Treatment Of Amblyopia Research Articles

Clear lens extraction and refractive lens exchange for the treatment of amblyopia.

Treatment of amblyopia typically involves spectacles or penalization of the nonamblyopic eye with occlusive patching or pharmacological penalization. However, these methods can be ineffective or difficult in certain children who may be unable to tolerate or are poorly compliant with such therapies. Untreated high refractive error can result in dense amblyopia, and thus, other treatment methods are necessary in this subset of children. With technological advances in ocular surgery, clear lens extraction (CLE) and refractive lens exchange (RLE) have emerged as popular alternative treatments for amblyopia, as they may avoid some of the challenges surrounding traditional methods. CLE involves lensectomy for refractive purposes in patients without cataracts, while RLE involves lensectomy followed by intraocular lens implantation. The purpose of this review was to summarize the use of CLE and RLE for the treatment of amblyopia in the pediatric population, discussing indications, techniques, treatment outcomes, safety, and potential complications.

Retinal microvascular changes in unilateral functional amblyopia detected by oct-angiography and follow-up during treatment.

To evaluate the macular microvascular changes using optical coherence tomographic angiography (OCT-A) in children with unilateral amblyopia and their reversibility during treatment. Patients with unilateral strabismic or anisometropic amblyopia or residual amblyopia from early congenital cataract surgery, examined between October 2019 and March 2021, were included. Vessel density and perfusion density in the superficial capillary plexus and area, perimeter and circularity of the foveal avascular zone (FAZ) were analysed using OCT-A in amblyopic eyes, contralateral eyes and control group healthy eyes. Correlation analyses between the microvascular parameters and the visual acuity were performed. In a pilot study on a few patients from the amblyopic cohort, longitudinal follow-up during treatment was also performed. A total of 128 eyes of 64 patients were included: 32 amblyopic eyes compared with 32 contralateral eyes and 64 control eyes. Vessel density and perfusion density in the superficial capillary plexus were significantly lower in amblyopic eyes compared to control eyes in 6 × 6 mm (p < 0.02) and 3 × 3 mm (p < 0.01) scans. Correlation analyses showed a linear decrease in vessel density and perfusion density with decreasing visual acuity. The microvascular changes observed were reversible with the occlusion treatment of amblyopia (p < 0.001). The study found a decrease in vessel density and perfusion density in the macula of children with unilateral functional amblyopia. These microvascular changes were correlated with visual acuity and appeared to be reversible with treatment of amblyopia. On the whole, OCT-A appears to be a relevant complementary examination when it comes to diagnosing and monitoring functional amblyopia.

Harnessing brain plasticity to improve binocular vision in amblyopia: An evidence-based update.

Amblyopia is a developmental visual disorder resulting from atypical binocular experience in early childhood that leads to abnormal visual cortex development and vision impairment. Recovery from amblyopia requires significant visual cortex neuroplasticity, i.e. the ability of the central nervous system and its synaptic connections to adapt their structure and function. There is a high level of neuroplasticity in early development and, historically, neuroplastic responses to changes in visual experience were thought to be restricted to a "critical period" in early life. However, as our review now shows, the evidence is growing that plasticity of the adult visual system can also be harnessed to improve vision in amblyopia. Amblyopia treatment involves correcting refractive error to ensure clear and equal retinal image formation in both eyes, then, if necessary, promoting the use of the amblyopic eye by hindering or reducing visual input from the better eye through patching or pharmacologic therapy. Early treatment in children can lead to visual acuity gains and the development of binocular vision in some cases; however, many children do not respond to treatment, and many adults with amblyopia have historically been untreated or undertreated. Here we review the current evidence on how dichoptic training can be used as a novel binocular therapeutic approach to facilitate visual processing of input from the amblyopic eye and can simultaneously engage both eyes in a training task that requires binocular integration. It is a novel and promising treatment for amblyopia in both children and adults.

