Refractive adaptation and efficacy of occlusion therapy in untreated amblyopic patients aged 12 to 40 years

  • Brigitte Simonsz-TóthEmail author
  • Maurits V. Joosse
  • Dorothea Besch



Since neurophysiological and clinical trials have shown evidence for plasticity in the adult visual system, the upper age limit for amblyopia treatment is not rigid. The aim of this study was to investigate the efficacy of occlusion therapy and refractive adaptation in untreated amblyopic patients 12 to 40 years of age.


In a prospective study, all patients had full orthoptic and ophthalmic assessment including cycloplegic retinoscopy. Patients with a newly prescribed optical correction underwent an 18-week refractive adaptation. All patients were treated with occlusion for 3 h a day for 18 weeks. Acuity gain and responder rates (≥ 0.2 log units) were calculated. The rate of recurrence (visual acuity 9 months after end of the occlusion therapy; ≥ 0.2 log units) and the acuity gain after refractive adaptation were determined. Self-reported compliance to occlusion therapy was assessed.


Median age of patients (n = 24) was 32.4 years (IQR 19.2). Best corrected visual acuity at start of occlusion therapy was 0.35 logMAR (IQR 0.5) and 0.30 (IQR 0.4) logMAR at the end of occlusion therapy, an acuity gain of 0.05 logMAR (P = 0.004). Six (25%) patients had an acuity gain of at least 0.2 logMAR units. Reading acuity was improved from 0.4 logMAR (IQR 0.4) to 0.3 logMAR (IQR 0.4) (P = 0.004).

Visual acuity was stable 9 months after occlusion therapy. The acuity gain after 18 weeks of refractive adaptation was 0.05 logMAR (P = 0.238, n = 8). Acuity gain by correcting refractive errors was 0.25 logMAR (P = 0.006). Twenty-one (92%) of 24 patients achieved full recording in the calendar. Overall compliance was 17% (IQR 38). Only 5 out of 22 (23%) had acceptable compliance (≥ 50%) to occlusion therapy. Improvement of visual acuity was significantly better in patients with at least 50% compliance (P = 0.013). Compliance was worse in non-native patients than in native patients (P = 0.022).


In adulthood, compliance to occlusion therapy is even more challenging than in children. Noncompliance is the main reason for treatment failure. Only a few patients with acceptable compliance to occlusion therapy had a small but significant improvement of visual acuity. The results suggest that some adults with amblyopia retain a degree of cortical plasticity. We found that untreated adult amblyopic patients did not wear optical correction on the amblyopic eye. The highest treatment benefit was achieved by correcting refractive errors prior to following period of refractive adaptation.


Amblyopia Occlusion Compliance Refractive adaptation Plasticity 



We gratefully acknowledge the contribution of: Jantien Hofland for help with data collection and research assistence; Ellen van Minderhout and Marleen Vermeulen-Jongen for help in recruiting patients; John Wieja, Elizabeth Wieja, and Prof. Alfred Tóth for English proofreading.

Funding information

The study was funded by the Hospital Grant (grant number METC ZWH 11-048) of the Haaglanden Medical Center.

Compliance with ethical standards

The study was carried out according to the declaration of Helsinki (WMA general assembly in October 2013, Brazil). The Medical Research Ethics Committee Southwest Holland approved the study protocol. Written informed consent was obtained from all participants (and the parents if the child was under age 18) included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Infomed consent

Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Supplementary material

417_2018_4170_MOESM1_ESM.jpg (84 kb)
ESM 1 (JPG 83 kb)


