Amblyopie: is occlusie achterhaald?

Abstract

Amblyopia: is patching outdated? Amblyopia is a reduced visual acuity resulting from insufficient visual stimulation during the first years of life. Standard treatment is occlusion therapy, in which the better eye is patched to stimulate the amblyopic eye and thereby improve vision. The disadvantages inherent to patches, like cost and discomfort, together with new insights on binocular dysfunction in amblyopia, have created a critical attitude towards this purely monocular approach. The search for new treatment strategies which can replace or be complementary to occlusion is therefore ongoing. Part-time occlusion appears to be a worthy alternative to traditional full-time occlusion. Pharmacological treatment with citicoline and levodopa or video games during patching can enhance the effect of occlusion, but are not yet routinely used due to potential side effects and/or insufficiently proven efficacy. The potential effect of video games on compliance is undoubtedly interesting however. ICL (implantable collamer lens) implantation and SMILE (small incision lenticule extraction) can be used to enhance optical correction and increase visual potential in high refractive errors. As a new treatment, the use of video games in binocular dichoptic therapy is discussed. Superiority over occlusion has not yet been demonstrated. Large-scale RCTs (randomized controlled trials) that distinguish between different forms of amblyopia, age and previous treatments, are necessary to further optimize guidelines for amblyopia treatment.