A Prospective Trial to Assess the Efficacy of Eye-Tracking-Based Binocular Treatment versus Patching for Children’s Amblyopia: A Pilot Study

ABSTRACT Purpose To assess visual acuity (VA) and stereoacuity (SA) improvements in children with amblyopia treated with either binocular dichoptic treatment or patching treatment. Methods In this pilot prospective coherent study, 34 participants between 4 and 9 years of age with unilateral anisometropic amblyopia and without history of prior amblyopia treatment were enrolled into three groups. Full treatment group (FTG; n = 12): participants were prescribed the binocular dichoptic treatment to watch for 90 minutes per day, 5 days a week. Part-time treatment group (PTTG; n = 8): participants were prescribed the same binocular treatment as FTG, 90 minutes per day, 3 days per week. Patching treatment group (PTG; n = 14): participants wore an adhesive patch over the dominant eye for 2 hours per day, 7 days per week. Amblyopic-eye distance visual acuity (DVA), near visual acuity (NVA) and SA were evaluated at baseline, 4, 8, and 12 weeks. Results At 12 weeks, mean amblyopic-eye DVA improved 1.8 lines (95% CI, 1.1–2.5) in FTG, 1.5 lines (95% CI, 0.4–2.7) in PTTG and 3.0 lines (95% CI, 2.0–4.0) in PTG. The amblyopic-eye NVA improved 2.9 lines (95% CI, 2.4–3.5) in FTG, 1.7 lines (95% CI, 0.5–3.0) in PTTG and 2.8 lines (95% CI, 1.8–3.9) in PTG. The SA improved 0.38 log-arcseconds (95% CI, 0.24–0.53) in FTG, 0.59 log-arcseconds (95% CI, 0.36–0.82) in PTTG and 0.40 log-arcseconds (95% CI, 0.13–0.67) in PTG. No significant differences were found in DVA, NVA or SA improvement between FTG and PTG at 12 weeks. Conclusions VA and SA after binocular dichoptic treatment produced a similar therapeutic outcome to patching, suggesting a potential value for binocular therapy when treating anisometropic moderate degree of Children’s amblyopia.

Impact of COVID-19 pandemic control measures on amblyopia treatment: a retrospective study of records from a tertiary eye hospital in China

ObjectivesAmblyopia is the most common cause of unilateral visual impairment in children and requires long-term treatment. This study aimed to quantify the impact of pandemic control measures on amblyopia management.Design...

Durable recovery from amblyopia with donepezil

An elevated threshold for neuroplasticity limits visual gains with treatment of residual amblyopia in older children and adults. Acetylcholinesterase inhibitors (AChEI) can enable visual neuroplasticity and promote recovery from amblyopia in adult mice. Motivated by these promising findings, we sought to determine whether donepezil, a commercially available AChEI, can enable recovery in older children and adults with residual amblyopia. In this open-label pilot efficacy study, 16 participants (mean age 16 years; range 9–37 years) with residual anisometropic and/or strabismic amblyopia were treated with daily oral donepezil for 12 weeks. Donepezil dosage was started at 2.5 or 5.0 mg based on age and increased by 2.5 mg if the amblyopic eye visual acuity did not improve by 1 line from the visit 4 weeks prior for a maximum dosage of 7.5 or 10 mg. Participants < 18 years of age further patched the dominant eye. The primary outcome was visual acuity in the amblyopic eye at 22 weeks, 10 weeks after treatment was discontinued. Mean amblyopic eye visual acuity improved 1.2 lines (range 0.0–3.0), and 4/16 (25%) improved by ≥ 2 lines after 12 weeks of treatment. Gains were maintained 10 weeks after cessation of donepezil and were similar for children and adults. Adverse events were mild and self-limited. Residual amblyopia improves in older children and adults treated with donepezil, supporting the concept that the critical window of visual cortical plasticity can be pharmacologically manipulated to treat amblyopia. Placebo-controlled studies are needed.

Investigation of the efficacy and safety of retinal inactivation as a treatment for amblyopia in cats.

