Effectiveness of Psychophysical Visual Stimuli-Based Interventions in Amblyopia Treatment: A Systematic Review
-
Ebrahim Jafarzadehpur
,
Mohammad Reza Pishnamaz
,
Mohammad Saeed Hoseinzade Firozabadi
,
Leila Mirzaei Saba
,
Faezeh Fayaz
,
Rasoul Amini Vishteh
Abstract
Introduction: Active vision therapy, integrating perceptual learning with dichoptic or binocular environments, has shown potential effectiveness in treating amblyopia. However, uncertainties linger regarding the optimal types of stimuli and the best approaches and sequences for their presentation. This systematic review evaluates the effectiveness of psychophysical visual stimuli-based interventions, particularly perceptual learning and dichoptic training, in treating amblyopia.
Materials and Methods: A comprehensive literature search across major databases, such as PubMed and Google Scholar, yielded 26 studies involving 993 amblyopic patients. These studies investigated various visual training methods, including perceptual learning, dichoptic stimulation, and combinations of both, with stimuli such as Gabor patches, letter optotypes, Vernier stimuli, and random-dot stereograms.
Results: The findings indicate that perceptual learning enhances visual acuity, contrast sensitivity, and stereopsis, even in adult patients, by leveraging neural plasticity. Dichoptic training, which engages both eyes simultaneously, shows promise in reducing suppression and improving binocular integration, providing a potential advantage over traditional patching therapy. Gabor patches emerged as particularly effective, stimulating the visual cortex to drive neural efficiency.
Conclusion: Vision therapy can be an effective strategy for treating amblyopia and potentially reduce the overall treatment time when used alongside patching. In addition, it is imperative to modify the stimuli to align with the distinct characteristics of the patient during both monocular and binocular training.
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6. Özdek, Ş., Berrocal, A., Spandau, U. Pediatric Vitreoretinal Surgery. 1st ed. Springer; 2023
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9. Coco-Martin MB, Valenzuela PL, Maldonado-López MJ, Santos-Lozano A, Molina-Martín A, Piñero DP. Potential of video games for the promotion of neuroadaptation to multifocal intraocular lenses: a narrative review. International Journal of Ophthalmology. 2019; 12(11):1782.
10. Dye, M.W.G., Green, C.S., Bavelier, D. The development of attention skills in action video game players. Neuropsychologia. 2009; 47(8-9):1780-9.
11. Levi DM, Li RW. Perceptual learning as a potential treatment for amblyopia: a mini-review. Vision research. 2009; 49(21):2535-49.
12. Barollo M, Contemori G, Battaglini L, Pavan A, Casco C. Perceptual learning improves contrast sensitivity, visual acuity, and foveal crowding in amblyopia. Restorative neurology and neuroscience. 2017; 35(5):483-96.
13. Deshpande PG, Bhalchandra PC, Nalgirkar AR, Tathe SR. Improvement of visual acuity in residual meridional amblyopia by astigmatic axis video games. Indian Journal of Ophthalmology. 2018; 66(8):1156-60.
14. Li J, Thompson B, Deng D, Chan LY, Yu M, Hess RF. Dichoptic training enables the adult amblyopic brain to learn. Current Biology. 2013; 23(8): R308-9.
15. Liu XY, Zhang YW, Gao F, Chen F, Zhang JY. Dichoptic perceptual training in children with amblyopia with or without patching history. Investigative ophthalmology & visual science. 2021; 62(6):4.
16. Iwata Y, Handa T, Ishikawa H, Goseki T, Shoji N. Comparison between Amblyopia Treatment with Glasses Only and Combination of Glasses and Open‐Type Binocular “Occlu‐Pad” Device. BioMed research international. 2018; 2018(1):2459696.
17. Birch EE, Li SL, Jost RM, Morale SE, De La Cruz A, Stager Jr D, Dao L, Stager Sr DR. Binocular iPad treatment for amblyopia in preschool children. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2015; 19(1):6-11.
18. Li SL, Jost RM, Morale SE, Stager DR, Dao L, Stager D, Birch EE. A binocular iPad treatment for amblyopic children. Eye. 2014; 28(10):1246-53.
