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.

Aim: To determine the effectiveness of the Amblyopia Treatment Chulalongkorn University (ATCU) application in improving compliance to occlusion therapy in amblyopic children. Methods: We developed a smartphone application called Amblyopia Treatment Chulalongkorn University (ATCU), which includes education, patching calendar, mini-games, and notifications, offering caregivers a comprehensive tool to enhance amblyopia treatment adherence through informative content, interactive features, and personalized reminders. Children aged 4-12 years with strabismic, anisometropic, deprivation, or mixed-type amblyopia were recruited and randomly assigned to either use ATCU application to facilitate eye patching (group A) or receive standard care (group B). Compliance with eye patching (primary outcome) was measured as a percentage of actual patching hours which were subjectively reported by caregivers, compared to prescribed patching hours, assessed at 1 and 3-month follow-up. Secondary outcomes include best corrected visual acuity (BCVA). Results: Between October 2018 and December 2019, 45 children were enrolled in our study, with all meeting eligibility criteria. One participant was lost to follow-up, and only one child was newly diagnosed with amblyopia, while the others had undergone patching as a prior treatment. At 1-month, compliance was significantly higher in group A (85%) than in group B (64%) [median difference 22% (95% CI, 3 to 48; p = .037)]. At 3-months, the compliance was also higher in group A (80%) than group B (55%), but not significantly [median difference 13% (95% CI, -6 to 30; p = .096)]. BCVA improvement in group A was higher than group B at both follow-up periods [mean difference 0.04 logMAR (95% CI, 0.01 to 0.07; p = .025) at 1-month and 0.04 logMAR (95% CI, 0.01 to 0.08; p = .022) at 3-month follow-up]. Conclusion: The ATCU application significantly improved compliance with occlusion therapy at 1-month. This application may be helpful as an adjunctive tool in the treatment of amblyopia.

OBJECTIVE: To assess the possible benefits of the use of perceptual learning and dichoptic therapy combined with patching in children with amblyopia over the use of only patching.
METHODS: Quasi-experimental multicentric study including 52 amblyopic children. Patients who improved their visual acuity (VA) by combining spectacles and patching were included in patching group (PG: 20 subjects), whereas those that did not improved with patching performed visual training (perceptual learning + dichoptic therapy) combined with patching, being assigned to the visual treatment group (VT: 32 subjects). Changes in VA, contrast sensitivity (CS), and stereopsis were monitored during a 6-month follow-up in each group.
RESULTS: Significant improvements in VA were found in both groups at 1 month (p < 0.01). The total improvement of VA was 0.18 ± 0.16 and 0.31 ± 0.35 logMAR in PG and VT groups, respectively (p = 0.317). The Wilcoxon effect size was slightly higher in VT (0.48 vs. 0.54) at 6 months. An enhancement in CS was observed in the amblyopic eye of the VT group for all spatial frequencies at 1 month (p < 0.001). Likewise, the binocular function score also increased significantly in VT group (p = 0.002). A prediction equation of VA improvement at 1 month in VT group was obtained by multiple linear regression analysis (p < 0.001, R2 = 0.747).
CONCLUSIONS: A combined treatment of visual training and patching is effective for obtaining a predictable improvement of VA, CS, and binocularity in patching-resistant amblyopic children.

Esophageal cancer (EC) remains a significant health challenge globally, with increasing incidence and high mortality rates. Despite advances in treatment, there remains a need for improved diagnostic methods and understanding of disease progression. This study addresses the significant challenges in the automatic classification of EC, particularly in distinguishing its primary subtypes: adenocarcinoma and squamous cell carcinoma, using histopathology images. Traditional histopathological diagnosis, while being the gold standard, is subject to subjectivity and human error and imposes a substantial burden on pathologists. This study proposes a binary class classification system for detecting EC subtypes in response to these challenges. The system leverages deep learning techniques and tissue-level labels for enhanced accuracy. We utilized 59 high-resolution histopathological images from The Cancer Genome Atlas (TCGA) Esophageal Carcinoma dataset (TCGA-ESCA). These images were preprocessed, segmented into patches, and analyzed using a pre-trained ResNet101 model for feature extraction. For classification, we employed five machine learning classifiers: Support Vector Classifier (SVC), Logistic Regression (LR), Decision Tree (DT), AdaBoost (AD), Random Forest (RF), and a Feed-Forward Neural Network (FFNN). The classifiers were evaluated based on their prediction accuracy on the test dataset, yielding results of 0.88 (SVC and LR), 0.64 (DT and AD), 0.82 (RF), and 0.94 (FFNN). Notably, the FFNN classifier achieved the highest Area Under the Curve (AUC) score of 0.92, indicating its superior performance, followed closely by SVC and LR, with a score of 0.87. This suggested approach holds promising potential as a decision-support tool for pathologists, particularly in regions with limited resources and expertise. The timely and precise detection of EC subtypes through this system can substantially enhance the likelihood of successful treatment, ultimately leading to reduced mortality rates in patients with this aggressive cancer.

