Effect of vision therapy on children and adults with amblyopia who showed plateaued improvement after occlusion therapy.

Purpose

To evaluate long‑term visual acuity (VA) trends following a structured vision therapy protocol in patients with amblyopia who had plateaued after conventional occlusion therapy.

Methods

This prospective cohort study included 157 patients diagnosed with amblyopia who showed no further VA improvement over at least three consecutive assessments during standard patching. All participants received individualized vision therapy comprising monocular and binocular exercises, fusion training, fixation stabilization, and perceptual tasks, combined with limited daily occlusion (1-3 hours). Therapy was delivered over 15 weekly in‑clinic sessions, followed by a structured home program. Visual acuity was monitored every 6 months over a 48‑month follow‑up period.

Results

A total of 177 amblyopic eyes from 157 patients (mean age 15.56 ± 10.6 years) were analyzed. Mean VA improved from 0.50 ± 0.23 at baseline to 0.70 ± 0.28 at 48 months (p < .001); 48.6% of eyes achieved a final VA of ≥0.8 decimal. Significant VA gains were observed across all age groups, with mean improvements of 0.24, 0.21, and 0.16 in decimal VA for ages ≤ 8 years, 8-18 years, and >18 years, respectively. The proportion of patients gaining ≥ 2 lines of VA was highest in the ≤8 years (62.5%) and 8-18 years (62.5%) groups, compared with 35.4% in those > 18 years. Isoametropic amblyopia showed the highest rate of ≥2‑line improvement (65.0%), followed by strabismic (63.6%) and anisometropic (44.2%) types. No statistically significant difference in visual outcomes was observed between the two protocols (Haidinger's brushes/flashing vs. adding perceptual learning; p = .385).

Conclusion

Vision therapy can produce clinically meaningful and durable visual improvements in amblyopic patients who no longer respond to occlusion alone. The present study also supports extending amblyopia treatment into adolescence and adulthood, while emphasizing the need for tailored approaches based on the etiology of amblyopia and age.