Deprivation of normal vision early in postnatal development elicits modifications of neural circuitry within the primary visual pathway that can cause a severe and intractable vision impairment (amblyopia). In cats, amblyopia is often modeled with monocular deprivation (MD), a procedure that involves temporarily closing the lids of one eye. Following long-term MD, brief inactivation of the dominant eye's retina can promote recovery from the anatomical and physiological effects of MD. In consideration of retinal inactivation as a viable treatment for amblyopia it is imperative to compare its efficacy against conventional therapy, as well as assess the safety of its administration. In the current study we compared the respective efficacies of retinal inactivation and occlusion of the dominant eye (reverse occlusion) to elicit physiological recovery from a prior long-term MD in cats. Because deprivation of form vision has been associated with development of myopia, we also examined whether ocular axial length or refractive error were altered by a period of retinal inactivation. The results of this study demonstrate that after a period of MD, inactivation of the dominant eye for up to 10 days elicited significant recovery of visually-evoked potentials that was superior to the recovery measured after a comparable duration of reverse occlusion. After monocular retinal inactivation, measurements of ocular axial length and refractive error were not significantly altered from their pre-inactivation values. The rate of body weight gain also was not changed during the period of inactivation, indicating that general well-being was not affected. These results provide evidence that inactivation of the dominant eye after a period of amblyogenic rearing promotes better recovery than eye occlusion, and this recovery was achieved without development of form-deprivation myopia.

Optical characterisation of holographic diffusers and Bangerter foils for treatment of amblyopia.

Amblyopia is a significant issue for children worldwide, and current treatment methods have drawbacks that can hinder treatment effectiveness and/or patient experience. This study proposes a new treatment method using holographic diffusers while also comparing their optical characteristics to a current treatment method (Bangerter foils). Holographic diffusers were developed by optically patterning thin polymer layers on a micron scale. Two compositions of photopolymer (acrylamide and diacetone acrylamide based) are analysed herein. Characterisation shows that holographic diffusers of either composition can achieve a wide range of on-axis intensity reductions, allowing for precise and customisable treatment levels by altering recording exposure time in a low-cost and durable manner.

ISOLATED FOVEAL HYPOPLASIA: A CASE REPORT

Foveal hypoplasia is a retinal disorder in which the foveal pit of the macula lutea is incompletely developed and is characterized by nystagmus and low visual acuity. It can manifest itself in isolation, without a clear etiology, or associated with other conditions such as albinism, aniridia, Stickler Syndrome, optic nerve hypoplasia, microphtalmus, etc. Modern retinal imaging technologies are key to diagnosis of this rare retinal disorder. We present a case of a 19-year-old woman with poor distance and near vision and nystagmus since childhood, without other associated diseases. Visual acuity was 0.5 Snellen decimal units in both eyes, with present latent nystagmus. The anterior segment was normal, while an absent foveal reflex was found on fundus examination. Optical coherence tomography (OCT) imaging confirmed the absence of foveal depression in the macular area. OCT-angiography (OCTA) was performed, which confirmed the absence of a foveal avascular zone in the macula. According to the proposed grading system parameters for foveal hypoplasia, this case corresponds with the most severe (grade 4) degree of foveal hypoplasia. Foveal hypoplasia can be associated with numerous etiological factors, and visual acuity can vary depending on the development of foveal photoreceptors and structural gradation. For this reason, especially in children with reduced visual acuity of unknown etiology and the existence of nystagmus, it is recommended to perform additional examinations and use multimodal imaging techniques (OCT and OCTA) in order to make a timely and accurate diagnosis. Management of this disorder includes treatment of the associated ocular and systemic conditions, refractive correction, treatment of amblyopia and use of low vision aids.&#x0D;

The Feasibility of an Educational Cartoon Video for Improving Adherence with Amblyopia Treatment in Children.