UNASSIGNED: An audit of the effectiveness of amblyopia treatment in the Newcastle Eye Centre (NEC) to determine how current visual acuity (VA) outcomes compare to those found in the 2011-12 audit.
UNASSIGNED: A retrospective database review. VA outcomes of patients who had undergone treatment for anisometropic, strabismic and mixed amblyopia; discharged between 31.08.2016 - 01.09.19, were compared with VA outcomes found in the previous audit. The previous audit reviewed patients commencing amblyopia treatment during 1.1.11-31.12.12.An unpaired T-test was used to assess if results were statistically significantly different to those found previously. Proportion of visual change from commencement to completion of treatment was calculated. The duration of episode from first visit to discharge, adverse events and percentage of patients who achieved acceptable visual outcomes following only six to eight weeks of occlusion, were also analysed.
UNASSIGNED: Between 31.8.16 and 01.09.19, 1,100 patients were discharged, of which 174 had completed amblyopia treatment and fit the inclusion criteria for the audit. Results show no statistically significant difference between current and previous VA outcomes for each type of amblyopia. The majority of patients (60%) achieve a VA outcome of ≤0.250 (logMAR) in the amblyopic eye. This is comparable to the previous audit where 59% of patients achieved a VA outcome of ≤0.250. Most patients still achieve a level of VA which is equal or almost equal to the fellow eye following amblyopia treatment. Treatment is still completed within a two-year period for the majority of patients (62%). There was only one adverse event and this related to atropine occlusion. Only 18 out of the 174 (10%) patients showed that occlusion could be discontinued following just six to eight weeks of treatment.
UNASSIGNED: The treatment of amblyopia in the NEC is as successful as found in the previous audit and the current amblyopia treatment protocol remains effective. Only 10% of patients achieved the appropriate VA for amblyopia treatment to be ceased on their first return visit. This indicates that the follow-up length for patients undergoing amblyopia treatment could be extended beyond six to eight weeks without causing a detriment to VA outcome.

Purpose: To compare the outcomes of patching to dichoptic stimulation using virtual reality (VR) in moderate and severe amblyopia.Methods: This study was conducted on 86 subjects with unilateral anisometropic and mixed amblyopia. The subjects were randomized to the VR or patching group. The VR group received treatment using the Vivid Vision software (Vivid Vision Inc., San Francisco, USA) with each subject receiving weekly 2 h-sessions for 10 weeks. The patching group was prescribed patching for 10 weeks. Best-corrected visual acuity (BCVA) was measured using a single crowded letter in an ETDRS chart before, after 10 weeks of treatment, and after another 10 weeks of cessation of treatment. Near stereoacuity was measured using the TNO test.Results: Forty-two patients were randomized to the patching group and 44 to the VR group. The median age of the subjects was 12.0 (range 6.0 to 37.0) years. In the VR group, mean amblyopic eye BCVA showed statistically significant improvement by 0.89 line (95% confidence interval {CI}, 0.73 to 1.35 lines; p < 0.001) after 10 weeks of therapy, and after another 10 weeks of follow-up by 1.32 lines from baseline (95% CI, 1.15 to 1.7 lines; p < 0.001). Regarding the patching group, mean BCVA showed statistically significant improvement after 10 weeks by 1.38 lines (95% CI, 0.82 to 1.8 lines; p < 0.001), and after another 10 weeks by 1 line from baseline (95% CI, 0.06-0.147; 0.6 to 1.47 lines; p < 0.001). There was no significant difference between both groups at any time-point (p values >0.05). No serious adverse events were noted. Adults and severe amblyopes in the VR group showed more significant VA improvement than their counterparts in the patching group.Conclusions: Amblyopes treated using VR dichoptic treatment demonstrated statistically significant VA improvement after 10 and 20 weeks of follow-up that is comparable to patching.

