Focal ambient visual acuity stimulation improves vision in amblyopic children with stagnating <scp>BCVA</scp> —A retrospective study

PURPOSE: The aim of this study was to investigate whether amblyopic children with stagnating best-corrected visual acuity (BCVA) would benefit from an additional stimulation therapy-specifically focal ambient visual acuity stimulation (FAVAS) integrated into a computer game-compared to occlusion therapy alone. METHODS: This retrospective, multicentre study analysed clinical records of 227 children with amblyopia showing stagnation of visual acuity despite at least 90 days of occlusion therapy. Analyses were performed on an eye-based level. Eyes that had received FAVAS (Caterna Vision GmbH, Potsdam, Germany) alongside occlusion therapy were assigned to the FAVAS group, while eyes treated with occlusion therapy alone served as controls. Post hoc propensity score matching was applied. After matching, 105 patients (114 eyes; 57 eyes per group) remained for analysis. The primary endpoint was improvement in best corrected visual acuity (BCVA, logMAR); the secondary endpoint was change in stereo vision. RESULTS: The FAVAS group showed a significant improvement in BCVA, with a mean gain of 0.15 logMAR (95% CI [0.11;0.18], p < 0.001), compared to a non-significant improvement of 0.01 logMAR (95% CI [-0.02;0.04], p = 0.356) in the control group. No significant changes were observed in stereo vision in either group. CONCLUSION: The combination of occlusion therapy and FAVAS was superior to occlusion alone in amblyopic children with stagnating BCVA, yielding significant and clinically relevant improvements in visual acuity. These findings support the integration of digital stimulation therapy as an effective adjunct to conventional amblyopia treatment. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00030216.