A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel: Stacy L. Pineles, MD,1 Vinay K. Aakalu, MD, MPH,2 Amy K. Hutchinson, MD,3 Jennifer A. Galvin, MD,4 Gena Heidary, MD, PhD,5 Gil Binenbaum, MD, MSCE,6 Deborah K. VanderVeen, MD,5 Scott R. Lambert, MD7
Ophthalmology, In Press, © 2019 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.
Methods: Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.
Results: Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.
Conclusions: There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.
1 Jules Stein Eye Institute, Los Angeles, California
2 Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
3 Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
4 Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
5 Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
6 Department of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
7 Department of Ophthalmology, Stanford University School of Medicine, Stanford, California