title: Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review.
abstract: OBJECTIVE
  New behavioral treatment methods, including dichoptic training, perceptual learning, and video gaming, have been proposed to improve visual function in adult amblyopia. Here, we conducted a meta-analysis of these methods to investigate the factors involved in amblyopia recovery and their clinical significance.
  
  
  METHODS
  Mean and individual participant data meta-analyses were performed on 24 studies using the new behavioral methods in adults. Studies were identified using PubMed, Google Scholar, and published reviews.
  
  
  RESULTS
  The new methods yielded a mean improvement in visual acuity of 0.17 logMAR with 32% participants achieving gains ≥ 0.2 logMAR, and a mean improvement in stereo sensitivity of 0.01 arcsec-1 with 42% of participants improving ≥2 octaves. The most significant predictor of treatment outcome was visual acuity at the onset of treatment. Participants with more severe amblyopia improved more on visual acuity and less on stereo sensitivity than those with milder amblyopia. Better initial stereo sensitivity was a predictor of greater gains in stereo sensitivity following treatment. Treatment type, amblyopia type, age, and training duration did not have any significant influence on visual and stereo acuity outcomes.
  
  
  CONCLUSIONS
  Our analyses showed that some participants may benefit from the new treatments; however, clinical trials are required to confirm these findings. Despite the diverse nature of the new behavioral methods, the lack of significant differences in visual and stereo sensitivity outcomes among them suggests that visual attention-a common element among the varied treatment methods-may play an important role in amblyopia recovery.
authors.affiliation: Program in Neuroscience and Mental Health The Hospital for Sick Children, Toronto, Canada.
authors.forename: Inna
authors.initials: I
authors.lastname: Tsirlin
authors.affiliation: Program in Neuroscience and Mental Health The Hospital for Sick Children, Toronto, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Colpa
authors.affiliation: Program in Neuroscience and Mental Health The Hospital for Sick Children, Toronto, Canada 2Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Goltz
authors.affiliation: Program in Neuroscience and Mental Health The Hospital for Sick Children, Toronto, Canada 2Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada 3Department of Ophthalmology and Vision Sciences, The Hospital for Sick Chil.
authors.forename: Agnes M F
authors.initials: AM
authors.lastname: Wong
mesh_terms: D000328:Adult; D000550:Amblyopia / Q000503:physiopathology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007858:Learning / Q000502:physiology*; D010470:Perceptual Masking / Q000502:physiology; D010775:Photic Stimulation / Q000379:methods; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology; D014796:Visual Perception / Q000502:physiology*