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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, visuomotor, 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). However, 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. (AU)

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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, visuomotor, 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 Ë‚ 0.001). However, 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.

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BACKGROUND: Intermittent exotropia (IXT) is one of the most common forms of strabismus usually seen in the pediatric age group, the prevalence of IXT is higher in Africa and the Middle East. IXT treatment strategies include both surgical and non-surgical methods, non-surgical management is preferred in general as it is less invasive and avoids the risks associated with surgery and anesthesia. AIMS: This study aims to determine the effectiveness of patching therapy for the treatment of IXT in different age groups and to compare the success of patching therapy in preventing surgery in IXT patients in different age groups. METHODOLOGY: A retrospective chart review was conducted from September 2022 until February 2023 at King Abdulaziz University Hospital in Riyadh. The data was collected retrospectively from electronic medical records from 2016 to 2021 of all patients diagnosed with IXT and were managed by patching therapy fitting the inclusion criteria. RESULTS: A total of 76 patients with IXT enrolled in the study with 56.5% of the participants were older than 7 years old. Overall, there was no improvement in the angle of deviation but 34% of patients had improved control over the follow-up period. 55.3% of the participants didn't require surgery. Younger age, longer duration of patching per month, and good compliance were significantly associated with treatment success. CONCLUSION: Younger age groups were more likely to benefit from patching therapy than older age groups, and good compliance to patching therapy is an important factor in preventing the need for surgery.

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Purpose: To investigate the development of refraction in anisometropic amblyopia who had been with patching therapy. Methods: We retrospectively reviewed 37,528 medical records of the amblyopes who had been treated with patching therapy between July 2003 and January 2020 at the School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University. We included unilateral anisometropic amblyopia with a follow-up length of not < 2 years. In total, 371 cases were enrolled and followed up for a mean of 4.76 ± 2.11 years. The subjects were then divided into different groups and periods according to their initial spherical equivalent (SE) refractive error and best-corrected visual acuity (BCVA) of the amblyopic eye. Linear mixed-effects models were fitted to calculate the annual change of SE. Results: The annual changes in SE were -0.32 (-0.35 to -0.30) and -0.16 (-0.19 to -0.14) D/yr for the amblyopic eye and the fellow eye, respectively. The annual changes in SE of amblyopic eyes during the treatment period and the successfully treated period were -0.36 (-0.43 to -0.29; 95% CI) and -0.27 (-0.32 to -0.23; 95% CI) D/yr, respectively; the annual SE changes of the fellow eye during the treatment period and the successfully-treated period were -0.07 (-0.14 to -0.01; 95% CI) and -0.18 (-0.22 to -0.14; 95% CI) D/yr, respectively. Conclusion: The amblyopic eye experienced a significantly greater degree of refractive error changes than the fellow eye and underwent a continuous refractive error reduction before and after 7 years old. After the patching therapy was terminated, emmetropization in the amblyopic eye remained synchronized, whereas the refractive error change was increased in the fellow eye.

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PURPOSE: Recently, Lunghi et al. (2016) showed that amblyopic eye's visual acuity per se after 2 months of occlusion therapy could be predicted by a homeostatic plasticity, that is, the temporary shift of perceptual eye dominance observed after a 2-h monocular deprivation, in children with anisometropic amblyopia. In this study, we assess whether the visual acuity improvement of the amblyopic eye measured after 2 months of occlusion therapy could be predicted by this plasticity. METHODS: Seven children (6.86 ± 1.46 years old; SD) with anisometropic amblyopia participated in this study. All patients were newly diagnosed and had no treatment history before participating in our study. They finished 2 months of refractive adaptation and then received a 4-h daily fellow eye patching therapy with an opaque patch for a 2-month period. Best-corrected visual acuity of the amblyopic eye was measured before and after the patching therapy. The homeostatic plasticity was assessed by measuring the temporary shift of perceptual eye dominance from 2-h occlusion of the amblyopic eye before treatment. A binocular phase combination paradigm was used for this study. RESULTS: We found that there was no significant correlation between the temporary shift of perceptual eye dominance observed after 2-h occlusion of the amblyopic eye and the improvement in visual acuity in the amblyopic eye from 2 months of classical patching therapy. This result, although in disagreements with the conclusions of Lunghi et al. involving the short-term patching of the amblyopic eye, is in fact consistent with a reanalysis of Lunghi and colleagues' data. CONCLUSION: The short-term changes in perceptual eye dominance as a result of short-term monocular deprivation do not provide an index of cortical plasticity in the general sense such that they are able to predict acuity outcomes from longer-term classical patching.

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PURPOSE: To analyze the results of treatment in pure anisometrpic amblyopia with unilateral visual acuity of 0.1 or worse. METHODS: The major eligibility criteria included pure anisometropic amblyopia with age <10 years, best-corrected visual acuity 0.1 or worse in the worse eye and 0.5 or better in the good eye after the wearing of optimal spectacle correction for a minimum of 4 weeks, and the minimum follow-up was 6 months. Twenty-one patients were selected and we analyzed the age at the amblyopia treatment, the type and degree of anisometropia, and the final visual acuity after treatment for visual improvement. Successful treatment was defined as a final visual acuity of 0.3 or more. RESULTS: The mean age at treatment was 5.2 years. The types of anisometropia were hypermetropic in 14 patients, astigmatic in 4, and myopic in 3. The mean duration of treatment of amblyopia was 16 months, and 13 of 21 children with pure anisometropic amblyopia achieved 0.3 or better. The age at treatment was younger and the compliance rate was higher in the success group than in the failure group. CONCLUSIONS: The most common type was hyperopic in the pure anisomteropic amblyopia. Compliance and age at treatment were significantly related to best visual acuity attained in pure anisometropic amblyopia with unilateral visual acuity of 0.1 or worse.

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PURPOSE: The purpose of this study is to assess the effect of intermittent atropine penalization (AP) in amblyopic children who have failed patching therapy. METHODS: Twenty-one amblyopic (visual acuity in the amblyopic eye >or= 0.3) children (mean age, 7.8 years) who had failed patching therapy were treated with intermittent AP consisting of one drop of atropine 1% in the sound eye, twice per week. The visual acuity was analyzed in the cases of at least 3-month follow-up after intermittent AP. Treatment success was defined as an improvement in final visual acuity of 2 lines more than baseline visual acuity in the amblyopic eye. RESULTS: The cause of amblyopia in the 21 cases was strabismus in 10 and anisometropia in 11. The mean visual acuities (logMAR) of the amblyopic eye were +0.28 before AP and +0.07 after AP. Of the 21 patients, success was achieved in 17 (84.2%), and their mean treatment duration was 7.5 months. The compliance rate with intermittent AP was 90.1%. CONCLUSIONS: Intermittent AP could be considered for amblyopic children (visual acuity in the amblyopic eye >or= 0.3) who have failed patching therapy.

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