Visual Rehabilitation Using Contact Lens–Assisted Vision Therapy in Adolescent Anisometropic Amblyopia with Exotropia: A 24-Week Case Report

Purpose: To report the visual rehabilitation of a 16-year-old male diagnosed with long-standing anisometropic amblyopia and exotropia through a structured vision therapy program combined with soft contact lens correction over 24 weeks. This case highlights that significant functional visual recovery may be achievable in adolescents beyond the traditionally defined critical period. Methods: The patient presented with a best-corrected visual acuity (BCVA) of 6/36 in the amblyopic right eye and 6/6 in the left eye, with high anisometropic refractive error and a constant 45∆ alternate exotropia. Baseline binocular vision assessment revealed suppression in the right eye, poor stereopsis (800 arc seconds on the TNO stereoacuity test), a receded near point of convergence (15 cm), and reduced accommodative and vergence reserves. Contrast sensitivity was measured using the Pelli-Robson chart. Monthly disposable soft contact lenses (CooperVision) were prescribed to provide optimal refractive correction and minimize aniseikonia. A structured vision therapy regimen—comprising in-office and home-based exercises—was delivered in three progressive phases focusing on monocular stimulation, binocular integration, and vergence enhancement. Results: After 24 weeks of intervention, BCVA in the right eye improved to 6/9, with stereopsis enhanced to 80 arc seconds. Exotropia reduced to 18∆, and other notable gains included normalized accommodative amplitudes, improved vergence control (NPC: 7 cm), enhanced contrast sensitivity, and subjective improvements in visual comfort and academic performance. No adverse effects from contact lens wear or vision therapy were reported. Conclusion: This case suggests that meaningful visual and binocular function recovery is possible in adolescent patients with amblyopia and strabismus when therapy is individualized, intensive, and sustained. Chronological age should not be considered an absolute barrier to initiating amblyopia treatment. The combined use of contact lens correction and structured vision therapy may represent an effective model for late-onset amblyopia rehabilitation in clinical settings.