Previous studies have shown that it is necessary to evaluate adherence during the treatment process, using educational intervention methods which have been shown to improve adherence with patching treatment. A previous study reported that an educational cartoon had significantly improved adherence with patching. However, this black-white cartoon is not commercially available. This study investigates the feasibility of a 4-minute educational cartoon video in improving adherence with patching therapy for amblyopic children. Children (3 to 10 years old) with unilateral amblyopia who were prescribed 2 hours or 6 hours of patching per day were enrolled. Objective adherence to the treatment was tracked using a microsensor. Children returned after 4 weeks ± 2 days to measure adherence. Participants with adherence ≤50% were eligible to watch the educational cartoon video. They continued with the previously prescribed treatment (2 hours or 6 hours patching) for an additional week to evaluate the follow-up adherence. A total of 27 participants were enrolled. The mean age (SD) was 6.6 (1.5) years. Twenty-two participants (12 in the 2 hours patching group and 10 in the 6 hours patching group) had adherence ≤50% and watched our cartoon video. The cartoon video improved mean adherence (SD) from 29.6% (11.9%) to 56.8% (12.1%) in all 22 participants from both regimens (paired 2-tailed t-test, t= -11, P < 0.000). The Educational cartoon video is feasible for use in a clinical setting. These data showed a trend of improvement in adherence with both patching regimens in children after watching the educational cartoon video.

The Association Between Improvement of Stereoacuity and Suppression in the Treatment of Anisometropic Amblyopia.

To investigate the association between stereoacuity and suppression during occlusion therapy for patients with anisometropic amblyopia. Retrospective study. This study included 19 patients with hyperopic anisometropic amblyopia who underwent occlusion therapy. The mean age of the patients was 5.5 ± 1.4 years. The participants were evaluated for improvement in stereoacuity and suppression before beginning occlusion therapy, when the highest amblyopic visual acuity (VA) was achieved, during tapering, at the end of occlusion therapy, and at the final visit. Stereoacuity was evaluated using the TNO test or JACO stereo test. The presence of suppression was evaluated using circle No. 1 of the Stereo Fly Test or JACO results as the optotype. Of the 19 patients, 13 (68.4%) had suppression before occlusion, eight (42.1%) when the highest VA was achieved, five (26.3%) during tapering, and none at the final visit. Of the 13 patients with suppression before occlusion, 10 (76.9%) showed further improvement in stereoacuity when suppression disappeared, and nine had foveal stereopsis of 60 arcseconds. A significant association was confirmed between foveal stereopsis and suppression when the highest VA was achieved and during the tapering period (P<0.05, Fisher's exact test). Suppression was observed even when the VA in amblyopic eyes reached the highest score. By gradually decreasing the duration of occlusion, suppression was eliminated, leading to the acquisition of foveal stereopsis.

Standard Amblyopia Therapy in Adults with Longstanding Amblyopia Improves Visual Acuity and Contrast Sensitivity.

Perceptual learning or dichoptic training may result in improved acuity in adult amblyopes. However, for amblyopic children (<18 years), most clinicians recommend standard part-time patching. The purpose of this study was to determine if standard amblyopia therapy results in an enhancement in vision in the amblyopic eye of adults. Fifteen amblyopes (20/30 or worse) were recruited and nine (age (SD) 32.9 (16.31)) with anisometropia or anisometropia and strabismus (ie, combined mechanism amblyopia) completed the study. Previous therapy did not exclude subjects. The subjects received a comprehensive eye exam and wore their best correction for at least four weeks prior to baseline testing. The non-amblyopic eye was patched for 2 hours per day (Amblyopia iNET training for 30 minutes and near/distance activities for 1.5 hours). The subjects had a baseline amblyopia evaluation followed by one visit per week for 12 weeks. At 12 weeks, the treatment was tapered off over one month and the subjects had a final amblyopia evaluation at 24 weeks. Contrast sensitivity was measured at baseline and 12 weeks with the Quick CSF system. The subjects had a significant improvement in visual acuity across the weeks (p < 0.001). At baseline, weeks 12 and 24, the average logMAR acuities (SE) were 0.55 (0.09), 0.41 (0.08), and 0.38 (0.09), respectively. Weeks 4 to 24 were significantly different (p < 0.001) from baseline. The average acuity improvement over the 24 weeks was 1.7 logMAR lines. There was a significant increase in the area under the log contrast sensitivity function (p = 0.002) and its estimated acuity (p = 0.036) from baseline to 12 weeks. Standard amblyopia treatment can result in an improvement in visual acuity and contrast sensitivity in adults with longstanding anisometropic or combined mechanism amblyopia even if they had prior therapy.