19. Holmes JM, Manh VM, Lazar EL, Beck RW, Birch EE, Kraker RT, Crouch ER, Erzurum SA, Khuddus N, Summers AI, Wallace DK. Effect of a binocular iPad game vs part-time patching in children aged 5 to 12 years with amblyopia: a randomized clinical trial. JAMA ophthalmology. 2016; 134(12):1391-400.
20. Hernández-Rodríguez CJ, Piñero DP, Molina-Martín A, Morales-Quezada L, de Fez D, Leal-Vega L, Arenillas JF, Coco-Martín MB. Stimuli characteristics and psychophysical requirements for visual training in amblyopia: a narrative review. Journal of clinical medicine. 2020; 9(12):3985.
21. Foss AJ. Use of video games for the treatment of amblyopia. Current opinion in ophthalmology. 2017; 28(3):276-81.
22. Hussain Z, Webb BS, Astle AT, McGraw PV. Perceptual learning reduces crowding in amblyopia and in the normal periphery. Journal of Neuroscience. 2012; 32(2):474-80.
23. Chung ST, Li RW, Levi DM. Learning to identify near-acuity letters, either with or without flankers, results in improved letter size and spacing limits in adults with amblyopia. Plos one. 2012; 7(4): e35829.
24. Polat U, Ma-Naim T, Belkin M, Sagi D. Improving vision in adult amblyopia by perceptual learning. Proceedings of the National Academy of Sciences. 2004; 101(17):6692-7.
25. Zhang W, Yang X, Liao M, Zhang N, Liu L. Internet-based perceptual learning in treating amblyopia. European journal of ophthalmology. 2013; 23(4):539-45.
26. Poltavski D, Adams RJ, Biberdorf D, Patrie JT. Effectiveness of a novel video game platform in the treatment of pediatric amblyopia. Journal of Pediatric Ophthalmology & Strabismus. 2024; 61(1):20-9.
27. Li RW, Levi DM. Characterizing the mechanisms of improvement for position discrimination in adult amblyopia. Journal of vision. 2004; 4(6):7.
28. Li RW, Young KG, Hoenig P, Levi DM. Perceptual learning improves visual performance in juvenile amblyopia. Investigative ophthalmology & visual science. 2005; 46(9):3161-8.
29. Liu XY, Zhang T, Jia YL, Wang NL, Yu C. The therapeutic impact of perceptual learning on juvenile amblyopia with or without previous patching treatment. Investigative ophthalmology & visual science. 2011; 52(3):1531-8.
30. Zhang JY, Cong LJ, Klein SA, Levi DM, Yu C. Perceptual learning improves adult amblyopic vision through rule-based cognitive compensation. Investigative ophthalmology & visual science. 2014; 55(4):2020-30.
31. Vedamurthy I, Nahum M, Bavelier D, Levi DM. Mechanisms of recovery of visual function in adult amblyopia through a tailored action video game. Scientific reports. 2015; 5(1):8482.
32. Vedamurthy I, Nahum M, Huang SJ, Zheng F, Bayliss J, Bavelier D, Levi DM. A dichoptic custom-made action video game as a treatment for adult amblyopia. Vision research. 2015; 114:173-87.
33. Liu XY, Zhang JY. Dichoptic training in adults with amblyopia: Additional stereoacuity gains over monocular training. Vision Research. 2018; 152:84-90.
34. Shuai L, Leilei Z, Wen W, Shu W, Gangsheng L, Yinglong L, Guoke Y, Xinrong C, Hong L, Rongfeng L. Binocular treatment in adult amblyopia is based on parvocellular or magnocellular pathway. European Journal of Ophthalmology. 2020; 30(4):658-67.
35. Magdalene D, Dutta P, Opt M, Deshmukh S, Ophthal DN, Borah CJ, Nath RP, Opt B. Neural Vision Perceptual Learning as an Effective Treatment of amblyopia. Vision Development & Rehabilitation. 2022; 8(4):260-9.
36. He Y, Feng L, Zhou Y, Zhuang Y, Xu Z, Yao Y, Chen X, Jiang R, Yuan J, Ye Q, Wen Y. Characteristics and predictive factors of visual function improvements after monocular perceptual learning in amblyopia. Heliyon. 2023; 9(6).
