Monocular and binocular vision function following patching alone versus combined patching and active vision therapy in non-strabismic refractive amblyopia.

PURPOSE: To evaluate binocular visual function in amblyopic patients who achieved optimal visual acuity following treatment with either conventional patching alone or combined patching and structured Active vision therapy (AVT). METHODS: This retrospective chart review included 67 patients with non strabismic refractive amblyopia (31 patching; 36 combined treatment) who achieved best-corrected visual acuity (BCVA) ≤0.17 logMAR in both eyes after treatment. The combined treatment consisted of patching with structured active vision therapy incorporating anti-suppression, accommodative, vergence, and visuomotor exercises. Post-treatment assessment included stereoacuity (log seconds of arc), vergence parameters (phoria, near point of convergence, fusional vergence), accommodative lag, accommodative facility (monocular and binocular), and binocular sensory status. Within-group changes were analyzed using Wilcoxon signed-rank tests; between-group comparisons were performed using Mann-Whitney U tests. Effect sizes (r) were calculated for intergroup comparisons. RESULTS: Both groups demonstrated significant reduction in accommodative lag (p < .001). Post-treatment stereoacuity was significantly better in the combined treatment group (p < .001; r = 0.724). The combined treatment group also showed superior vergence function, with larger positive fusional vergence amplitudes (r = 0.60) and improved near point of convergence (r = 0.488). Monocular and binocular accommodative facility were significantly higher in the combined treatment group (r = 0.656 and r = 0.690, respectively). Treatment duration was significantly shorter in the combined treatment group (p < .001). CONCLUSIONS: Combined patching and structured AVT group was associated with superior binocular vision function outcomes and reduced treatment duration. However, due to the non-randomized, retrospective design of the study, findings should be interpreted with caution. AVT is a more intensive treatment requiring greater motivation, adherence, supervision, and access to care.