  1. 1.
    Baker DH, Meese TS, Mansouri B, Hess RF (2007) Binocular summation of contrast remains intact in strabismic amblyopia. Invest Ophthalmol Vis Sci 48:5332–5338. CrossRefGoogle Scholar
  2. 2.
    Baker DH, Meese TS, Hess RF (2008) Contrast masking in strabismic amblyopia: attenuation, noise, interocular suppression and binocular summation. Vis Res 48:1625–1640. CrossRefGoogle Scholar
  3. 3.
    Hess RF, Mansouri B, Thompson B (2011) Restoration of binocular vision in amblyopia. Strabismus 19:110–118. CrossRefGoogle Scholar
  4. 4.
    Vedamurthy I, Suttle CM, Alexander J (2007) Interocular interactions during acuity measurement in children and adults, and in adults with amblyopia. Vis Res 47:179–188. CrossRefGoogle Scholar
  5. 5.
    Vedamurthy I, Nahum M, Bavelier D (2015) Mechanisms of recovery of visual function in adult amblyopia through a tailored action video game. Sci Rep 5:8482. CrossRefGoogle Scholar
  6. 6.
    Algaze A, Roberts C, Leguire L, Schmalbrock P, Rogers G (2002) Functional magnetic resonance imaging as a tool for investigating amblyopia in the human visual cortex: a pilot study. J AAPOS 6:300–308CrossRefGoogle Scholar
  7. 7.
    Anderson SJ, Holliday IE, Harding GFA (1999) Assessment of cortical dysfunction in human strabismic amblyopia using magnetoencephalography (MEG). Vis Res 39:1723–1738CrossRefGoogle Scholar
  8. 8.
    Barnes GR, Hess RF, Dumoulin SO, Achtman RL, Pike GB (2001) The cortical deficit in humans with strabismic amblyopia. J Physiol 533:281–297CrossRefGoogle Scholar
  9. 9.
    Demer JL, Von Noorden GK, Volkow ND, Gould KL (1988) Imaging of cerebral blood flow and metabolism in amblyopia by positron emission tomography. Am J Ophthalmol 105:337–347CrossRefGoogle Scholar
  10. 10.
    Goodyear BG, Nicolle DA, Humphrey GK, Menon RS (2000) BOLD fMRI response of early visual areas to perceived contrast in human amblyopia. J Neurophysiol 84:1907–1913. CrossRefGoogle Scholar
  11. 11.
    Imamura K, Richer H, Fischer H, Lennerstrand G, Franzén O, Rydberg A, Andersson J, Schneider H, Onoe H, Watanabe Y, Långström B (1997) Reduced activity in the extrastiate cortex of individuals with strabismic amblyopia. Neurosci Lett 225:173–176CrossRefGoogle Scholar
  12. 12.
    Kiorpes L, Kiper DC, O'Keefe LP, Cavanaugh JR, Movshon JA (1998) Neuronal correlates of amblyopia in the visual cortex of macaque monkeys with experimental strabismus and anisometropia. J Neurosci 18:6411–6424CrossRefGoogle Scholar
  13. 13.
    Kiorpes L, McKee SP (1999) Neural mechanisms underlying amblyopia. Curr Opin Neurobiol 9:480–486CrossRefGoogle Scholar
  14. 14.
    Lerner Y, Pianka P, Azmon B, Leiba H, Stolovitch C, Loewensrein A (2003) Area-specific amblyopic effects in human occipitotemporal object representations. Neuron 40:1023–1029CrossRefGoogle Scholar
  15. 15.
    Muckli L, Kiess S, Tonhausen N, Singer W, Goegel R, Sireteanu R (2006) Cerebral correlates of impaired grating perception in individual psychophysically assessed human amblyopes. Vis Res 46:506–526. CrossRefGoogle Scholar
  16. 16.
    Ciuffreda KJ, Fisher SK (1987) Impairment of contrast discrimination in amblyopic eyes. Ophthalmic Physiol Opt 7:461–467CrossRefGoogle Scholar
  17. 17.
    Ehlers H (1936) The movements of the eyes during reading. Acta Ophthalmol 14:56–63CrossRefGoogle Scholar
  18. 18.
    Haase W, Hohmann A (1982) Ein neuer Test (C-Test) zur quantitativen Prüfung der Trennschwierigkeiten („crowding‟) - Ergebnisse bei Amblyopie und Ametropie. Klin Monatsbl Augenheilkd 180:210–215. CrossRefGoogle Scholar
  19. 19.
    Joosse MV, Boothe RG, Wilson JR (1990) Monocular visual fields of macaque monkeys with naturally-occurring strabismus. Clin Vis Sci 5:101–111Google Scholar
