Comparative efficacy of advanced and conventional vision therapy for amblyopia, convergence insufficiency, and accommodative dysfunction

Background: To compare the effectiveness of Advanced Vision Therapy (AVT) versus Conventional Vision Therapy(CVT) in amblyopia, convergence insufficiency (CI), and accommodative dysfunction (AD).Methods: In this prospective, randomized clinical trial, 90 patients aged 6–30 years with amblyopia (n = 30), CI (n =30), or AD (n = 30) were randomized equally to AVT or CVT. Primary outcomes included best-corrected visual acuity(BCVA, LogMAR), near point of convergence (NPC, cm), positive fusional vergence (PFV, Δ), amplitude ofaccommodation (AA, D), accommodative facility (AF, cycles/min), and near point of accommodation (NPA, cm).Secondary outcome was symptom burden (CISS score). Outcomes were assessed at baseline, 2, 4, and 6 months.Results: AVT improved amblyopia (BCVA) more than CVT, with a mean difference of -0.19 LogMAR at 6 months(95% CI -0.22 to -0.17; p < 0.001; Cohen's d = 2.84). AVT increased PFV by +2.6Δ (95% CI 1.90 to 3.30; p < 0.001; d =1.77) and decreased NPC by -3.7 cm (95% CI -4.18 to -3.22; p < 0.001; d = 4.03), indicating convergence insufficiency.Accommodative dysfunction (NPA, AA, AF): AF increased by +2.6 cycles/min (95% CI 1.83 to 3.37; p < 0.001; d =1.78), whereas AA changes were negligible and did not statistically differ across groups. NPA improved by –3.2 cm(95% CI –3.63 to –2.77; p < 0.001; d = 3.81). Symptoms (CISS): 82% of AVT patients achieved asymptomatic state,compared to 48% in CVT, and AVT decreased ratings by -5.2 points as compared to CVT (95% CI –6.58 to –3.82; p <0.001; d = 2.00).Conclusions: When compared to the traditional method, advanced vision therapy showed more rapid and noticeableenhancements in visual acuity, convergence, accommodation, and symptom reduction. According to these findings, AVTis a useful and successful treatment for common binocular vision problems.