37. Zhou Y, He Y, Feng L, Jia Y, Ye Q, Xu Z, Zhuang Y, Yao Y, Jiang R, Chen X, Pang Y. Perceptual learning based on the lateral masking paradigm in anisometropic amblyopia with or without a patching history. Translational vision science & technology. 2024; 13(1):16-.
38. Levi DM, Polat U. Neural plasticity in adults with amblyopia. Proceedings of the National Academy of Sciences. 1996; 93(13):6830-4.
39. Levi DM, Polat U, Hu YS. Improvement in Vernier acuity in adults with amblyopia. Practice makes better. Investigative ophthalmology & visual science. 1997; 38(8):1493-510.
40. Vedamurthy I, Knill DC, Huang SJ, Yung A, Ding J, Kwon OS, Bavelier D, Levi DM. Recovering stereo vision by squashing virtual bugs in a virtual reality environment. Philosophical Transactions of the Royal Society B: Biological Sciences. 2016; 371(1697):20150264.
41. Martín-González S, Portela-Camin J, Ruiz-Alcocer J, Illarramendi-Mendicute I, Garrido-Mercado R. Stereoacuity improvement using random-dot video games. Journal of Visualized Experiments. 2020; 155: e60236.
42. Pérez-Benito M, Calderón-González T, Álvarez-Martín E, Martín-González S, Portela-Camino JA. Study protocol for a randomized controlled trial using VISIONARY, a dichoptic Gabor patch video game, to improve visual function in children with amblyopia. Res Sq 3772007 [Preprint]. 2023.
43. Portela-Camino JA, Martín-González S, Ruiz-Alcocer J, Illarramendi-Mendicute I, Garrido-Mercado R. A random dot computer video game improves stereopsis. Optometry and Vision Science. 2018; 95(6):523-35.
44. Chen PL, Chen JT, Fu JJ, Chien KH, Lu DW. A pilot study of anisometropic amblyopia improved in adults and children by perceptual learning: an alternative treatment to patching. Ophthalmic and Physiological Optics. 2008; 28(5):422-8.
45. Battaglini L, Oletto CM, Contemori G, Barollo M, Ciavarelli A, Casco C. Perceptual learning improves visual functions in patients with albinistic bilateral amblyopia: a pilot study. Restor Neurol Neurosci. 2021; 39:45–59
46. Avram E, Stănilă A. Treating anisometric amblyopia with HTS Amblyopia iNet Software--preliminary results. Oftalmologia (Bucharest, Romania: 1990). 2013; 57(2):32
47. Chung STL, Legge GE, Cheung SH. Letter-recognition and reading speed in peripheral vision benefit from perceptual learning. Vision Research. 2004; 44:695–709.
48. Li RW, Provost A, Levi DM. Extended perceptual learning results in substantial recovery of positional acuity and visual acuity in juvenile amblyopia. Investigative ophthalmology & visual science. 2007; 48(11):5046-51.
49. Durrie D, McMinn PS. Computer-based primary visual cortex training for treatment of low myopia and early presbyopia. Transactions of the American Ophthalmological Society. 2007; 105:132.
50. Saarinen J, Levi DM. Perceptual learning in vernier acuity: what is learned? Vision research. 1995; 35(4):519-27.
51. Westheimer G, Hauske G. Temporal and spatial interference with vernier acuity. Vision research. 1975; 15(10):1137-41.
52. Li RW, Levi DM. Slow Perceptual Learning of Vernier Acuity in Adult Amblyopia: An Intensive Amblyopia Treatment Study. Investigative Ophthalmology & Visual Science. 2007; 48(13):4889.
53. Astle AT, McGraw PV, Webb BS. Recovery of stereo acuity in adults with amblyopia. Case Reports. 2011; 2011: bcr0720103143.
54. Ding J, Levi DM. Recovery of stereopsis through perceptual learning in human adults with abnormal binocular vision. Proceedings of the National Academy of Sciences. 2011; 108(37): E733-41.
