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Amblyopia, commonly affecting children aged 0–6 years, results from disrupted visual processing during early development and often leads to reduced visual acuity in one eye. This study presents the development and preliminary usability assessment of a non-invasive ocular monitoring device designed to support oculomotor engagement and therapy adherence in amblyopia management. The system incorporates an interactive maze-navigation task controlled via gaze direction, implemented during monocular and binocular sessions. The device tracks lateral and anteroposterior eye movements and generates visual reports, including displacement metrics and elliptical movement graphs. Usability testing was conducted with a non-probabilistic adult sample (n = 15), including individuals with and without amblyopia. The System Usability Scale (SUS) yielded an average score of 75, indicating good usability. Preliminary tests with two adults diagnosed with amblyopia suggested increased eye displacement during monocular sessions, potentially reflecting enhanced engagement rather than direct therapeutic improvement. This feasibility study demonstrates the device’s potential as a supportive, gaze-controlled platform for visual engagement monitoring in amblyopia rehabilitation. Future clinical studies involving pediatric populations and integration of visual stimuli modulation are recommended to evaluate therapeutic efficacy and adaptability for early intervention.

Background This pilot exploratory study aimed to assess the impact of a 6-month app-based multimodal visual therapy program (AmblyoPlay ® ) on visual acuity (VA), stereopsis, oculomotor control, motor proficiency, and postural stability in children with anisometropic amblyopia. Methods This study, non-randomized controlled study included 29 children aged 7–13 years. Group I ( n  = 14) had anisometropic amblyopia and performed daily 20-minute gamified dichoptic therapy using AmblyoPlay ® for 6 months. Group II ( n  = 15) were age- and sex-matched typically developing controls without intervention. Assessments included VA (LogMAR), stereopsis (Titmus Fly), oculomotor parameters (saccadic latency, smooth pursuit gain, optokinetic gain), motor proficiency (BOT-2 subtests), and postural stability (Sensory Organization Test). Group I was evaluated at baseline, 1, 3, and 6 months; controls at baseline and 6 months. Friedman and Wilcoxon signed-rank tests were used for within-group comparisons; Mann–Whitney U tests for between-group differences. Results In Group I, amblyopic eye LogMAR VA improved from 0.23 ± 0.10 to 0.08 ± 0.05 at 6 months ( p  < 0.001), and stereopsis improved from 494.3 ± 874.5 to 60.7 ± 28.9 arcsec ( p  < 0.001). Significant reductions in saccadic latency and increases in smooth pursuit and optokinetic gains were observed (all p  < 0.05). Motor proficiency and postural stability composite scores also improved significantly ( p  < 0.05). No significant changes occurred in controls. Conclusions AmblyoPlay-based multimodal visual therapy led to significant improvements in visual and oculomotor function, with secondary benefits in motor coordination and balance, in pediatric anisometropic amblyopia. Trial registration Not applicable.

Purpose To assess the possible benefits of the use of perceptual learning and dichoptic therapy combined with patching in children with amblyopia over the use of only patching. Methods Quasi-experimental multicentric study including 52 amblyopic children. Patients who improved their visual acuity (VA) by combining spectacles and patching were included in patching group (PG: 20 subjects), whereas those that did not improved with patching performed visual training (perceptual learning + dichoptic therapy) combined with patching, being assigned to the visual treatment group (VT: 32 subjects). Changes in VA, contrast sensitivity (CS), and stereopsis were monitored during a 6-month follow-up in each group. Results Significant improvements in VA were found in both groups at 1 month ( p  < 0.01). The total improvement of VA was 0.18 ± 0.16 and 0.31 ± 0.35 logMAR in PG and VT groups, respectively ( p  = 0.317). The Wilcoxon effect size was slightly higher in VT (0.48 vs. 0.54) at 6 months. An enhancement in CS was observed in the amblyopic eye of the VT group for all spatial frequencies at 1 month ( p  < 0.001). Likewise, the binocular function score also increased significantly in VT group ( p  = 0.002). A prediction equation of VA improvement at 1 month in VT group was obtained by multiple linear regression analysis ( p  < 0.001, R 2  = 0.747). Conclusions A combined treatment of visual training and patching is effective for obtaining a predictable improvement of VA, CS, and binocularity in patching-resistant amblyopic children.

Amblyopia is a monocular or binocular reduction in visual acuity that results from prolonged visual deprivation in the early years of life. It is second only to refractive error as a cause of poor vision in children. The gold standard treatment of amblyopia includes patching and, less commonly, atropine penalization and filters. These therapies are aimed at improvements in the visual acuity of the amblyopic eye alone. They have compliance and psychosocial issues and gains are accrued after prolonged periods. Experimental studies have demonstrated the presence of binocular cortical communication even in amblyopes and neural plasticity in late childhood as well as adulthood. On this basis, binocular vision therapy aimed at the stimulation of both eyes rather than forced use of the amblyopic eye was developed. Such therapies involve visual tasks designed in such a way that they can be completed only by binocular viewing. These tasks vary from simple game play using red-green glasses, to engaging 3D games and movie viewing. Preliminary data suggest that binocular vision therapy has led to lasting improvements in visual acuity and can be a useful adjunct, if not replacement, to the conventional treatment of amblyopia. In this article, we aim to describe the various binocular vision therapies and review the available literature on the same.