Evaluation of Aniseikonia in Patients with Successfully Treated Anisometropic Amblyopia Using Spatial Aniseikonia Test.

Anisometropic amblyopia is decreased visual acuity in one eye, and treatment consists of wearing complete corrective spectacles. Aniseikonia occurs with complete correction of anisometropia using spectacles. Aniseikonia has been ignored when treating pediatric anisometropic amblyopia because of the prevailing belief that anisometropic symptoms are suppressed by adaptation. However, the conventional direct comparison method for evaluating aniseikonia significantly underestimates the degree of aniseikonia. This study investigated whether the adaptation occurs due to long-term anisometropic amblyopia treatment in patients who have had successful amblyopia treatment using a spatial aniseikonia test with high accuracy and repeatability compared with the conventional direct comparison method. The amount of aniseikonia was not significantly different between the patients with successful amblyopia treatment and individuals with anisometropia without a history of amblyopia. In both groups, the aniseikonia per 1.00 D of anisometropia and the aniseikonia per 1.00 mm of aniso-axial length were comparable. The repeatability of the amount of aniseikonia using the spatial aniseikonia test did not differ significantly between the two groups, indicating a high degree of agreement. These findings suggest that aniseikonia is not adapted to amblyopia treatment and that aniseikonia increases as the difference between spherical equivalent and axial length increases.

Binocular vision therapy for the treatment of Amblyopia—A review

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.

The impact of COVID-19 on compliance to amblyopia treatment in a tertiary eye care center.

To investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children. The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID-19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open-ended questions for 15 min. The questions were related to patients' compliance toward amblyopia treatment and the date of follow-up with their practitioners. The data collected were entered on Excel sheets in the participant's own words and later converted to a transcript for analysis. A total of 217 parents of children with amblyopia who were due for follow-up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia. In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow-up with the eye care practitioner.

Thought of the future of amblyopia treatment

Thought of the future of amblyopia treatment

Evaluation of retinal microcirculation alterations using OCTA in hyperopic ametropic amblyopia patients before and after treatment

PurposeWe aimed to compare retinal microcirculation in hyperopic ametropic amblyopia patients before and after treatment and in healthy children using optical coherence tomography angiography (OCTA), and to explore the pathogenesis of hyperopic ametropic amblyopia.MethodsEighteen patients with hyperopic ametropic amblyopia aged 4–8 years were selected as the patient group, and 18 age-matched healthy children were randomly selected as controls. The foveal avascular zone (FAZ) area, perimeter and circularity, vessel density (VD) and perfusion density (PD) of macular superficial retinal capillary plexus, macular thickness, peripapillary retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness were compared between both groups. After 6 months of amblyopia treatment, the same parameters were measured again.ResultsThe VD and PD in the central, inner, inner nasal, and inner inferior regions in hyperopic ametropic amblyopia were lower than in the control group after adjustment for axial length. After 6 months of treatment, the VD increased significantly, except in the outer nasal and outer inferior regions. The PD in the central (p < 0.001), inner superior (p = 0.001), inner inferior (p = 0.011) and inner temporal (p = 0.026) regions increased. The FAZ perimeter and circularity significantly differed between the groups. After 6 months of treatment, the FAZ area and perimeter decreased, but circularity increased.ConclusionHyperopic ametropic amblyopia eyes showed a significant decrease in vessel and perfusion densities. After amblyopia treatment, the vessel and perfusion densities of patients with hyperopic ametropic amblyopia increased, suggesting that abnormalities in the microvascular system are a pathogenic factor of amblyopia.