55. Li RW, Ngo C, Nguyen J, Lam J, Nia B, Ren D, Levi D. Playing video game improves visual acuity and visual attention in adult amblyopia-A potentially useful tool for amblyopia treatment. Investigative Ophthalmology & Visual Science. 2008; 49(13):2832.
2. Evans BJW. Pickwell’s Binocular Vision Anomalies: Investigation and Treatment, 4th ed. Oxford: Butterworth-Heinemann; 2002.
3. DeSantis D. Amblyopia. Pediatric Clinics of North America. 2014; 61(3):505-18.
4. Anderson SJ, Swettenham JB. Neuroimaging in human amblyopia. Strabismus. 2006; 14(1):21-35.
5. Körtvélyes J, Bankó É, Andics A, Rudas G, Németh J, Hermann P, Vidnyánszky Z. Visual cortical responses to the input from the amblyopic eye are suppressed during binocular viewing. Acta Biologica Hungarica. 2012; 63(Supplement-1):65-79.
6. Özdek, Ş., Berrocal, A., Spandau, U. Pediatric Vitreoretinal Surgery. 1st ed. Springer; 2023
7. Moore B D. Eye Care for Infants and Young Children. Boston; Butterworth, 1998.
8. Kraus CL, Culican SM. New advances in amblyopia therapy I: binocular therapies and pharmacologic augmentation. British Journal of Ophthalmology. 2018; 102(11):1492-6.
9. Coco-Martin MB, Valenzuela PL, Maldonado-López MJ, Santos-Lozano A, Molina-Martín A, Piñero DP. Potential of video games for the promotion of neuroadaptation to multifocal intraocular lenses: a narrative review. International Journal of Ophthalmology. 2019; 12(11):1782.
10. Dye, M.W.G., Green, C.S., Bavelier, D. The development of attention skills in action video game players. Neuropsychologia. 2009; 47(8-9):1780-9.
11. Levi DM, Li RW. Perceptual learning as a potential treatment for amblyopia: a mini-review. Vision research. 2009; 49(21):2535-49.
12. Barollo M, Contemori G, Battaglini L, Pavan A, Casco C. Perceptual learning improves contrast sensitivity, visual acuity, and foveal crowding in amblyopia. Restorative neurology and neuroscience. 2017; 35(5):483-96.
13. Deshpande PG, Bhalchandra PC, Nalgirkar AR, Tathe SR. Improvement of visual acuity in residual meridional amblyopia by astigmatic axis video games. Indian Journal of Ophthalmology. 2018; 66(8):1156-60.
14. Li J, Thompson B, Deng D, Chan LY, Yu M, Hess RF. Dichoptic training enables the adult amblyopic brain to learn. Current Biology. 2013; 23(8): R308-9.
15. Liu XY, Zhang YW, Gao F, Chen F, Zhang JY. Dichoptic perceptual training in children with amblyopia with or without patching history. Investigative ophthalmology & visual science. 2021; 62(6):4.
16. Iwata Y, Handa T, Ishikawa H, Goseki T, Shoji N. Comparison between Amblyopia Treatment with Glasses Only and Combination of Glasses and Open‐Type Binocular “Occlu‐Pad” Device. BioMed research international. 2018; 2018(1):2459696.
17. Birch EE, Li SL, Jost RM, Morale SE, De La Cruz A, Stager Jr D, Dao L, Stager Sr DR. Binocular iPad treatment for amblyopia in preschool children. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2015; 19(1):6-11.
18. Li SL, Jost RM, Morale SE, Stager DR, Dao L, Stager D, Birch EE. A binocular iPad treatment for amblyopic children. Eye. 2014; 28(10):1246-53.
19. Holmes JM, Manh VM, Lazar EL, Beck RW, Birch EE, Kraker RT, Crouch ER, Erzurum SA, Khuddus N, Summers AI, Wallace DK. Effect of a binocular iPad game vs part-time patching in children aged 5 to 12 years with amblyopia: a randomized clinical trial. JAMA ophthalmology. 2016; 134(12):1391-400.
20. Hernández-Rodríguez CJ, Piñero DP, Molina-Martín A, Morales-Quezada L, de Fez D, Leal-Vega L, Arenillas JF, Coco-Martín MB. Stimuli characteristics and psychophysical requirements for visual training in amblyopia: a narrative review. Journal of clinical medicine. 2020; 9(12):3985.
