弱视是一种视觉系统的神经发育障碍,会损害全世界数百万儿童的视力。弱视最好在儿童7岁以下的视觉发育敏感期内进行治疗。目前,早期治疗儿童弱视的黄金标准是修补,近年来出现了新的治疗方法。我们的目标是评估这些新开发的治疗7岁及以下儿童弱视的有效性,同时将它们与当前的行业标准进行比较。我们搜索了包括PubMed在内的在线数据库,谷歌学者,和Cochrane图书馆的随机对照试验(RCT),系统评价,荟萃分析,以及与7岁及以下儿童弱视治疗有关的叙述性评论。我们只包括在过去五年内完成的文章和研究,以及那些用英语写的。在整理了297篇文章的清单后,我们删除了重复项,没有可用全文的文章,和那些与我们的主题无关的。在剩下的51篇文章中,在阅读摘要并删除更多无关的文章后,我们剩下22个。我们对其余22篇文章进行了质量评估,在删除了8篇低质量文章后,剩下14篇文章用于我们的系统评价。在14篇文章中,我们有八个RCT,两次系统审查,一项比较介入研究,和三个叙述评论。其中七篇文章包含的数据增强了修补的有效性,同时将其与其他治疗方式进行了比较。其中三篇文章有数据支持眼镜矫正,包括一种称为替代闪烁玻璃的新颖形式,通过带有独特镜片的眼镜架提供闭塞治疗,并最终认为它至少与修补一样有效或更多。来自三篇文章的数据支持使用手术成功校正斜视角度。五篇文章的结果支持药物治疗的使用,特别是阿托品,当与修补一起使用时,作为单独修补的更有效的替代品。然而,左旋多巴加修补没有优势单独修补。此外,7篇文章讨论了使用虚拟现实(VR)和二联疗法作为儿童弱视的前瞻性治疗方法.在斜视手术后一周内使用VR疗法被证明是有益的。当单独使用或与眼镜结合使用时,视神经训练也可有效改善弱视眼的视敏度。此外,人们发现二话不说的电影疗法比修补更有效。因此,我们发现了多种治疗儿童弱视的高效治疗方法,其效果与补片一样或更高.未来的研究应该考虑将这些治疗方法处方给更大的队列,同时对每种治疗方法进行成本效益分析。此外,需要更多地了解这些治疗的潜在不良副作用,尤其是药物治疗。
Amblyopia is a neurodevelopmental disorder of the visual system that impairs the vision of millions of children worldwide. Amblyopia is best treated within the sensitive period of visual development when a child is up to seven years of age. Currently, the gold standard for early treatment of childhood amblyopia is
patching, with new treatments emerging in recent years. We aim to evaluate the effectiveness of these newly developed treatments for amblyopia in children aged seven years and younger while comparing them to the current industry standard of patching. We searched online databases including PubMed, Google Scholar, and Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and narrative reviews relating to amblyopia treatment in children aged seven and younger. We only included articles and studies completed within the last five years and those written in the English language. After compiling a list of 297 articles, we removed duplicates, articles without an available full text, and those not relevant to our topic. Of the remaining 51 articles, we were left with 22 after reading abstracts and removing further irrelevant articles. We did a quality assessment on the remaining 22 articles and were left with 14 articles for our systematic review after removing eight low-quality articles. Of the 14 articles, we had eight RCTs, two systematic reviews, one comparative interventional study, and three narrative reviews. Seven of the articles contained data reinforcing the effectiveness of
patching while comparing it to other treatment modalities. Three of the articles had data supporting spectacle correction, including a novel form called alternative flicker glass which delivers occlusion therapy via a spectacle frame with unique lenses, and ultimately deemed it at least as effective or more than patching. Data from three articles supported the use of surgery to successfully correct the angle of strabismus. Findings from five articles backed the use of pharmacologic therapy, specifically atropine when used alongside patching as a more effective alternative to
patching solely. However, levodopa plus
patching had no advantage over
patching alone. Additionally, seven articles addressed the use of virtual reality (VR) and dichoptic therapy as prospective treatments for childhood amblyopia. VR therapy proved beneficial when used within one week after strabismus surgery. Dichoptic training was also effective in improving amblyopic-eye visual acuity when used on its own or in conjunction with spectacles. Furthermore, dichoptic movie therapy was found to be more effective than
patching. Thus, we found multiple highly effective treatments for childhood amblyopia that are as effective or more than patching. Future studies should consider prescribing these treatments to larger cohorts while also performing a cost-benefit analysis for each treatment. In addition, more needs to be learned about the potential adverse side effects of these treatments, especially for pharmaceutical therapy.