Faculty of Medicine, Albert Ludwig University of Freiburg; Institute for Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL - Private University for Health Sciences and Technology; Department of Information Management, Quality and Economic Efficiency in Health Care (IQWiG), Cologne; Center for Geriatric Medicine and Gerontology, Freiburg University Hospital, Faculty of Medicine, Albert Ludwigs University Freiburg; Department of Ophthalmology, Freiburg University Hospital, Faculty of Medicine, Albert Ludwigs University Freiburg; Cochrane Germany, Cochrane Germany Foundation, Freiburg.
Dtsch Arztebl Int. 2023 Nov 3;120(44):747-753. doi: 10.3238/arztebl.m2023.0191.
BACKGROUND: In this systematic review, we address the question whether children and adolescents with developmental visual disorders benefit from computer-assisted visual training. METHODS: Systematic literature searches were carried out in three bibliographic databases (initial search in October 2021) and trial registries. Included were randomized controlled trials that evaluated the efficacy of computer-assisted visual training in children and adolescents with developmental visual disorders in comparison to no training, sham training, or conservative treatment. RESULTS: The inclusion criteria were met by 17 trials (with a total of 1323 children and adolescents) focusing on binocular or monocular computer-assisted visual training for the treatment of amblyopia. In these trials, visual training was carried out for 2 to 24 weeks, either as "stand alone" therapy or in addition to occlusion therapy. Six trials showed a statistically significant difference in favor of the visual training for the outcome "best corrected visual acuity of the amblyopic eye." However, this difference was small and mostly below the threshold of clinical relevance of -0.05 logMAR (equivalent to an improvement of 0.5 lines on the eye chart, or 2.5 letters per line). Only few data were available for the outcomes "binocular vision" and "adverse events"; the differences between the groups were similarly small. CONCLUSION: The currently available data do not permit any firm conclusions regarding the efficacy of visual training in children and adolescents with amblyopia. Moreover, treatment adherence was often insufficient and the treatment durations in the trials was relatively short. No results from randomized trials have yet been published with respect to other developmental visual disorders (refractive errors, strabismus).
背景:在这项系统评价中,我们探讨了儿童和青少年发育性视觉障碍是否受益于计算机辅助视觉训练的问题。
方法:我们在三个文献数据库(2021 年 10 月首次搜索)和试验登记处进行了系统文献搜索。纳入的研究为随机对照试验,评估了与无训练、假训练或保守治疗相比,计算机辅助视觉训练对发育性视觉障碍儿童和青少年的疗效。
结果:共有 17 项试验(共纳入 1323 名儿童和青少年)符合纳入标准,这些试验主要关注双眼或单眼计算机辅助视觉训练治疗弱视。在这些试验中,视觉训练的持续时间为 2 至 24 周,既可以作为“独立”治疗,也可以作为遮盖治疗的补充。6 项试验表明,在“弱视眼最佳矫正视力”这一结局上,视觉训练具有统计学意义上的优势。然而,这种差异很小,且大多低于临床相关阈值-0.05 对数视力(相当于视力表上提高 0.5 行或每行提高 2.5 个字母)。仅有少量数据可用于“双眼视觉”和“不良事件”这两个结局,组间差异同样较小。
结论:目前的数据尚不能确定弱视儿童和青少年进行视觉训练的疗效。此外,治疗依从性往往不足,且试验中的治疗持续时间相对较短。尚未有关于其他发育性视觉障碍(屈光不正、斜视)的随机试验结果发表。
Dtsch Arztebl Int. 2023-11-3
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