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New advances in amblyopia therapy I: binocular therapies and pharmacologic augmentation
  1. Courtney L Kraus1,
  2. Susan M Culican2
  1. 1 Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
  1. Correspondence to Dr Courtney L Kraus, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, USA; ckraus6{at}jhmi.edu

Abstract

Amblyopia therapy options have traditionally been limited to penalisation of the non-amblyopic eye with either patching or pharmaceutical penalisation. Solid evidence, mostly from the Pediatric Eye Disease Investigator Group, has validated both number of hours a day of patching and days per week of atropine use. The use of glasses alone has also been established as a good first-line therapy for both anisometropic and strabismic amblyopia. Unfortunately, visual acuity equalisation or even improvement is not always attainable with these methods. Additionally, non-compliance with prescribed therapies contributes to treatment failures, with data supporting difficulty adhering to full treatment sessions. Interest in alternative therapies for amblyopia treatment has long been a topic of interest among researchers and clinicians alike. Incorporating new technology with an understanding of the biological basis of amblyopia has led to enthusiasm for binocular treatment of amblyopia. Early work on perceptual learning as well as more recent enthusiasm for iPad-based dichoptic training have each generated interesting and promising data for vision improvement in amblyopes. Use of pharmaceutical augmentation of traditional therapies has also been investigated. Several different drugs with unique mechanisms of action are thought to be able to neurosensitise the brain and enhance responsiveness to amblyopia therapy. No new treatment has emerged from currently available evidence as superior to the traditional therapies in common practice today. But ongoing investigation into the use of both new technology and the understanding of the neural basis of amblyopia promises alternate or perhaps better cures in the future.

  • vision
  • treatment medical
  • child health (paediatrics)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors CLK wrote the first draft of the review. SMC edited and added relevant references and citations. Both authors approved the final version of the manuscript.

  • Funding This work was supported by awards to the Department of Ophthalmology and Visual Sciences at Washington University from a Research to Prevent Blindness, unrestricted grant (New York, New York), the NIH Vision Core Grant P30 EY 0268 (Bethesda, Maryland). The funding organisations had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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