Effectiveness of Active Vision Therapy in Children with Bilateral Refractive Amblyopia

To compare the effectivity of vision therapy plus patching versus patching combined with placebo therapy in bilateral refractive amblyopia.

In this randomized controlled trial, children with bilateral refractive amblyopia were enrolled. Monocular best-corrected visual acuity (BCVA) ranged from 0.3 logMAR (20/40) to 0.6 logMAR (20/80) in both eyes, and visual acuity (VA) difference was less than 0.2 logMAR between the eyes. The experimental group received patching plus in-office vision therapy with Vision Therapy System 4 (VTS4), including accommodation, stereopsis, ocular movements, and visual memory skills, while the control group received patching plus in-office placebo therapy. The primary outcome measure was BCVA, and the secondary outcomes were stereo acuity, and accommodative facility measured pre- and post-therapy.

Forty children aged 5 to 8 were included. After 4 months of therapy, the mean VA improvement was 0.23 $\pm$ 0.08 logMAR [2.3 line] (P $<$ 0.001) in the experimental group and 0.09 $\pm$ 0.06 logMAR [0.09 line] (P $<$ 0.001) in the control group. The difference in VA improvement between the two groups was statistically significant (P $<$ 0.001). Post-therapy, the improvements in Randot stereoacuity and in monocular and binocular accommodative facilities were statistically significant between the experimental and the control groups (P = 0.013, P = 0.005, P = 0.002, respectively).

Administering vision therapy in conjunction with patching significantly improved VA, stereo acuity, and accommodation facility in bilateral refractive amblyopia compared to patching alone.