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Objectives: This study was aimed at analyzing the efficacy on the improvement of the visual function of a dichoptic online cloud-based platform for the treatment of amblyopia in anisometropic children. Methods: A quasi-experimental (pretest–post-test) study was conducted in 23 subjects with ages from 5 to 15 years old with anisometropic amblyopia combined with additional presence (2 subjects) or not (21 subjects) of microtropia. A total of 30 home-based training sessions of 30 min per session with Bynocs® platform were prescribed for 6 weeks. Results: Amblyopic eye logMAR visual acuity (VA) significantly improved from 0.28 ± 0.24 to 0.13 ± 0.20 after the 6-week treatment (p < 0.001). At baseline, 60.9% of participants had VA in amblyopic eye of 0.20 logMAR or worse, whereas this percentage decreased to 21.7% after treatment. Binocular function (BF) significantly improved from 2.82 ± 1.11 to 2.32 ± 0.94 (p < 0.001). Mean compliance was 92%, 87% and 93% at 2, 4 and 6 weeks of treatment, respectively. Conclusions: In conclusion, home-based dichoptic training with the digital platform evaluated is an effective method to improve amblyopic VA and stereoacuity in children with anisometropic amblyopia combined or not with microtropia.

The use of digital devices provides a wide range of possibilities for measuring and improving visual function, including concepts such as perceptual learning and dichoptic therapy. Different technologies can be used to apply these concepts, including, in recent years, the introduction of virtual reality (VR) systems. A preliminary experience in treating anisometropic amblyopia through an immersive VR device and using prototype software is described. A total of 4 children were treated by performing 18 office-based sessions. Results showed that distance VA in amblyopic eyes remained constant in two subjects, whereas the younger subjects improved after the training. Near VA improved in three subjects. All subjects showed an increase in the stereopsis of at least one step, with three subjects showing a final stereopsis of a 60 s arc. A total of three subjects showed an increase of approximately 0.5 CS units for the spatial frequency of 3 cpd after the training. Results from this pilot study suggest that visual training based on perceptual learning through an immersive VR environment could be a viable treatment for improving CS, VA, and stereopsis in some children with anisometropic amblyopia. Future studies should support these preliminary results.

Eye-tracking technologies (ETs) and serious games (SGs) have emerged as new methods promising better support for vision screening and training. Previous research has shown the practicality of eye-tracking technology for vision screening in health care, but there remains a need for studies showing that the effective utilization of SGs and ETs are beneficial for vision training. This study investigates the feasibility of SGs and ETs for vision training by designing, developing, and evaluating a prototype influenced by commercially available games, based on a battery of exercises previously defined by vision experts. Data were collected from five participants, including a vision teacher, through a user experience questionnaire (UEQ) following a mixed method. Data analysis of the UEQ results and interviews highlighted the current challenges and positive attitudes in using SGs and ET for vision training. In conjunction with UEQ indicators such as attractiveness and perspicuity, the stimulation of the vision training battery based on the user experience provided insights into using ETs and further developing SGs to better approach different eye movements for vision training.

Vision therapy, also known as behavioral therapy, is theorized by its practitioners to treat a variety of visual disorders, including learning disability in children. However, the utility of vision therapy to treat various learning disabilities is challenged by the American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and the American Association of Certified Orthoptists. The purpose of this review is to (1) provide an overview of vision therapy, (2) evaluate the evidence for vision therapy, and (3) give practical recommendations for pediatric primary care providers regarding vision therapy. A review of the literature demonstrates evidence that vision therapy is useful in the management of convergence insufficiency only. There is insufficient evidence to recommend in-office vision therapy for the management of other types of strabismus, amblyopia, or learning disability in the pediatric population.

A typical procedure in vision therapy is the use of Quoits vectograms to train fusional vergence ranges by improving stereo-localization, which is the ability to correctly locate the target stimulus in space. With this procedure, the Small-In Large-Out (SILO) effect is usually reported in patients with normal binocular vision and accommodation. In this study, the influence of vergence and accommodation cues, as determined with the accommodative-convergence over accommodation (AC/A) ratio, to correctly locate the Quoits vectograms in space was investigated. Twenty participants, aged 29.2 ± 2.8 (mean ± standard deviation) years, without amblyopia or strabismus, were recruited. A geometrical formula was obtained to calculate the theoretical distance to the target stimulus for different vergence demands. Theoretical values were compared with measured distances to the perceived stimuli and stereo-localization accuracy was determined. Stereo-localization accuracy was significantly worse at 10∆ Base In vergence demand (p < 0.001). A statistically significant positive correlation was found between AC/A ratio and stereo-localization accuracy (i.e., worse accuracy) at 10Δ Base Out vergence demand (rho = 0.446, p = 0.049). These findings highlight that AC/A ratio may be a secondary cue for stereo-localization when using vectograms in which the SILO effect is manifest. These results assist in the understanding of the physiological basis of vision therapy procedures.

