COMPARISON OF BINOCULAR SPECTACLE PRESCRIPTION VERSUS PATCHING THERAPY IN REFRACTIVE AMBLYOPIA PATIENTS

Abstract

Background: Amblyopia is the leading cause of visual impairment in children, adolescents, and middle-aged adults, characterized by a loss of binocularity and a significant reduction in best-corrected visual acuity (BCVA). It is clinically defined as a difference of two or more lines in BCVA between the eyes. Traditional treatment approaches, such as patching therapy, are effective but often limited by compliance issues. Binocular spectacle prescription has emerged as a promising alternative, addressing both refractive correction and binocular function improvement.

Objective: To assess and compare the effects of binocular spectacle prescription and patching therapy on binocular function and monocular visual acuity improvement in patients with refractive amblyopia.

Methods: A randomized controlled trial was conducted at the LRBT Primary Care Center 18 Hazari, District Jhang, following approval from the Superior University Ethical Committee. A total of 32 participants (62.5% male, 37.5% female) aged 8 to 16 years (mean 12.69 ± 2.60) were enrolled. Cycloplegic refraction was performed, and a two-month refractive adaptation period was observed before intervention. Participants were randomized into two equal groups: one receiving binocular spectacle prescription and the other undergoing patching therapy. Baseline assessments of BCVA, stereopsis, and binocular single vision (BSV) were performed using the Titmus Fly Test and Worth Four Dot Test. Follow-ups at six and ten weeks evaluated improvements in binocular function and visual acuity. Data were analyzed using IBM SPSS Version 27, with a significance level of p<0.05.

Results: Statistical analysis revealed a significant difference between treatment groups. Mean BCVA in the amblyopic eye improved from 0.62 ± 0.16 to 0.38 ± 0.12 in the binocular spectacle group, while the patching group improved from 0.64 ± 0.23 to 0.32 ± 0.10 (p<0.05). Binocular spectacle prescription showed a faster shift towards the best Titmus Fly Test category (“60-40”) by the third visit. In contrast, patching therapy exhibited greater variability and a higher prevalence of “Absent” and “Partial” Fly status initially, along with a more pronounced shift towards non-response category (NRC) in the Worth Four Dot Test.

Conclusion: Both binocular spectacle prescription and patching therapy were effective in treating refractive amblyopia, with significant improvements in visual acuity and binocular function. However, binocular spectacle prescription demonstrated greater efficacy in stabilizing binocular function with better patient adherence, making it a viable alternative to traditional patching therapy.