The efficacy and safety of dichoptic therapy in comparison to patching in children with amblyopia: A systematic review and meta-analysis.

Abstract

Amblyopia is the leading cause of monocular vision loss in children. Standard treatment begins with refractive correction, followed by interventions to stimulate the amblyopic eye. Dichoptic therapy (DT) and patching therapy (PT) are commonly used but differ in mechanism. This systematic review and meta-analysis compares their efficacy, compliance and safety in paediatric amblyopia. A comprehensive search of PubMed, Scopus, Web of Science and Embase was conducted for randomized controlled trials (RCTs) comparing DT and PT in children with amblyopia. Methodological quality was assessed using the Cochrane Risk of Bias tool. Pooled data were analysed using a random-effects model, reported as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CIs). Twelve RCTs involving 1034 children were included. No significant differences were observed between DT and PT in visual acuity (MD = -0.01, 95% CI [-0.05, 0.03], p = 0.54; I² = 85%), stereoacuity (MD = 0.01, 95% CI [-0.07, 0.08], p = 0.84; I² = 17%), compliance (RR = 0.91, 95% CI [0.71, 1.18], p = 0.49; I² = 85%) or adverse events (RR = 1.46, 95% CI [0.53, 4.04], p = 0.46; I² = 54%). DT and PT show comparable outcomes in visual acuity, stereoacuity, compliance and safety based on pooled data. However, these findings may not apply to all amblyopia types, particularly strabismic amblyopia, where binocular function is often absent. Future studies should include subtype-specific analyses to better define the roles of each treatment.