Binocular Treatment for Childhood Amblyopia

Abstract

Amblyopia (‘lazy eye’) is the leading cause of monocular visual impairment in children. In addition to abnormal visual acuity, amblyopia can result in functional impairments in reading and fine motor abilities, and low self-esteem. The most common treatment is to patch the stronger eye to force use of the amblyopic eye, but normal visual acuity is not always achieved and normal binocular vision is rarely recovered. Patching can also be uncomfortable and an emotional burden for the child, resulting in low adherence. Recent advances in the treatment of childhood amblyopia have focused on binocular therapies consisting of games and movies that may reduce interocular suppression so the child can experience binocular vision. Laboratory and clinical trial data have shown improvements in visual acuity and binocular outcomes with as little as 2 to 4 weeks of binocular treatment in amblyopic children and adults. However, a few clinical trials have poor results with binocular treatment, possibly due to low adherence, small tropias, or a high prevalence of intractable amblyopia in older, previously treated participants. Although binocular treatments show promise, particularly in younger children, more research must be conducted to determine the most effective way to implement binocular treatment for maximum visual improvement, and to tease apart the mechanisms by which visual improvement occurs. Advanced binocular treatments have the potential to be added to the repertoire of standard-of-care treatment for childhood amblyopia, but questions remain to be answered before they can be used nationally and internationally in clinical settings.