Narayanan, Anju, Robinson, Grant  ORCID: https://orcid.org/0009-0007-1320-559X and Woodhouse, Joy ORCID: https://orcid.org/0000-0002-7149-5077
2026.
Evaluation of digital binocular therapies for amblyopia after refractive adaptation in treatment-naive children aged 3–13 years: A systematic review and meta-analysis of
randomised controlled trials.
Plos One
21
(10)
, e0361102.
10.1371/journal.pone.0361102
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Abstract
Background Patching has been the mainstay of unilateral amblyopia treatment, but adherence is challenging. Digital binocular therapies have emerged as a novel approach; however, evidence in treatment-naive children remains limited, as existing studies have pre dominantly included previously treated children. Objective To evaluate the effectiveness of digital binocular therapies versus patching for improving visual acuity in treatment-naive children aged 3–13 years with unilateral amblyopia following refractive adaptation. Design A systematic review and meta-analysis of randomised controlled trials was con ducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420261278100). Comprehensive literature searches were conducted from January 2000 to December 2025. Two independent reviewers screened and selected studies, extracted data, and assessed risk of bias using the Cochrane RoB 2 tool. The primary outcome was change in best-corrected visual acuity. Data were pooled using a random-effects model. The GRADE approach was used to rate the certainty of evidence. Results Five RCTs (n = 225) were included in the primary analysis. Digital binocular therapies showed no statistically significant difference in visual acuity compared with patching using a random-effects model (MD 0.00 logMAR, 95% CI −0.09 to 0.10; I2 = 50.2%). Sensitivity analysis including two additional RCTs judged to be at high risk of bias, one of which compared digital binocular therapy plus spectacles with spectacles alone (7 RCTs; n = 292), yielded similar results (MD 0.04 logMAR, 95% CI −0.03 to 0.10; I2 = 75.2%). The certainty of evidence for visual acuity was moderate, downgraded for inconsistency. Conclusion Digital binocular therapies may serve as adjunctive treatment options when adher ence to patching is challenging. However, current evidence does not demonstrate superiority over patching in treatment-naive children with unilateral amblyopia. The evidence remains limited by the small number of RCTs and modest sample sizes.
| Item Type: | Article |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Optometry and Vision Sciences |
| Subjects: | R Medicine > RE Ophthalmology R Medicine > RJ Pediatrics R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services |
| Publisher: | Public Library of Science |
| ISSN: | 1932-6203 |
| Date of First Compliant Deposit: | 30 October 2026 |
| Date of Acceptance: | 3 October 2026 |
| Last Modified: | 30 Oct 2026 16:44 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/190553 |
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