Background: In this study we aim to determines the effect of our vision therapy program for 7- to 10-year-old patients who exhibit bilateral amblyopia that is no longer responsive to conventional treatment. Methods: Children with bilateral amblyopia between the ages of 7 and 10 treated with vision therapy at the China Medical University Hospital between 2016 and 2019 were retrospectively reviewed. Age and visual acuity-matched bilateral amblyopes are included as a control group. The visual acuity for both groups showed no improvement for more than 3 months with part-time patching and full refraction correction. The initial and final visual acuity, stereopsis, and refractive status were analyzed. Results: Here, 15 cases were included as the treatment group and 16 cases as a control group. At the endpoint, the study group shows a significant improvement in BCVA, with a mean of 0.32 ± 0.15 logMAR (3 lines improvement) versus 0.003 ± 0.19 logMAR (nearly no improvement) for the control group (p < 0.001). The benefits of treatment are most obvious in the first 3 months after treatment (p < 0.001) and last until the end point. Stereoacuity also improves from 190.00 ± 163.34 to 85.00 ± 61.24 arc seconds, which is a 55.26% improvement. Conclusions: Vision therapy, comprising orthoptic therapy, perceptual learning and dichoptic training, is a successful program for increasing visual acuity and stereoacuity in 7- to 10-year-old children with bilateral amblyopia that is unresponsive to conventional treatment.

A case of an adult with anisometropic amblyopia who underwent a successful vision therapy program playing videogames in a virtual reality environment is described, reporting changes in conventional visual clinical data, as well as in brain activity. The patient was a 22 year old man on baseline examination that never previously wore correction for his anisometropia. After prescribing contact lens correction for the anisometropia and after 44 h of virtual reality-based vision therapy over a period of 1.5 years, the best corrected distance visual acuity (BCDVA) in the amblyopic eye improved from 0.05 to 0.5 (Sloan chart). One year after finishing the visual training, the BCDVA experienced a slight decrease to 0.4 (Sloan chart). Through the visual training, the patient gradually developed stereopsis. Likewise, changes were also detected after visual therapy on functional magnetic resonance imaging while the patient was viewing 2D and 3D stimuli. The preliminary results of this case show the potential of using virtual reality-based visual training as a treatment for adult amblyopia.

A retrospective study was conducted to evaluate preliminarily the efficacy of perceptual learning (PL) visual training in medium-term follow-up with a specific software (Amblyopia iNET, Home Therapy Systems Inc., Gold Canyon, AZ, USA) for visual acuity (VA) and contrast sensitivity (CS) recovering in a sample of 14 moderate to severe amblyopic subjects with a previously unsuccessful outcome or failure with patching (PL Group). This efficacy was compared with that achieved in a patching control group (13 subjects, Patching 2). At one-month follow-up, a significant VA improvement in the amblyopic eye (AE) was observed in both groups, with no significant differences between them. Additionally, CS was measured in PL Group and exhibited a significant improvement in the AE one month after the beginning of treatment for 3, 6, 12, and 18 cycles/º (p = 0.003). Both groups showed long-lasting retention of visual improvements. A combined therapy of PL-based visual training and patching seems to be effective for improving VA in children with amblyopia who did not recover vision with patching alone or had a poor patching compliance. This preliminary outcome should be confirmed in future clinical trials.

This case report describes the outcome of vision therapy for three patients who were referred to therapy due to visual symptoms after mild traumatic brain injury (MTBI). The criterion for inclusion was a high score (>21p) on the Convergence Insufficiency Symptom Survey (CISS) scale. The vision therapy program (VTP) included both face-to-face sessions and home-based tasks. Cases #1 and #2 had a substantial CISS scale evaluation improvement, and case #2 normalized the CISS scale score from 36 to 19. All patients agreed that vision therapy helped them understand their own vision and changes in their vision, which helped their overall recovery after MTBI. Rehabilitation professionals have an important role in screening for vision impairments and treating functional vision challenges after mild traumatic brain injury.

Individuals with traumatic brain injury (TBI) manifest a wide range of visual dysfunctions. One of the most prevalent involves the oculomotor system, which includes version, vergence, and accommodation. However, until recently, there has been no comprehensive, computer-based program for remediation of these oculomotor deficits. We present such an oculomotor rehabilitation program that has been tested in a clinical trial in patients having TBI with a high degree of success based on before-and-after objective system recordings, performance measures, and related visual symptomotology. The basic program components include a versatile stimulus package incorporating the attentional paradigm of rapid serial visual presentation (RSVP), the ability to add a visual and/or auditory distractor to the training to increase difficulty level (“task loading”), automated assessment of RSVP errors, and automated assessment of visual performance over the training period. Program limitations and future directions are also considered.

Active vision therapy using perceptual learning and/or dichoptic or binocular environments has shown its potential effectiveness in amblyopia, but some doubts remain about the type of stimuli and the mode and sequence of presentation that should be used. A search was performed in PubMed, obtaining 143 articles with information related to the stimuli used in amblyopia rehabilitation, as well as to the neural mechanisms implied in such therapeutic process. Visual deficits in amblyopia and their neural mechanisms associated are revised, including visual acuity loss, contrast sensitivity reduction and stereopsis impairment. Likewise, the most appropriate stimuli according to the literature that should be used for an efficient rehabilitation of the amblyopic eye are described in detail, including optotypes, Gabor's patches, random-dot stimuli and Vernier's stimuli. Finally, the properties of these stimuli that can be modified during the visual training are discussed, as well as the psychophysical method of their presentation and the type of environment used (perceptual learning, dichoptic stimulation or virtual reality). Vision therapy using all these revised concepts can be an effective option for treating amblyopia or accelerating the treatment period when combining with patching. It is essential to adapt the stimuli to the patient's individual features in both monocular and binocular training.