Quantitative evaluation of anisometropic amblyopia treatment efficacy by coupling multiple visual functions via CRITIC algorithm

BackgroundThe evaluation of amblyopia treatment efficacy is essential for amblyopia prevention, control, and rehabilitation.MethodsTo evaluate the amblyopia treatment efficacy more precisely and quantitatively, this study recorded four visual function examination results, i.e., visual acuity, binocular rivalry balance point, perceptual eye position, and stereopsis before and after amblyopia treatment.ResultsWe found that all these four results had a significant difference between before and after treatment, and the relationship between visual acuity improvement and the difference of BRBP, PEP, and stereoacuity cannot show a fitting correlation regarding the widely used index of visual acuity as the standard of treatment efficacy. By using the Criteria Importance Through Inter-criteria Correlation (CRITIC) method, a more comprehensive and quantitative index by coupling the selected four indexes with objective weights was obtained for further training efficacy representation, and the validation dataset also showed a good performance.ConclusionsThis study proved that our proposed coupling method based on different visual function examination results via the CRITIC algorithm is a potential means to quantify the amblyopia treatment efficacy.

Assessment of macular microvascular changes in children following treatment of anisometropic myopic amblyopia using optical coherence tomography angiography

PurposeTo evaluate macular microvascular changes in the form of foveal avascular zone (FAZ) area and vessel density in the superficial, deep capillary plexuses, and choriocapillaris using optical coherence tomography angiography (OCTA) in children with anisometropic myopic amblyopia before and after treatment.MethodsThis prospective observational study included 32 patients younger than 12 years old with anisomyopic amblyopia. OCTA was done before patients’ treatment with optical correction with or without patching and was repeated after successful amblyopia treatment. Outcomes included superficial, deep, and choriocapillaris vessel density (VD) and superficial and deep FAZ areas.ResultsThe study included 13 males (40.6%) and 19 females (59.4%), and the mean age was 9.52 ± 1.33 years. Fifty-three percent (53%) of patients needed only optical correction, and the remaining 47% needed additional patching therapy. After successful treatment, there was a significant improvement in amblyopic eyes in best-corrected visual acuity (p < 0.001), with higher VD values in superficial capillary plexuses (p < 0.001), deep capillary plexuses (p < 0.001), and foveal choriocapillaris (p = 0.030). In the glasses with patching subgroup, the difference between pre-treatment and post-treatment parameters revealed a significant improvement in vessel density in superficial retinal plexuses (foveal and parafoveal; p values 0.023 and < 0.001, respectively) and deep retinal plexuses (whole image, foveal, and parafoveal; p values 0.003, < 0.001, and 0.002, respectively). While amblyopic eyes treated with glasses alone had a significantly greater difference in choriocapillaris foveal VD (p value = 0.022).ConclusionAfter effective amblyopia treatment, amblyopic eyes exhibited improved best-corrected visual acuity and better macular perfusion along the superficial, deep vascular density, and choriocapillaris foveal VD.Clinical trial registrationCinicalTrials.gov Identifier: NCT05223153.

How do parents experience patching or dichoptic action video gaming as amblyopia treatment? A qualitative study exploring treatment preferences and information needs to facilitate decision‐making

To explore parents' experiences, preferences and information needs when either patching treatment or dichoptic action video gaming is used as an amblyopia treatment for their child. A qualitative study was carried out on parents whose newly diagnosed amblyopic children participated in a randomised controlled trial (RCT) comparing the effects of dichoptic action video gaming versus patching. A purposive heterogenic sample was selected for an additional interview after the study period. Semi-structured interviews were conducted with one or both parents and transcribed verbatim, and a thematic analysis was performed. Ten families agreed to participate: seven in the patching group and three in the gaming group. Two themes emerged from the data exploring experiences with treatment: (1) factors influencing compliance and (2) burden with treatment. Parents reported creating a routine which improved compliance with patching, as opposed to gaming where parents felt less need to conduct the treatment themselves as it was performed in the outpatient clinic. In both groups, parents experienced an information hiatus regarding the role of refractive error. In deciding the type of treatment to be used, parents preferred to deliberate the choice with the healthcare professional and discuss considerations resulting in shared decisions. The emerging themes were (1) effect and efficiency of treatment, (2) organisational aspects of treatments and (3) their child's traits. This study provides insight into the experiences of parents whose children underwent different types of amblyopia therapy. Both treatments have their own advantages and disadvantages. For parents, the effectiveness and efficiency of treatment were the most important aspects when deciding the method of management. Parents wish to come to a well-informed, shared decision regarding the type of amblyopia treatment.