Evaluation of digital binocular therapies for amblyopia after refractive adaptation in treatment-naive children aged 3-13 years: A systematic review and meta-analysis of randomised controlled trials.
Anju Thadathikunnal Narayanan, David Grant Robinson, J Margaret Woodhouse
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In 30 seconds
This systematic review and meta-analysis of randomised controlled trials assessed digital binocular therapies versus patching for visual acuity improvement in treatment-naive children aged 3–13 years with unilateral amblyopia after refractive adaptation. Five trials (225 children) contributed to the primary analysis. The pooled difference in best-corrected visual acuity was 0.00 logMAR (95% CI -0.09 to 0.10), with no statistically significant difference between treatments. Evidence certainty was moderate, downgraded for inconsistency. The findings do not establish superiority of digital binocular therapy over patching.
Key findings
- Across five RCTs involving 225 children, the visual acuity difference was MD 0.00 logMAR (95% CI -0.09 to 0.10; I2 = 50.2%).
- Sensitivity analysis of seven RCTs (292 children) found MD 0.04 logMAR (95% CI -0.03 to 0.10; I2 = 75.2%).
- Certainty of evidence for visual acuity was moderate, downgraded because of inconsistency.
Why it matters
For treatment-naive children with unilateral amblyopia after refractive adaptation, the pooled evidence does not show better visual acuity with digital binocular therapies than with patching. This helps frame digital approaches as possible alternatives or adjuncts when patching adherence is difficult, while recognising that the evidence base is limited and does not establish comparative superiority.
What to keep in mind
The review included only five RCTs in its primary analysis, with modest total sample size; the authors also note limited evidence and inconsistency.