Dichoptic Therapy, Patching Yield Similar Vision Improvement in Recent Study

Binocular treatment may better improve stereoacuity than patching because of directly addressing intraocular suppression and promoting binocular integration, which are essential to restore stereopsis, while BCVA can potentially be improved via either treatment. Photo: AmblyoPlay. Click image to enlarge. Amblyopia remains a significant cause of monocular vision loss in kids and young adults. Intervention often proves troublesome to achieve. Traditional patching can be effective but imposes social and psychological burdens on the child. Video-based dichoptic therapy offers a more discreet avenue for treatment but can be considered tedious and difficult for the child to maintain. To compare efficacy of the two options, researchers conducted a systematic search to identify randomized clinical trials reviewing both in children with anisometropic or strabismic amblyopia.Included in the analysis were 14 studies and a total of 1,110 participants, with the primary outcome of change in best-corrected visual acuity (BCVA) in the amblyopic eye and secondary outcomes of change in stereoacuity and adverse events. It was found that no significant differences existed between dichoptic therapy and patching in terms of BCVA changes, stereoacuity or overall adverse events. However, there was significant improvement in vision among children with high adherence to dichoptic therapy compared with patching. That is, greater adherence with dichoptic therapy significantly predicted greater BCVA improvement.In their article on the work, the authors of the Ophthalmology study explain that subgroup analysis revealed adherence to dichoptic therapy above 60% exhibited the significant benefit of the method for improving BCVA when compared with patching. A meta-regression also revealed significant correlation of greater adherence of this option with greater BCVA improvement.Interestingly, they add that prior reports demonstrated a positive correlation between cumulative patching dose and VA; however, patient characteristics like age may influence this dose-response relationship. The investigators also specify that this may not be true for dichoptic therapy, as their meta-regression analysis demonstrates that higher total number of hours with dichoptic therapy was actually associated with less VA improvement. This could be observed due to a ceiling effect, in which limited neuroplasticity in the visual system is restricting the potential for more visual improvement—even with treatment.What’s more, adherence to treatment has already been shown to decrease as the prescribed dose and duration of patching increase. The findings of the current study suggest that adherence, “reflecting the true extent of patient participation, is a more accurate predictor of visual improvement than simply total hours prescribed or reported, which may not account for incomplete or missed sessions.” Along with this, other factors likely contribute to the complex relationship between therapy and cumulative dose and visual outcomes, like heterogeneity in treatment protocols, such as differences in daily dosage and dichoptic therapy devices, as well as patient characteristic variability in age, baseline amblyopia severity and response to prior treatments.Based on these observations, the authors write that “video-based dichoptic therapy and patching are similarly effective for improving vision in amblyopic children.”Click here for the journal source. Valentim CCS, Lopes GMM, Chavez MP, et al. Effectiveness of video-based dichoptic therapy vs patching in amblyopic children: a. meta-analysis of randomized controlled trials. Ophthalmology. October 24, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.