The combined therapies in treating amblyopia: a systematic review and network meta-analysis of randomized controlled trials

Introduction Amblyopia, or “lazy eye,” is a common vision disorder primarily affecting children, characterized by reduced visual acuity in one eye. Treatments aim to stimulate the development of the weaker eye to enhance visual acuity and promote binocular vision. Various treatment modalities, including patching, atropine drops, corrective lenses, vision therapy, and surgery, are often used in combination. Objective To evaluate the effectiveness of combined treatment approaches compared to monotherapy in improving visual acuity in amblyopia. Methodology We conducted a network meta-analysis of randomized controlled trials (RCTs) involving amblyopic patients aged 3–17 years. Studies comparing combined treatments to monotherapy for improving visual acuity were included. Data were sourced from four databases: PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials, up until September 2023. Risk of bias was assessed using Cochrane’s ROB2 tool, and results were analyzed using MetaInsight and RevMan. Results The combined treatments showed significant improvement in visual acuity (mean difference -0.05 log MAR; 95% CI [−0.09, −0.01]; P = 0.02). Subgroup analyses revealed superior outcomes with spectacles plus intervention and patching plus intervention over single treatments. Atropine plus patching was the most effective for improving best corrected visual acuity (BCVA). Conclusion Combined treatments, particularly spectacles, atropine, and patching, were more effective than monotherapy in improving visual acuity in amblyopia. Early visual acuity improvement supports the superiority of combination strategies for optimal efficacy.