Dichoptic Rescue for Spectacle-Flip Sabotage of Anisometropic Amblyopia Therapy

Background: To be successful, amblyopia therapeutic techniques must respond when ingenious (shrewd) amblyopic children sabotage treatment effect by discovering ways(1) to alter those therapy aspects they find frustrating. Methods: Her guardian consented to IRB-approved study outside typical FDA enrollment guidelines for CureSight dichoptic therapy. Acuity (EVA) and stereopsis was by PEDIG protocols. Results: A 6-year-old rural Alaska native girl in foster care had previously been diagnosed with anisometropic amblyopia and treated with spectacles and patching but had poor compliance with BCVA 0.9–1.0 logMAR. She demonstrated exceptional creativity and hyperactivity but had no other medical issues. Atropine was prescribed in addition to her spectacles +5.50+1.00x90 and +0.50+1.00x90, but the patient discovered the rare “Spectacle Flip” method that sabotaged therapeutic impact. She had EVA enrollment acuities of logMAR 0.9 right and −0.1 left with stereo 400 seconds of arc. After just one month dichoptic therapy 1.5 hours 6 days per week, acuity improved to logMAR 0.7 and −0.1 with stereo up to 140 second of arc. Four months later acuity was 0.6 right and −0.2 left. Stereoacuity improved from 400 to 200 arc seconds. Conclusion: Even when conventional compliance methods fail, dichoptic therapy with eye-tracking has the novel and unique potential to improve amblyopia treatment compliance with real-time monitored fixation compliance and confirmation of correct spectacle wear. Clinical Trial Registration: NCT06165705. Plain Language Summary: Dichoptic therapy with eye-tracking improved compliance and achieved de novo acuity and stereo gains in a girl with severe refractory anisometropic amblyopia compounded by the rare complication of topical atropine therapy called “spectacle-flip sabotage”