21. Foss AJ. Use of video games for the treatment of amblyopia. Current opinion in ophthalmology. 2017; 28(3):276-81.
22. Hussain Z, Webb BS, Astle AT, McGraw PV. Perceptual learning reduces crowding in amblyopia and in the normal periphery. Journal of Neuroscience. 2012; 32(2):474-80.
23. Chung ST, Li RW, Levi DM. Learning to identify near-acuity letters, either with or without flankers, results in improved letter size and spacing limits in adults with amblyopia. Plos one. 2012; 7(4): e35829.
24. Polat U, Ma-Naim T, Belkin M, Sagi D. Improving vision in adult amblyopia by perceptual learning. Proceedings of the National Academy of Sciences. 2004; 101(17):6692-7.
25. Zhang W, Yang X, Liao M, Zhang N, Liu L. Internet-based perceptual learning in treating amblyopia. European journal of ophthalmology. 2013; 23(4):539-45.
26. Poltavski D, Adams RJ, Biberdorf D, Patrie JT. Effectiveness of a novel video game platform in the treatment of pediatric amblyopia. Journal of Pediatric Ophthalmology & Strabismus. 2024; 61(1):20-9.
27. Li RW, Levi DM. Characterizing the mechanisms of improvement for position discrimination in adult amblyopia. Journal of vision. 2004; 4(6):7.
28. Li RW, Young KG, Hoenig P, Levi DM. Perceptual learning improves visual performance in juvenile amblyopia. Investigative ophthalmology & visual science. 2005; 46(9):3161-8.
29. Liu XY, Zhang T, Jia YL, Wang NL, Yu C. The therapeutic impact of perceptual learning on juvenile amblyopia with or without previous patching treatment. Investigative ophthalmology & visual science. 2011; 52(3):1531-8.
30. Zhang JY, Cong LJ, Klein SA, Levi DM, Yu C. Perceptual learning improves adult amblyopic vision through rule-based cognitive compensation. Investigative ophthalmology & visual science. 2014; 55(4):2020-30.
31. Vedamurthy I, Nahum M, Bavelier D, Levi DM. Mechanisms of recovery of visual function in adult amblyopia through a tailored action video game. Scientific reports. 2015; 5(1):8482.
32. Vedamurthy I, Nahum M, Huang SJ, Zheng F, Bayliss J, Bavelier D, Levi DM. A dichoptic custom-made action video game as a treatment for adult amblyopia. Vision research. 2015; 114:173-87.
33. Liu XY, Zhang JY. Dichoptic training in adults with amblyopia: Additional stereoacuity gains over monocular training. Vision Research. 2018; 152:84-90.
34. Shuai L, Leilei Z, Wen W, Shu W, Gangsheng L, Yinglong L, Guoke Y, Xinrong C, Hong L, Rongfeng L. Binocular treatment in adult amblyopia is based on parvocellular or magnocellular pathway. European Journal of Ophthalmology. 2020; 30(4):658-67.
35. Magdalene D, Dutta P, Opt M, Deshmukh S, Ophthal DN, Borah CJ, Nath RP, Opt B. Neural Vision Perceptual Learning as an Effective Treatment of amblyopia. Vision Development & Rehabilitation. 2022; 8(4):260-9.
36. He Y, Feng L, Zhou Y, Zhuang Y, Xu Z, Yao Y, Chen X, Jiang R, Yuan J, Ye Q, Wen Y. Characteristics and predictive factors of visual function improvements after monocular perceptual learning in amblyopia. Heliyon. 2023; 9(6).
37. Zhou Y, He Y, Feng L, Jia Y, Ye Q, Xu Z, Zhuang Y, Yao Y, Jiang R, Chen X, Pang Y. Perceptual learning based on the lateral masking paradigm in anisometropic amblyopia with or without a patching history. Translational vision science & technology. 2024; 13(1):16-.
38. Levi DM, Polat U. Neural plasticity in adults with amblyopia. Proceedings of the National Academy of Sciences. 1996; 93(13):6830-4.