Amblyopia affects 1–4% of the population and remains a leading cause of unilateral visual impairment, with adherence and residual deficits limiting outcomes of standard therapies. This systematic review and meta-analysis compared the effectiveness of conventional and emerging amblyopia treatments in children, adolescents, and adults with anisometropic, strabismic, or mixed amblyopia. Following PRISMA guidelines and PROSPERO registration (CRD420251123552), PubMed, Web of Science, and Scopus were searched up to 5 August 2025 for randomized controlled trials. Sixty-six trials (sample sizes 7–404) were included, with thirty-six contributing to the meta-analysis. Primary outcomes were best-corrected visual acuity (logMAR) and stereopsis. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was assessed using GRADE. Atropine penalization and occlusion demonstrated equivalent effects on visual acuity (mean difference 0.04 logMAR; 95% CI −0.04 to 0.12; moderate-certainty evidence). Digital, dichoptic, binocular, and virtual reality therapies showed a statistically significant but small improvement over patching (mean difference 0.02 logMAR; 95% CI 0.00–0.04; low-certainty evidence). Pharmacological adjuvants combined with patching yielded slightly larger gains (mean difference 0.08 logMAR; 95% CI 0.03–0.13; low-to-moderate certainty). No consistent benefit was observed for stereopsis outcomes. Overall, the certainty of evidence ranged from low to moderate, and most pooled effects were below commonly accepted thresholds for clinically meaningful visual acuity improvement (≈0.1 logMAR, one line). Atropine and occlusion remain equivalent first-line treatments, while adjunctive and multimodal approaches may offer limited additional benefit in selected patients when adherence, tolerability, and engagement are prioritized.

Background and Objectives: Amblyopia is a neurodevelopmental disorder caused by interocular suppression of visual input, affecting visual acuity, stereopsis, contrast sensitivity, and other visual functions. Conventional treatment comprises occlusion of the sound eye. In recent years, novel therapies that deploy perceptual learning (PL) principles have been introduced. The purpose of this study is to assess the latest scientific data on this topic. Materials and Methods: For this purpose, we conducted a literature search for relevant studies published during the previous 4 years (2020–2023). Results: A plethora of visual perceptual learning protocols have been recently developed. Dichoptic video games, contrast rebalanced movies, and online perceptual training platforms are the main formats. Perceptual learning activates neuroplasticity, overcomes interocular suppression, and improves the visual impairments induced by amblyopia. Conclusions: This novel treatment is effective in both children and adults, as well as in patients non-responding to patching.

This systematic review and meta-analysis compares the efficacy and safety of dichoptic therapy vs traditional patching in treating pediatric amblyopia. The primary focus was on improvements in visual acuity (VA) and stereoacuity (SA), with an evaluation of adverse events and treatment compliance. A comprehensive search was conducted across PubMed, Scopus, Cochrane, and other databases up to August 2024. Randomized controlled trials (RCTs) comparing dichoptic therapy with eye patching in children (aged 0-18) with amblyopia were included. Studies reporting VA and SA outcomes were analyzed. The primary outcome was VA improvement; secondary outcomes included changes in SA and adverse events. Meta-analysis was performed using RevMan software, with random-effects models. Eleven studies involving 902 children with amblyopia were included. Patching resulted in a statistically significant improvement in VA, with a pooled standardized mean difference (SMD) of 0.27 logMAR lines (95% CI: 0.07-0.48, p = 0.008), favoring patching over dichoptic therapy. Stereoacuity improvements were not significantly different between the two approaches (SMD: 0.28, 95% CI: -0.11-0.68, p = 0.16). Adverse events were more common in the patching group, with skin irritation being the most frequently reported issue. Both treatments showed moderate to high levels of compliance. While patching demonstrated a modest advantage in improving visual acuity, dichoptic therapy provides a promising alternative, particularly due to its interactive nature and potential to improve treatment compliance. Given no significant difference in stereoacuity outcomes and the mild adverse events associated with both methods, dichoptic therapy should be considered a viable option for amblyopia treatment in children.

