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Effectiveness of binocular therapy as a complementary treatment of part-time patching in older amblyopic children: a randomized clinical trial

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Abstract

Purpose

To assess the effectiveness of combined use of stereoscopic 3D video movies and part-time patching in treating older amblyopic children with poor response or compliance to traditional patching treatments and comparing this combined treatment with patching alone.

Methods

Thirty-two children aged 5–12 years with amblyopia associated with anisometropia, strabismus, or both were recruited in a randomized clinical trial. Eligible participants were assigned randomly to the combined and patching groups. Here, binocular treatment refers to using the Bangerter filter to blur the fellow eye and subsequently watching a close-up 3D movie with large parallax. The primary outcome was amblyopic eye (AE) best-corrected visual acuity (BCVA) improvement at six weeks. In addition, secondary outcomes included BCVA of AE improvement at three weeks and change of stereoacuity.

Results

Of 32 participants, mean (SD) age was 6.63 (1.46) years, and 19 (59%) were female. At 6 weeks, mean (SD) amblyopic eye VA improved by 0.17 ± 0.08 logMAR (2-sided 95% CI, 0.13 to 0.22; F = 57.2, p < 0.01) and 0.05 ± 0.04 logMAR (2-sided 95% CI, 0.05 to 0.09; F = 8.73, p = 0.01) in the combined and patching groups, respectively. The difference was statistically significant (mean difference, 0.13 logMAR [1.3 line]; 95% CI, 0.08–0.17 logMAR [0.8–1.7 lines]; t25 = 5.65, p < 0 .01). After treatment, only the combined group had significantly improved stereoacuity, such as binocular function score (median [interquartile range], 2.30 [2.23 to 2.68] vs. 1.69 [1.60 to 2.30] log arcsec; paired, z = –3.53, p < 0.01), and mean stereoacuity gain was 0.47 log arcsec (± 0.22). Changes in other types of stereoacuity were similar.

Conclusion

Our laboratory-based binocular treatment strategy engaged a high level of compliance that led to a substantial gain in visual function after a short period of treatment for older amblyopic children having poor response or compliance to traditional patching treatments. Notably, the improving stereoacuity showed a greater advantage.

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Data availability

The data used to support the findings of this study are included within the article and supplementary material.

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Funding

This study was funded by the Life Science Society of Liaoning.

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Author notes

  1. Qi Zhao, Ran Liang, Xing He, Mingjun Gao have contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, the Second Hospital of Dalian Medical University, Dalian, 116027, China

    Qing Zhu, Qi Zhao, Ran Liang, Xing He & Mingjun Gao

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  1. Qing Zhu
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Contributions

All authors contributed to the study conception and design. QZ: participated in the design of the study, carried out the study and drafted the manuscript and performed the statistical analyses. QZ: has participated in the study’s coordination and has helped to draft the manuscript and has been involved in revising the manuscript carefully. Material preparation, data collection were performed by RL, XH and M-JG.

Corresponding author

Correspondence to Qi Zhao.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the second hospital of Dalian Medical University and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consents were obtained from the subjects after explanation of the nature of the study.

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The parents of patients agreed to collect and publish the data of their children.

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Zhu, Q., Zhao, Q., Liang, R. et al. Effectiveness of binocular therapy as a complementary treatment of part-time patching in older amblyopic children: a randomized clinical trial. Int Ophthalmol 43, 2433–2445 (2023). https://doi.org/10.1007/s10792-023-02642-0

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  • DOI: https://doi.org/10.1007/s10792-023-02642-0

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