Treatment of childhood Amblyopia and directions for the future

This thesis investigated amblyopia treatment in children. Fifteen years after standard occlusion therapy, most children maintained their visual improvements, demonstrating good long-term outcomes. Patients at risk for visual acuity deterioration after cessation of treatment had a large initial interocular visual acuity difference, increasing anisometropia, eccentric fixation and non-compliance during treatment.

We also showed that wearing the correct spectacles alone can improve visual acuity, even in children with strabismus. In fact, more than a third of the children improved to such an extent, that they no longer classified as having amblyopia. With a small electronic device, the occlusion dose monitor (ODM) we could objectively monitor compliance with spectacle wear.

The thesis further compared standard occlusion therapy with a new approach: dichoptic action video games played through virtual reality goggles training both eyes together. Both treatments resulted in significant visual acuity improvement with no significant difference between them. However, the video games needed much less therapy hours and were fifteen times more efficient. Still, many children stopped the game treatment, mostly because they were too young to understand the game, it was hard for families to fit into daily life, or they simply did not want to game anymore. Finally, parents’ experiences were studied. They valued clear information about treatment effectiveness, practical demands on family life, and the fit with their child’s needs. Parents also preferred making the treatment decision together with the doctor.