Tang Ang Cang, Wang Xi, Yang Wen Jie, Guo Jiu Lin, Li Yu Lin, Yang Tian Yu, An Zhen, Reynaud Alexandre, Liu Long Qian
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China.
Ophthalmic Epidemiol. 2025 Mar 26:1-15. doi: 10.1080/09286586.2025.2483680.
To review the efficacy of dichoptic and monocular strategies for treating monocular amblyopia, and to examine the factors that determine the degree of recovery from amblyopia.
Mean and individual participant data (IPD) from studies that used either monocular or dichoptic training methods to treat monocular amblyopic patients were analyzed. A mixed-effects model was used to analyze influential factors. Studies were searched using PubMed, OVID, Cochrane library, and EBM reviews.
The mean improvements in visual acuity (VA) for dichoptic and monocular training were 0.153 logMAR and 0.162 logMAR, respectively. In the dichoptic training subgroup, the mean VA improvements were 0.201 logMAR, and 0.145 logMAR for strabismic and anisometropic amblyopia, respectively. In the monocular training subgroup, the mean VA improvements were 0.171 logMAR, and 0.143 logMAR for strabismic and anisometropic amblyopia, respectively. The mean improvements in stereopsis of dichoptic training and monocular training were 1.201 octaves and 1.661 octaves, respectively. Baseline visual acuity of the amblyopic eye and training duration were significant factors influencing visual gains. We found no significant impacts of age, astigmatism, and baseline stereopsis on visual acuity and stereopsis outcomes.
This IPD meta-analysis provides evidence that both monocular and dichoptic training yield different visual acuity outcomes in treating unilateral amblyopia. Subgroup analysis suggests that strabismic amblyopia may respond differently to dichoptic training. Baseline visual acuity of the amblyopic eye and training duration are significant factors influencing visual gains. We believe that a more personalized training program could help restore binocularity in patients with monocular amblyopia.
回顾双眼分视和单眼训练策略治疗单眼弱视的疗效，并探讨决定弱视恢复程度的因素。
分析采用单眼或双眼分视训练方法治疗单眼弱视患者的研究中的均值和个体参与者数据（IPD）。使用混合效应模型分析影响因素。通过PubMed、OVID、Cochrane图书馆和循证医学综述进行文献检索。
双眼分视训练和单眼训练的视力平均改善分别为0.153 logMAR和0.162 logMAR。在双眼分视训练亚组中，斜视性弱视和屈光参差性弱视的视力平均改善分别为0.201 logMAR和0.145 logMAR。在单眼训练亚组中，斜视性弱视和屈光参差性弱视的视力平均改善分别为0.171 logMAR和0.143 logMAR。双眼分视训练和单眼训练的立体视平均改善分别为1.201倍频程和1.661倍频程。弱视眼的基线视力和训练时长是影响视力提高的重要因素。我们发现年龄、散光和基线立体视对视力和立体视结果没有显著影响。
这项个体参与者数据的荟萃分析提供了证据，表明单眼和双眼分视训练在治疗单侧弱视时产生不同的视力结果。亚组分析表明，斜视性弱视对双眼分视训练的反应可能不同。弱视眼的基线视力和训练时长是影响视力提高的重要因素。我们认为，更个性化的训练方案有助于恢复单眼弱视患者的双眼视功能。