Background: Acquired brain injury (ABI) often disrupts binocular vision, causing deviations on the cover test and reduced stereopsis that impair functional visual performance. This study investigated the effects of a dichoptic vision therapy protocol—based on an immersive virtual reality (VR) system—on visual field parameters, oculomotor reaction times, and self-reported visual symptoms in adults with ABI. Methods: In a controlled parallel-group design, adult ABI patients (median age 51 years) were assigned to an experimental group (dichoptic VR therapy) or a control group. Six sessions of visual therapy were performed. Primary outcomes included perimetric visual field indices and oculomotor reaction times; the secondary outcome was the Brain Injury Vision Symptom Survey (BIVSS) score. Etiology (stroke vs. traumatic brain injury) was recorded. Results: No statistically significant improvements were found in perimetric visual field indices (p > 0.05), except for a slight gain in the top-right quadrant in the experimental group. Reaction times did not differ significantly between groups. However, the experimental group reported a greater reduction in visual symptoms as measured by the BIVSS. Patients with traumatic brain injury exhibited better functional improvement, particularly in the top-left quadrant (p = 0.04). Conclusions: Dichoptic VR-based therapy did not restore perimetric field losses in ABI patients but reduced visual symptoms and may enhance functional adaptation of residual vision rather than structural recovery. The therapeutic response varied by etiology, favoring traumatic brain injury. Larger, longer trials integrating objective and subjective measures, including neuroimaging, are warranted.

Aim: To evaluate the effect of home-based dichoptic visual therapy using anaglyphic red-green filters on the stereo acuity in a sample of young adults with non-strabismic anisometropic amblyopia. Methods: The study was observational and cross-sectional in design. Two groups (experimental vs control) were sourced using purposive sampling of young adults with non-strabismic amblyopia (experimental group) in comparison to an age- match control group without amblyopia. For the purpose of refractive adaptation, all participants in both groups were asked to wear their spectacle correction constantly for at least 16 weeks prior to exposure to home-based dichoptic therapy. Stereo acuity measurements using the Stereo Fly test were obtained before and after 40 hours exposure to home-based dichoptic therapy. The changes in stereo acuity post eight weeks (40 hours) training from baseline measurements was obtained. The difference in medians between the experimental and control groups using the Mann-Whitney Li-test was measured with significance set at P value of <0.05. Results: A total of 38 young adults (19 males, 19 females) with a mean age of 24.05 [+ or -] 5.66 years were enrolled in this study. Nineteen anisometropic amblyopes comprised the experimental group, fifteen of which were classified as moderate amblyopia (6/12-6/36) and 19 non-amblyopes comprised the control group. Home-based dichoptic therapy used on the experimental group after 8 weeks showed a significant improvement in stereo-acuity with a mean improvement of 345.26 [+ or -] 184.85 sec [arc.sup.-1] [IQR:260;600; p<0.001] when compared to the control group. Conclusion: Home-based dichoptic therapy improved stereo-acuity in non-strabismic anisometropic amblyopes (moderate) in young adults. Thus suggesting that binocularity can improve in anisometropic adult amblyopes with a treatment modality that may be a convenient option better suit the demanding lifestyle of economically active adults who may not be able to comply with clinic-based therapy. Keywords: adult amblyopia, stereo acuity, anisometropia, binocular vision, dichoptic therapy

PurposeThe purpose of this review is to provide an update on current management and recent research for amblyopia treatment. Part I will review patching, atropine penalization, and pharmacological treatments. Part II will focus on perceptual learning, video gaming, and binocular dichoptic approaches.MethodsA literature search was performed in PubMed, ClinicalTrials.gov, Google Scholar, and reference lists of retrieved articles until December 20, 2018, for all papers containing “amblyopia treatment” or “amblyopia therapy.” We have included RCTs, prospective observational studies, prospective and retrospective cohort studies, pilot studies, and review articles.ResultsThe mainstay of treatment for amblyopia has been based on increasing visual stimulation of the amblyopic eye by occlusion, atropine, or optical penalization of the dominant eye. It has been established that refractive adaptation alone can significantly enhance visual acuity. However, the duration of optical correction varies between studies and the effectiveness of spectacle wear over early beginning of patching is still under investigation. Additionally, by means of occlusion dose monitors, it was found that adherence to occlusion affects the outcome, as a dose-response relationship exists between adherence and visual acuity. Treatment efficiency declines with age; however, recent evidence indicates cortical plasticity beyond the “critical period” and recommends that an attempt at treatment should be offered to all amblyopic children regardless of age, including those in later childhood. Novel approaches targeted to the restoration of binocular functions, such as perceptual learning, video gaming, and dichoptic training, have shown small effects on visual acuity and have failed to demonstrate non-inferiority over standard treatments.ConclusionsOn review, significant evidence for the successful management of amblyopia, with occlusion therapy and atropine, has been found. However, the management of amblyopia remains challenging, mainly due to compliance issues and suboptimal treatment outcomes during occlusion and atropine penalization. Recent studies have found evidence of new ways of treating amblyopia particularly in regard to binocular treatment although these remain under investigation. Further robust clinical trials on these new treatment modalities are still warranted in order to establish their role in treating amblyopia.