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The treatment of amblyopia: current practice and emerging trends

  • Eleni PapageorgiouEmail author
  • Ioannis Asproudis
  • Gail Maconachie
  • Evangelia E. Tsironi
  • Irene Gottlob
Review Article
  • 206 Downloads

Abstract

Purpose

The purpose of this review is to provide an update on current management and recent research for amblyopia treatment. Part I will review patching, atropine penalization, and pharmacological treatments. Part II will focus on perceptual learning, video gaming, and binocular dichoptic approaches.

Methods

A literature search was performed in PubMed, ClinicalTrials.gov, Google Scholar, and reference lists of retrieved articles until December 20, 2018, for all papers containing “amblyopia treatment” or “amblyopia therapy.” We have included RCTs, prospective observational studies, prospective and retrospective cohort studies, pilot studies, and review articles.

Results

The mainstay of treatment for amblyopia has been based on increasing visual stimulation of the amblyopic eye by occlusion, atropine, or optical penalization of the dominant eye. It has been established that refractive adaptation alone can significantly enhance visual acuity. However, the duration of optical correction varies between studies and the effectiveness of spectacle wear over early beginning of patching is still under investigation. Additionally, by means of occlusion dose monitors, it was found that adherence to occlusion affects the outcome, as a dose-response relationship exists between adherence and visual acuity. Treatment efficiency declines with age; however, recent evidence indicates cortical plasticity beyond the “critical period” and recommends that an attempt at treatment should be offered to all amblyopic children regardless of age, including those in later childhood. Novel approaches targeted to the restoration of binocular functions, such as perceptual learning, video gaming, and dichoptic training, have shown small effects on visual acuity and have failed to demonstrate non-inferiority over standard treatments.

Conclusions

On review, significant evidence for the successful management of amblyopia, with occlusion therapy and atropine, has been found. However, the management of amblyopia remains challenging, mainly due to compliance issues and suboptimal treatment outcomes during occlusion and atropine penalization. Recent studies have found evidence of new ways of treating amblyopia particularly in regard to binocular treatment although these remain under investigation. Further robust clinical trials on these new treatment modalities are still warranted in order to establish their role in treating amblyopia.

Keywords

Amblyopia Occlusion Atropine Perceptual learning Video gaming Dichoptic training 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyUniversity Hospital of LarissaLarissaGreece
  2. 2.Department of Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal InfirmaryUniversity of LeicesterLeicesterUK
  3. 3.Department of OphthalmologyUniversity of IoanninaIoanninaGreece

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