39. Levi DM, Polat U, Hu YS. Improvement in Vernier acuity in adults with amblyopia. Practice makes better. Investigative ophthalmology & visual science. 1997; 38(8):1493-510.
40. Vedamurthy I, Knill DC, Huang SJ, Yung A, Ding J, Kwon OS, Bavelier D, Levi DM. Recovering stereo vision by squashing virtual bugs in a virtual reality environment. Philosophical Transactions of the Royal Society B: Biological Sciences. 2016; 371(1697):20150264.
41. Martín-González S, Portela-Camin J, Ruiz-Alcocer J, Illarramendi-Mendicute I, Garrido-Mercado R. Stereoacuity improvement using random-dot video games. Journal of Visualized Experiments. 2020; 155: e60236.
42. Pérez-Benito M, Calderón-González T, Álvarez-Martín E, Martín-González S, Portela-Camino JA. Study protocol for a randomized controlled trial using VISIONARY, a dichoptic Gabor patch video game, to improve visual function in children with amblyopia. Res Sq 3772007 [Preprint]. 2023.
43. Portela-Camino JA, Martín-González S, Ruiz-Alcocer J, Illarramendi-Mendicute I, Garrido-Mercado R. A random dot computer video game improves stereopsis. Optometry and Vision Science. 2018; 95(6):523-35.
44. Chen PL, Chen JT, Fu JJ, Chien KH, Lu DW. A pilot study of anisometropic amblyopia improved in adults and children by perceptual learning: an alternative treatment to patching. Ophthalmic and Physiological Optics. 2008; 28(5):422-8.
45. Battaglini L, Oletto CM, Contemori G, Barollo M, Ciavarelli A, Casco C. Perceptual learning improves visual functions in patients with albinistic bilateral amblyopia: a pilot study. Restor Neurol Neurosci. 2021; 39:45–59
46. Avram E, Stănilă A. Treating anisometric amblyopia with HTS Amblyopia iNet Software--preliminary results. Oftalmologia (Bucharest, Romania: 1990). 2013; 57(2):32
47. Chung STL, Legge GE, Cheung SH. Letter-recognition and reading speed in peripheral vision benefit from perceptual learning. Vision Research. 2004; 44:695–709.
48. Li RW, Provost A, Levi DM. Extended perceptual learning results in substantial recovery of positional acuity and visual acuity in juvenile amblyopia. Investigative ophthalmology & visual science. 2007; 48(11):5046-51.
49. Durrie D, McMinn PS. Computer-based primary visual cortex training for treatment of low myopia and early presbyopia. Transactions of the American Ophthalmological Society. 2007; 105:132.
50. Saarinen J, Levi DM. Perceptual learning in vernier acuity: what is learned? Vision research. 1995; 35(4):519-27.
51. Westheimer G, Hauske G. Temporal and spatial interference with vernier acuity. Vision research. 1975; 15(10):1137-41.
52. Li RW, Levi DM. Slow Perceptual Learning of Vernier Acuity in Adult Amblyopia: An Intensive Amblyopia Treatment Study. Investigative Ophthalmology & Visual Science. 2007; 48(13):4889.
53. Astle AT, McGraw PV, Webb BS. Recovery of stereo acuity in adults with amblyopia. Case Reports. 2011; 2011: bcr0720103143.
54. Ding J, Levi DM. Recovery of stereopsis through perceptual learning in human adults with abnormal binocular vision. Proceedings of the National Academy of Sciences. 2011; 108(37): E733-41.
55. Li RW, Ngo C, Nguyen J, Lam J, Nia B, Ren D, Levi D. Playing video game improves visual acuity and visual attention in adult amblyopia-A potentially useful tool for amblyopia treatment. Investigative Ophthalmology & Visual Science. 2008; 49(13):2832.
| Issue | Articles in Press | |
| Section | Review Article(s) | |
| Keywords | ||
| Amblyopia; Orthoptics; Psychophysics; Systematic review | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Jafarzadehpur E, Pishnamaz MR, Hoseinzade Firozabadi MS, Mirzaei Saba L, Fayaz F, Amini Vishteh R. Effectiveness of Psychophysical Visual Stimuli-Based Interventions in Amblyopia Treatment: A Systematic Review. jmr. 2025;(-).
