, adherence, supervision, and access to care.
