Treatment of anisometropic amblyopia in older children using macular stimulation with telescopic magnification.

BACKGROUND Brain plasticity exists beyond the critical period in children aged 9-17 years and in adults, and can result in vision restitution following more intense amblyopia treatments. Telescopic magnification provides a clearer image and better visual stimulation and hence promotes brain plasticity. The purpose of this study was to investigate the impact of vision therapy with telescopic magnification on brain plasticity when given after the traditional methods of amblyopia treatment currently in use in older children. METHODS The study was a prospective, nonrandomized, interventional case series of children aged 7-18 years with a confirmed diagnosis of anisometropic amblyopia not amenable to any further medical or surgical treatments. Strabismic and deprivation amblyopia cases were excluded. The patients wore newly prescribed glasses and were instructed to use a telescopic device in conjunction with the glasses for 30 minutes every day while watching, undisturbed, a favourite television show. Compliance was verified by the parents and investigated at each visit. The outcome measure selected for this study was best corrected visual acuity (BCVA) achieved at the 6-month follow-up visit. RESULTS Eighteen study subjects (11 males and 7 females) were recruited aged 7-16 (mean 11.7) years. Before telescopic training sessions the mean BCVA in the amblyopic eye for the entire group was 0.5 (SD 0.3) logMAR units (20/63 equivalent), and this improved following the sessions to 0.24 (SD 0.34) logMAR units (20/35 equivalent) (p < 0.0001). A BCVA of 20/25 or better was achieved in the amblyopic eye in 10 (55.6%) of our 18 study subjects and a BCVA of 20/40 or better in 15 (83.3%) of the 18. There were no side effects evident from the intervention, specifically, no diplopia. Compliance with training was complete as per protocol. INTERPRETATION The addition of vision rehabilitation therapy in the form of training sessions with telescopic magnification as described in this paper enhanced vision restitution in older children with anisometropic amblyopia.