Impact of active vision therapy compared to conventional patching therapy on visual acuity and stereoacuity in children with amblyopia

Purpose: To compare improvements in visual acuity (VA) and stereoacuity between active vision therapy (AVT) and conventional patching therapy in children with amblyopia. Methods: This study included 65 children aged 5 to 16 years (mean age +/- SD, 11.00 +/- 3.29 years) with unilateral amblyopia. Among them, 31 children underwent active vision therapy (AVT group), and 34 children underwent conventional patching therapy (patching group). AVT group underwent three sequential phases of AVT: Monocular phase (pursuit, saccades, fixation, visuo-motor, eye-hand coordination, and central peripheral activities), biocular phase (diplopia awareness, antisuppression, monocular fixation in a binocular field, accommodative activities, bilateral integration, and fine motor activities) and binocular phase (fusion and stereopsis). Patching group patched their fellow eyes as per guidelines by Pediatric Eye Disease Investigator Group. Best-corrected monocular VA and stereoacuity were measured at baseline and after three months of therapy in both groups. Results: There were significant improvements in the mean acuities in amblyopic eye (AE) in both AVT (0.32 +/- 0.11 logMAR, p <0.001) and patching groups (0.27 +/- 0.19 logMAR, p < 0.001). How-ever, there was no significant difference in mean acuity gains in AE between AVT and patching groups (p = 0.059). Mean gains in stereoacuities (log seconds of arc) were statistically significant in both AVT (0.81 +/- 0.34, p < 0.001) and patching groups (0.32 +/- 0.34, p < 0.001). The stereoacuity gain in the AVT group was significantly higher compared to patching group (p < 0.001). Conclusion: Active vision therapy had a better impact than conventional patching therapy in terms of improvement of stereoacuity but not in terms of VA when used for treating children with amblyopia. (c) 2023 Spanish General Council of Optometry. Published by Elsevier Espana, S.L.U.