  20. 20.
    Lagrèze WA, Sireteanu R (1991) Verzerrte Formwahrnehmung bei Schielamblyopie. Zeitschr prakt Augenheilk 12:309–313Google Scholar
  21. 21.
    Singman E, Matta N, Tian J, Silbert D (2013) Association between accommodative amplitudes and amblyopia. Strabismus 21:137–139. CrossRefGoogle Scholar
  22. 22.
    Sireteanu R, Bäumer CC, Iftime A (2008) Temporal instability in amblyopic vision: relationship to a displacement map of visual space. Invest Ophthalmol Vis Sci 49:3940–3954. CrossRefGoogle Scholar
  23. 23.
    Loudon SE, Simonsz HJ (2005) The history of the treatment of amblyopia. Strabismus 13:93–106CrossRefGoogle Scholar
  24. 24.
    Awan M, Proudlock FA, Gottlob I (2005) A randomized controlled trial of unilateral strabismus and mixed amblyopia using occlusion dose monitors to record compliance. Invest Ophthalmol Vis Sci 46:1435–1439. CrossRefGoogle Scholar
  25. 25.
    Fielder AR, Irwin M, Auld R, Cocker KD, Jones HS, Moseley MJ (1995) Compliance in amblyopia therapy: objective monitoring of occlusion. Br J Ophthalmol 79(6):585–589CrossRefGoogle Scholar
  26. 26.
    Loudon SE, Fronius M, Looman CWN, Awan M, Simonsz B, van der Maas PJ, Simonsz HJ (2006) Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. Invest Ophthalmol Vis Sci 47:4393–4400. CrossRefGoogle Scholar
  27. 27.
    Simonsz HJ, Polling JR, Voorn R, van Leeuwen J, Meester H, Romijn C, Dijkstra BG (1999) Electronic monitoring of treatment compliance in patching for amblyopia. Strabismus 7:113–123CrossRefGoogle Scholar
  28. 28.
    Stewart CE, Fielder AR, Stephens DA, Moseley MJ (2005) Treatment of unilateral amblyopia: factors influencing visual outcome. Invest Ophthalmol Vis Sci 46:3152–3160. CrossRefGoogle Scholar
  29. 29.
    Rahi J, Logan S, Timms C, Russel-Eggitt I, Taylor D (2002) Risk, causes, and outcomes of visual impairment after loss of vision in the non-amblyopic eye: a population-based study. Lancet 360:597–602CrossRefGoogle Scholar
  30. 30.
    Van Leeuwen R, Eijkemans MJ, Vingerling JR, Hofman A, de Jong PT, Simonsz HJ (2007) Risk of bilateral visual impairment in individuals with amblyopia: the Rotterdam study. Br J Ophthalmol 91:1450–1451. CrossRefGoogle Scholar
  31. 31.
    Van de Graaf ES, van der Sterre GW, Polling JR, van Kempen H, Simonsz B, Simonsz HJ (2004) Amblyopia & Strabismus Questionnaire: design and initial validation. Strabismus 12:181–193. CrossRefGoogle Scholar
  32. 32.
    Cleemput I, Kesteloot K (2002) Economic implications of non-compliance in health care. Lancet 359:2129–2130. CrossRefGoogle Scholar
  33. 33.
    Bavelier D, Levi DM, Li RW, Dan Y, Hensch TK (2010) Removing brakes on adult brain plasticity: from molecular to behavioral interventions. J Neurosci 30:14964–14971. CrossRefGoogle Scholar
  34. 34.
    Morishita H, Hensch TK (2008) Critical period revisited: impact on vision. Curr Opin Neurobiol 18:101–107. CrossRefGoogle Scholar
  35. 35.
    Kuhlman SJ, Olivas ND, Tring E, Ikrar T, Xu X, Trachtenberg JT (2013) A disinhibitory microcircuit initiates critical-period plasticity in the visual cortex. Nature 501:543–546. CrossRefGoogle Scholar
  36. 36.
    Levelt CN, Hübener M (2012) Critical-period plasticity in the visual cortex. Annu Rev Neurosci 35:309–330. CrossRefGoogle Scholar
  37. 37.
    Mitchell DE, MacNeill K, Crowder NA, Holman K, Duffy KR (2016) Recovery of visual functions in amblyopic animals following brief exposure to total darkness. J Physiol 594:149–167. CrossRefGoogle Scholar
  38. 38.
    Stephany CÉ, Ikrar T, Nguyen C, Xu X, McGee AW (2016) Nogo receptor 1 confines a Disinhibitory microcircuit to the critical period in visual cortex. J Neurosci 36:11006–11012. CrossRefGoogle Scholar
