Efficacy of Dichoptic Treatment vs Eye Patching in Pediatric Patients with Amblyopia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE

This systematic review and meta-analysis compares the efficacy and safety of dichoptic therapy vs traditional patching in treating pediatric amblyopia. The primary focus was on improvements in visual acuity (VA) and stereoacuity (SA), with an evaluation of adverse events and treatment compliance.

METHODS

A comprehensive search was conducted across PubMed, Scopus, Cochrane, and other databases up to August 2024. Randomized controlled trials (RCTs) comparing dichoptic therapy with eye patching in children (aged 0-18) with amblyopia were included. Studies reporting VA and SA outcomes were analyzed. The primary outcome was VA improvement; secondary outcomes included changes in SA and adverse events. Meta-analysis was performed using RevMan software, with random-effects models.

RESULTS

Eleven studies involving 902 children with amblyopia were included. Patching resulted in a statistically significant improvement in VA, with a pooled standardized mean difference (SMD) of 0.27 logMAR lines (95% CI: 0.07-0.48, p = 0.008), favoring patching over dichoptic therapy. Stereoacuity improvements were not significantly different between the two approaches (SMD: 0.28, 95% CI: -0.11-0.68, p = 0.16). Adverse events were more common in the patching group, with skin irritation being the most frequently reported issue. Both treatments showed moderate to high levels of compliance.

CONCLUSION

While patching demonstrated a modest advantage in improving visual acuity, dichoptic therapy provides a promising alternative, particularly due to its interactive nature and potential to improve treatment compliance. Given no significant difference in stereoacuity outcomes and the mild adverse events associated with both methods, dichoptic therapy should be considered a viable option for amblyopia treatment in children.