Digital binocular therapy matched patching in untreated amblyopia

Design

Systematic review and meta-analysis of randomised trials

Population

225 treatment-naive children aged 3–13 with unilateral amblyopia

Primary outcome

Change in best-corrected visual acuity

Effect

MD 0.00 logMAR (95% CI −0.09 to 0.10); moderate certainty

A meta-analysis pooled five randomised trials in 225 children aged 3 to 13 with unilateral amblyopia who had not had treatment beyond glasses. It compared digital binocular therapies — games or videos shown differently to each eye — with patching.

Visual acuity gain was the same (mean difference 0.00 logMAR, 95% CI −0.09 to 0.10), with moderate certainty. Adding two higher-risk trials did not change the result.

Patching remains the standard, but adherence is a common reason for failure. These results support offering a digital binocular option where patching is refused or not tolerated, rather than accepting an untreated eye. Availability and cost in India vary, and the trials were small.

• Start with spectacles and a period of refractive adaptation, as in these trials
• Keep patching as the default first-line treatment
• Consider a digital binocular therapy where patching is refused or adherence is poor
• Monitor acuity at regular intervals whichever treatment is used
• Discuss cost and device access with families before offering it

Why it matters

Poor adherence to patching need not mean no treatment.

Don't overread it

Five small trials; it shows similar effect, not superiority, and long-term durability is unknown.

The statistics, in plain English

A difference of 0.00 logMAR with an interval of −0.09 to 0.10 means the two approaches gave similar results, within about one line on the chart either way.

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