  39. 39.
    Fronius M, Cirina L, Cordey A, Ohrloff C (2005) Visual improvement during psychophysical training in an adult amblyopic eye following visual loss in the contralateral eye. Graefes Arch Clin Exp Ophthalmol 243:278–280. CrossRefGoogle Scholar
  40. 40.
    Astle AT, Webb BS, McGraw PV (2011) Can perceptual learning be used to treat amblyopia beyond the critical period of visual development? Ophthalmic Physiol Opt 31:564–573. CrossRefGoogle Scholar
  41. 41.
    Hou F, Huang CB, Tao L, Feng L, Zhou Y, Lu ZL (2011) Training in contrast detection improves motion perception of sinewave gratings in amblyopia. Invest Ophthalmol Vis Sci 52:6501–6510. CrossRefGoogle Scholar
  42. 42.
    Levi DM, Polat U (1996) Neural plasticity in adults with amblyopia. Proc Natl Acad Sci U S A 93:6830–6834CrossRefGoogle Scholar
  43. 43.
    Li RW, Klein SA, Levi DM (2008) Prolonged perceptual learning of positional acuity in adult amblyopia: perceptual template retuning dynamics. J Neurosci 28:14223–14229. CrossRefGoogle Scholar
  44. 44.
    Li RW, Ngo C, Nguyen J, Levi DM (2011) Video-game play induces plasticity in the visual system of adults with amblyopia. PLoS Biol 9:e1001135. CrossRefGoogle Scholar
  45. 45.
    Zhou Y, Huang C, Xu P, Tao L, Qiu Z, Li X, Lu ZL (2006) Perceptual learning improves contrast sensitivity and visual acuity in adults with anisometropia amblyopia. Vis Res 46:739–750. CrossRefGoogle Scholar
  46. 46.
    Green CS, Bavelier D (2003) Action video game modifies visual selective attention. Nature 423:534–537. CrossRefGoogle Scholar
  47. 47.
    Green CS, Bavelier D (2007) Action-video-game experience alters the spatial resolution of vision. Psychol Sci 18:88–94. CrossRefGoogle Scholar
  48. 48.
    Li RW, Polat U, Makous W, Bavelier D (2009) Enhancing the contrast sensitivity function through action video game training. Nat Neurosci 12:549–551. CrossRefGoogle Scholar
  49. 49.
    Li J, Thompson B, Deng D, Chan LY, Yu M, Hess RF (2013) Dichoptic training enables the adult amblyopic brain to learn. Curr Biol 23:308–309. CrossRefGoogle Scholar
  50. 50.
    Li J, Spiegel DP, Hess RF, Chen Z, Chan LY, Deng D, Yu M, Thompson B (2015) Dichoptic training improves contrast sensitivity in adults with amblyopia. Vis Res 114:161–172. CrossRefGoogle Scholar
  51. 51.
    Tsirlin I, Colpa L, Goltz HC, Wong AM (2015) Behavioral training as new treatment for adult amblyopia: a meta-analysis and systematic review. Invest Ophthalmol Vis Sci 56:4061–4075. CrossRefGoogle Scholar
  52. 52.
    Fronius M, Cirina L, Ackermann H, Kohnen T, Diehl CM (2014) Efficiency of electronically monitored amblyopia treatment between 5 and 16 years of age: new insight into declining susceptibility of the visual system. Vis Res 103:11–19. CrossRefGoogle Scholar
  53. 53.
    Holmes JM, Beck RW, Kraker RT, Astle WF, Birch EE, Cole SR, Cotter SA, Donahue S, Everett DF, Hertle RW, Keech RV, Paysse E, Quinn GF, Repka MX, Scheiman MM, Pediatric Eye Disease Investigator Group (2004) Risk of amblyopia recurrence after cessation of treatment. J AAPOS 8:420–428. CrossRefGoogle Scholar
  54. 54.
    Fronius M, Bachert I, Lüchtenberg M (2009) Electronic monitoring of occlusion treatment for amblyopia in patients aged 7 to 16 years. Graefes Arch Clin Exp Ophthalmol 247:1401–1408. CrossRefGoogle Scholar
  55. 55.
    Pediatric Eye Disease Investigator Group (2005) Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 123:437–447. CrossRefGoogle Scholar
  56. 56.
    Ayed T, Sokkah M, Charfi O, El Matri L (2002) Epidemiologic study of refractive errors in schoolchildren in socioeconomically deprived regions in Tunisia. J Fr Ophtalmol 25:712–717Google Scholar
  57. 57.
