Effectiveness of Active Vision Therapy in Children with Bilateral Refractive Amblyopia.

PURPOSE: To compare the effectivity of vision therapy plus patching versus patching combined with placebo therapy in bilateral refractive amblyopia. METHODS: In this randomized controlled trial, children with bilateral refractive amblyopia were enrolled. Monocular best-corrected visual acuity (BCVA) ranged from 0.3 logMAR (20/40) to 0.6 logMAR (20/80) in both eyes, and visual acuity (VA) difference was less than 0.2 logMAR between the eyes. The experimental group received patching plus in-office vision therapy with Vision Therapy System 4 (VTS4), including accommodation, stereopsis, ocular movements, and visual memory skills, while the control group received patching plus in-office placebo therapy. The primary outcome measure was BCVA, and the secondary outcomes were stereo acuity, and accommodative facility measured pre- and post-therapy. RESULTS: Forty children aged 5 to 8 were included. After 4 months of therapy, the mean VA improvement was 0.23 ± 0.08 logMAR [2.3 line] (P < 0.001) in the experimental group and 0.09 ± 0.06 logMAR [0.09 line] (P < 0.001) in the control group. The difference in VA improvement between the two groups was statistically significant (P < 0.001). Post-therapy, the improvements in Randot stereoacuity and in monocular and binocular accommodative facilities were statistically significant between the experimental and the control groups (P = 0.013, P = 0.005, P = 0.002, respectively). CONCLUSION: Administering vision therapy in conjunction with patching significantly improved VA, stereo acuity, and accommodation facility in bilateral refractive amblyopia compared to patching alone.