Contrast-rebalanced dichoptic movies have been shown to be an effective binocular treatment for amblyopia in the laboratory. Yet, at-home therapy is a more practical approach. In a randomized clinical trial, we compared dichoptic movies, streamed at-home on a handheld 3D-enabled game console, versus patching as amblyopia treatment. Sixty-five amblyopic children (3–7 years; 20/32–125) were randomly assigned to one of two parallel arms, binocular treatment (3 movies/week) or patching (14 h/week). The primary outcome, change in best corrected visual acuity (BCVA) at the 2-week visit was completed by 28 and 30, respectively. After the primary outcome, both groups of children had the option to complete up to 6 weeks of binocular treatment. At the 2-week primary outcome visit, BCVA had improved in the movie (0.07 ± 0.02 logMAR; p < .001) and patching (0.06 ± 0.01 logMAR; p < 0.001) groups. There was no significant difference between groups (CI95%: − 0.02 to 0.04; p = .48). Visual acuity improved in both groups with binocular treatment up to 6 weeks (0.15 and 0.18 logMAR improvement, respectively). This novel, at-home, binocular movie treatment improved amblyopic eye BCVA after 2 weeks (similar to patching), with additional improvement up to 6 weeks. Repeated binocular visual experience with contrast-rebalanced binocular movies provides an additional treatment option for amblyopia.Clincaltrials.gov identifier: NCT03825107 (31/01/2019).
eral ptosis can see well in the nonptotic eye and do not have the stimulation to lift the ptotic eyelid. 3 However, the influence of compensatory contraction of the levator-lower eyelid retractor may be limited in congenital ptosis because of improper or faulty development of the levator muscle. 4 Another possible mechanism is the mechanical effect of upper eyelid lift during ptosis surgery. Upper eyelid lift can lead to lower eyelid elevation due to the circumferential structure of the orbicularis muscle and changeability of the canthi position. 5 These 2 mechanisms may be operative at the same time. Compensatory contraction may be stronger in patients with poorer levator function, and the larger amount of intraoperative upper eyelid lift may result in greater elevation of the lower eyelid. In conclusion, this study shows lower eyelid elevation after surgical correction of congenital ptosis, especially after frontalis suspension or in bilateral ptosis. Surgeons should inform patients that lower eyelids can displace upward after ptosis surgery and that preoperative lower scleral show can be diminished postoperatively.
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