    Gilbert CE, Shah SP, Jadoon MZ, Bourne R, Dineen B, Khan MA, Johnson GJ, Khan MD, Pakistan National Eye Survey Study Group (2008) Poverty and blindness in Pakistan: results from the Pakistan national blindness and visual impairment survey. BMJ 336:29–32. CrossRefGoogle Scholar
  58. 58.
    Shahriari HA, Izadi S, Rouhani MR, Ghasemzadeh F, Maleki AR (2007) Prevalence and causes of visual impairment and blindness in Sistan-Va-Baluchestan Province Iran: Zahedan eye study. Br J Ophthalmol 91:579–584. CrossRefGoogle Scholar
  59. 59.
    Al-Yahya A, Al-Odan K, Allam K, Al-Onazi B, Mousa A, Al-Saleh A (2012) Compliance to patching in the treatment of amblyopia. Saudi J Ophthalmol 26:305–307. CrossRefGoogle Scholar
  60. 60.
    Loudon SE, Passchier J, Chaker L, de Vos S, Fronius M, Harrad RA, Looman CW, Simonsz B, Simonsz HJ (2009) Psychological causes of non-compliance with electronically monitored occlusion therapy for amblyopia. Br J Ophthalmol 93:1499–1503. CrossRefGoogle Scholar
  61. 61.
    Tjiam AM, Akcan H, Ziylan F, Vukovic E, Loudon SE, Looman CW, Passchier J, Simonsz HJ (2011) Sociocultural and psychological determinants in migrants for noncompliance with occlusion therapy for amblyopia. Graefes Arch Clin Exp Ophthalmol 249:1893–1899. CrossRefGoogle Scholar
  62. 62.
    Loudon SE, Polling JR, Simonsz HJ (2003) Electronically measured compliance with occlusion therapy for amblyopia is related to visual acuity increase. Graefes Arch Clin Exp Ophthalmol 241:176–180. CrossRefGoogle Scholar
  63. 63.
    Wallace MP, Stewart CE, Moseley MJ, Stephens DA, Fielder AR, Monitored Occlusion Treatment Amblyopia Study (MOTAS) Cooperatives; Randomized Occlusion Treatment Amblyopia Study (ROTAS) Cooperatives (2013) Compliance with occlusion therapy for childhood amblyopia. Invest Ophthalmol Vis Sci 54:6158–6166. CrossRefGoogle Scholar
  64. 64.
    Cerkoney KA, Hart LK (1980) The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes Care 3:594–598CrossRefGoogle Scholar
  65. 65.
    Rubin RR (2005) Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med 118(Suppl 5A):27–34. CrossRefGoogle Scholar
  66. 66.
    Tebbi CK, Cummings KM, Zevon MA, Smith L, Richards M, Mallon J (1986) Compliance of pediatric and adolescent cancer patients. Cancer 58:1179–1184CrossRefGoogle Scholar
  67. 67.
    Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J (1986) Compliance with topical pilocarpine treatment. Am J Ophthalmol 10:515–523CrossRefGoogle Scholar
  68. 68.
    Laidlaw DA, Tailor V, Shah N, Atamian S, Harcourt C (2008) Validation of a computerised logMAR visual acuity measurement system (COMPlog): comparison with ETDRS and the electronic ETDRS testing algorithm in adults and amblyopic children. Br J Ophthalmol 92:241–244. CrossRefGoogle Scholar
  69. 69.
    Rosser DA, Cousens SN, Murdoch IE, Fitzke FW, Laidlaw DA (2003) How sensitive to clinical change are ETDRS logMAR visual acuity measurements? Invest Ophthalmol Vis Sci 44:3278–3281CrossRefGoogle Scholar
  70. 70.
    Siderov J, Tiu AL (1999) Variability of measurements of visual acuity in a large eye clinic. Acta Ophthalmol Scand 77:673–676CrossRefGoogle Scholar
  71. 71.
    Stewart CE, Moseley MJ, Fielder AR, Stephens DA, the MOTAS cooperative (2004a) Refractive adaptation in amblyopia: quantification of effect and implications for practice. Br J Ophthalmol 88:1552–1556. CrossRefGoogle Scholar
  72. 72.
    Stewart CE, Stephens DA, Fielder AR, Moseley MJ, ROTAS Cooperative (2007) Objectively monitored patching regimens for treatment of amblyopia: randomised trial. BMJ 335(7622):707. CrossRefGoogle Scholar
  73. 73.
    Stewart CE, Moseley MJ, Stephens DA, Fielder AR (2004b) Treatment dose-response in amblyopia therapy: the monitored occlusion treatment of amblyopia study (MOTAS). Invest Ophthalmol Vis Sci 45:3048–3054. CrossRefGoogle Scholar
