Can Bynocs Digital Dichoptic Therapy improve vision and stereopsis in patients with amblyopia who failed occlusion therapy due to non-compliance or poor response?
Elizabeth Joseph, J. S. Arun LalABSTRACT
Background:
Amblyopia patients who fail to respond to conventional occlusion therapy remain a significant therapeutic challenge. Digital dichoptic therapy has emerged as a promising binocular treatment approach aimed at reducing suppression and improving binocular visual function.
Purpose:
To evaluate the effectiveness of home-based digital dichoptic training using the Bynocs® platform in improving distance visual acuity and stereopsis in amblyopic patients who had not responded to conventional patching therapy.
Methods:
This retrospective observational study included 21 patients with amblyopia (median age: 10 years; interquartile range [IQR]: 8–11 years; 9 females, 12 males). Eligible patients had completed six months of patching therapy (2 hours/day for moderate amblyopia and 6 hours/day for severe amblyopia, according to the Pediatric Eye Disease Investigator Group (PEDIG) protocol without significant improvement due to either non-compliance or non-responsiveness. Participants were required to have access to a laptop and reliable internet connectivity. All subjects underwent a 12-week home-based binocular vision training programme using the Bynocs® platform, consisting of 30-minute sessions, five days per week. The programme included dichoptic anti-suppression exercises, stereopsis enhancement activities, and convergence training. Best-corrected distance visual acuity (BCVA) was assessed using a standardized LogMAR chart, while near stereopsis was measured using a Random Dot Stereogram at 40 cm before and after therapy. As data were non-normally distributed on Shapiro–Wilk testing, non-parametric statistical analysis was performed.
Results:
Median BCVA in the amblyopic eye improved significantly from 0.56 LogMAR (IQR: 0.36–0.74) at baseline to 0.30 LogMAR (IQR: 0.24–0.48) following therapy. Median stereopsis also improved significantly from 200 arc seconds (IQR: 100–400) to 100 arc seconds (IQR: 30–125). Both improvements were statistically significant on Wilcoxon signed-rank testing (p < 0.001).
Conclusion:
Home-based digital dichoptic therapy using the Bynocs® platform resulted in significant improvements in both visual acuity and stereopsis in amblyopic patients who showed poor response to conventional patching therapy. These findings support the potential role of binocular digital therapy as an effective rehabilitation option for refractory amblyopia.