Abstract
Purpose The aim of the study was evaluation of the scientific evidence about the efficacy of vision therapy in children and teenagers with anisometropic amblyopia by performing a systematic literature review. Methods A search was performed using 3 searching strategies in 4 different databases (PubMed, Web of Science, Scopus, and PruQuest). The quality of the included articles was evaluated using two tools for the risk of bias assessment, ROBINS-I for nonrandomized studies of intervention (NRSI), and ROB 2.0 for randomized clinical trials. Results The search showed 1274 references, but only 8 of them passed the inclusion criteria after the complete text review. The articles that were finally included comprised 2 randomized control trials and 6 nonrandomized studies of intervention. These articles provided evidence supporting the efficacy of vision therapy for the treatment of anisometropic amblyopia in children and teenagers. Assessment of the risk of bias showed an appropriate risk of bias for the randomized control trials, but a high risk of bias for nonrandomized studies of intervention (NRSI). A main source of risk of bias for NRSI was the domain related to the measurements of the outcomes, due to a lack of double-blind studies. Conclusion Vision therapy is a promising option for the treatment of anisometropic amblyopia in children and teenagers. However, the level of scientific evidence provided by the studies revised is still limited, and further randomized clinical trials are necessary to confirm the results provided to date and to optimize the vision therapy techniques by knowing the specific neural mechanisms involved.
Highlights
Functional amblyopia is a visual developmental disorder consisting of reduced best-corrected visual acuity in one or rarely in both eyes without the presence of any ocular pathology [1]
Due to the abnormalities in visual processing occurring in amblyopia, there are deficits in contrast sensitivity, accommodation, binocular vision, fixation, saccades, color, and form and motion perception, among others [2,3,4,5,6,7,8,9]. ere are four types of amblyopia depending on its etiology: anisometropic amblyopia, strabismic amblyopia, mixed amblyopia, and deprivation amblyopia [7]
Conventional treatments for amblyopia are glasses, patch, and penalization with atropine drops or Bangerter filters, but in recent years new approaches based on computerized visual training using different types of stimuli have been developed and evaluated. ese trainings are justified by the influence of video games in neuromodulatory pathways and the enhancement of attentional skills promoted by these games according to neurophysiological studies [14]. ese new approaches have allowed clinicians to develop new protocols based on the following techniques: perceptual learning, dichoptic training, and binocular therapy
Summary
Functional amblyopia is a visual developmental disorder consisting of reduced best-corrected visual acuity in one or rarely in both eyes without the presence of any ocular pathology [1]. Conventional treatments for amblyopia are glasses, patch, and penalization with atropine drops or Bangerter filters, but in recent years new approaches based on computerized visual training using different types of stimuli have been developed and evaluated. Ese new approaches have allowed clinicians to develop new protocols based on the following techniques: perceptual learning, dichoptic training, and binocular therapy. Dichoptic training is normally based on the use of polarized glasses, whereas for binocular therapy the use of red–green glasses is required With both techniques, binocular fusion training is performed using stimuli with some common parts and disparate elements for each eye individually [17, 18]. Active visual therapy based on perceptual learning, dichoptic stimulation, and binocular training with anaglyph glasses is an interesting new area of research that can complement and optimize conventional methods for amblyopia treatment [18, 19]. Erefore, systematic reviews are the best option to add high-level quality for an evidence-based clinical practice
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