  74. 74.
    Cleary M (2000) Efficacy of occlusion for strabismic amblyopia: can an optimal duration be identified? Br J Ophthalmol 84:572–578CrossRefGoogle Scholar
  75. 75.
    Kracht J, Bachert I, Diehl CM, Kämmerling S, Lüchtenberg M, Zubcov A, Simonsz H, Fronius M (2010) Electronically recorded occlusion treatment in amblyopes older than 7 years: acuity gain after more than 4 months of treatment? Klin Monatsbl Augenheilkd 227:774–781. CrossRefGoogle Scholar
  76. 76.
    Bhola R, Keech RV, Kutschke P, Pfeifer W, Scott WE (2006) Recurrence of amblyopia after occlusion therapy. Ophthalmology 113:2097–2100. CrossRefGoogle Scholar
  77. 77.
    Lee YR, Lee JY (2006) Part-time occlusion therapy for anisometropic amblyopia detected in children eight years of age and older. Korean J Ophthalmol 20:171–176. CrossRefGoogle Scholar
  78. 78.
    Mohan K, Saroha V, Sharma A (2004) Successful occlusion therapy for amblyopia in 11- to 15-year-old children. J Pediatr Ophthalmol Strabismus 41:89–95CrossRefGoogle Scholar
  79. 79.
    Pediatric Eye Disease Investigator Group (2007) Stability of visual acuity improvement following discontinuation of amblyopia treatment in children aged 7 to 12 years. Arch Ophthalmol 125:655–659. CrossRefGoogle Scholar
  80. 80.
    Walsh LA, Hahn EK, LaRoche GR (2009) The method of treatment cessation and recurrence rate of amblyopia. Strabismus 17:107–116. CrossRefGoogle Scholar
  81. 81.
    Garoufalis P, Georgievski Z, Koklanis K (2007) Long term vision outcomes of conventional treatment of strabismic and anisometropic functional amblyopia. Binocul Vis Strabismus Q 22:49–56Google Scholar
  82. 82.
    Scott WE, Dickey CF (1988) Stability of visual acuity in amblyopic patients after visual maturity. Graefes Arch Clin Exp Ophthalmol 226:154–157CrossRefGoogle Scholar
  83. 83.
    Simonsz-Toth B, Loudon SE, van Kempen-du Saar H, van de Graaf ES, Groenewoud JH, Simonsz HJ (2007) Visusevaluierung in einer historischen Kohorte von 137 okkludierten Probanden, 30-35 Jahre nach Ende der Okklusionsbehandlung. Klin Monatsbl Augenheilkd 224:40–46. CrossRefGoogle Scholar
  84. 84.
    Tacagni DJ, Stewart CE, Moseley MJ, Fielder AR (2007) Factors affecting the stability of visual function following cessation of occlusion therapy for amblyopia. Graefes Arch Clin Exp Ophthalmol 245:811–816. CrossRefGoogle Scholar
  85. 85.
    Gao TY, Anstice N, Babu RJ, Black JM, Bobier WR, Dai S, Guo CX, Hess RF, Jenkins M Jiang Y, Kearns L, Kowal L, Lam CSY, Pang PCK, Parag V, South J, Staffieri SE, Wadham A, Walker N, Thompson B, Binocular Treatment of Amblyopia Using Videogames (BRAVO) Study Team (2018) Optical treatment of amblyopia in older children and adults is essential prior to enrolment in a clinical trial. Ophthalmic Physiol Opt.
  86. 86.
    Pediatric Eye Disease Investigator Group (2003) A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol 121:603–611. CrossRefGoogle Scholar
  87. 87.
    Chen PL, Chen JT, Tai MC, Fu JJ, Chang CC, Lu DW (2007) Anisometropic amblyopia treated with spectacle correction alone: possible factors predicting success and time to start patching. Am J Ophthalmol 143:54–60. CrossRefGoogle Scholar
  88. 88.
    Steele AL, Bradfield YS, Kushner BJ, France TD, Struck MC, Gangnon RE (2006) Successful treatment of anisometropic amblyopia with spectacles alone. J AAPOS 10:37–43. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OphthalmologyHaaglanden Medical CentreThe HagueThe Netherlands
  2. 2.Department of OphthalmologyEberhard Karls UniversityTübingenGermany

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