Effect of active vision therapy on task-based saccadic and smooth pursuit performance in children with anisometropic amblyopia

PURPOSE: To evaluate the association between Active Vision Therapy (AVT) combined with occlusion and occlusion-only therapy in task-based saccadic and pursuit visuomotor performance and visual outcomes in children with anisometropic amblyopia. METHODS: Forty children (median age=9years, IQR=7-11) with persistent anisometropic amblyopia after six weeks of spectacle adaptation were alternately assigned to AVT-occlusion (n = 23) or occlusion-only (n = 17). BCVA, stereopsis, contrast sensitivity, and task-based saccadic and smooth pursuit performance were measured at baseline, three weeks, six weeks, and three months. AVT included structured monocular and binocular exercises using Vision Training System 4 and Cheiroscope, while occlusion involved daily patching of the fellow eye. Repeated-measures ANOVA and Friedman tests evaluated changes over time, partial Spearman correlations adjusted for group examined associations between oculomotor and visual improvements. RESULTS: Both groups improved in BCVA, and task-based saccadic and smooth pursuit performance (p < 0.05) in the AVT-occlusion group. Significant time × therapy interactions were found for BCVA, task-based saccadic and smooth pursuit performance, and contrast sensitivity (p ≤ 0.03). At three months, AVT-occlusion outperformed occlusion-only in BCVA (-0.13 logMAR, p = 0.01), task-based saccadic response time (-0.78 ms equivalent, P < 0.001) and task-based smooth pursuit performance (4.68%, p = 0.03), and contrast sensitivity (0.06 log-units, p = 0.005). Greater gain in task-based saccadic (ρ=-0.43, p = 0.006) and smooth pursuit (ρ=-0.53, p = 0.001) performance correlated with BCVA improvement; faster saccadic response performance (ρ=0.35, p = 0.026) correlated with better stereopsis. CONCLUSIONS: AVT with occlusion was associated with greater improvements in functional visuomotor task performance and visual outcomes in children with anisometropic amblyopia, supporting its role as a function-oriented adjunct to conventional therapy.