The optimal method of treatment for a child depends on the patient\'s age at the time of diagnosis, the onset and type of amblyopia, and the degree of compliance attainable. In deprivation amblyopia, the cause of visual impairment (e.g., cataract, ptosis) needs to be treated first, and then the disorder can be treated such as other types of amblyopia. Anisometropic amblyopia needs glasses first. In strabismic amblyopia, conventionally amblyopia should be treated first, and then strabismus corrected. Correction of strabismus will have little if any effect on the amblyopia, although the timing of surgery is controversial. Best outcomes are achieved if amblyopia is treated before the age of 7 years. The earlier the treatment, the more efficacious it is. In selected cases of bilateral amblyopia, the more defective eye must be given a competitive advantage over the comparatively good eye. Glasses alone can work when a refractive component is present, but occlusion might make the glasses work faster. The gold standard therapy for amblyopia remains occlusion of the better eye although penalization is also evidenced to achieve equal results. Pharmacotherapy has been shown to achieve suboptimal outcomes. Newer monocular and binocular therapies based on neural tasks and games are adjuncts to patching and can also be used in adults.

UNASSIGNED: To assess visual acuity (VA) and stereoacuity (SA) improvements in children with amblyopia treated with either binocular dichoptic treatment or patching treatment.
UNASSIGNED: In this pilot prospective coherent study, 34 participants between 4 and 9 years of age with unilateral anisometropic amblyopia and without history of prior amblyopia treatment were enrolled into three groups. Full treatment group (FTG; n = 12): participants were prescribed the binocular dichoptic treatment to watch for 90 minutes per day, 5 days a week. Part-time treatment group (PTTG; n = 8): participants were prescribed the same binocular treatment as FTG, 90 minutes per day, 3 days per week. Patching treatment group (PTG; n = 14): participants wore an adhesive patch over the dominant eye for 2 hours per day, 7 days per week. Amblyopic-eye distance visual acuity (DVA), near visual acuity (NVA) and SA were evaluated at baseline, 4, 8, and 12 weeks.
UNASSIGNED: At 12 weeks, mean amblyopic-eye DVA improved 1.8 lines (95% CI, 1.1-2.5) in FTG, 1.5 lines (95% CI, 0.4-2.7) in PTTG and 3.0 lines (95% CI, 2.0-4.0) in PTG. The amblyopic-eye NVA improved 2.9 lines (95% CI, 2.4-3.5) in FTG, 1.7 lines (95% CI, 0.5-3.0) in PTTG and 2.8 lines (95% CI, 1.8-3.9) in PTG. The SA improved 0.38 log-arcseconds (95% CI, 0.24-0.53) in FTG, 0.59 log-arcseconds (95% CI, 0.36-0.82) in PTTG and 0.40 log-arcseconds (95% CI, 0.13-0.67) in PTG. No significant differences were found in DVA, NVA or SA improvement between FTG and PTG at 12 weeks.
UNASSIGNED: VA and SA after binocular dichoptic treatment produced a similar therapeutic outcome to patching, suggesting a potential value for binocular therapy when treating anisometropic moderate degree of Children\'s amblyopia.

UNASSIGNED: Previous studies have shown that it is necessary to evaluate adherence during the treatment process, using educational intervention methods which have been shown to improve adherence with patching treatment. A previous study reported that an educational cartoon had significantly improved adherence with patching. However, this black-white cartoon is not commercially available.
UNASSIGNED: This study investigates the feasibility of a 4-minute educational cartoon video in improving adherence with patching therapy for amblyopic children.
UNASSIGNED: Children (3 to 10 years old) with unilateral amblyopia who were prescribed 2 hours or 6 hours of patching per day were enrolled. Objective adherence to the treatment was tracked using a microsensor. Children returned after 4 weeks ± 2 days to measure adherence. Participants with adherence ≤50% were eligible to watch the educational cartoon video. They continued with the previously prescribed treatment (2 hours or 6 hours patching) for an additional week to evaluate the follow-up adherence.
UNASSIGNED: A total of 27 participants were enrolled. The mean age (SD) was 6.6 (1.5) years. Twenty-two participants (12 in the 2 hours patching group and 10 in the 6 hours patching group) had adherence ≤50% and watched our cartoon video. The cartoon video improved mean adherence (SD) from 29.6% (11.9%) to 56.8% (12.1%) in all 22 participants from both regimens (paired 2-tailed t-test, t= -11, P < 0.000).
UNASSIGNED: The Educational cartoon video is feasible for use in a clinical setting. These data showed a trend of improvement in adherence with both patching regimens in children after watching the educational cartoon video.

To explore parents\' experiences, preferences and information needs when either patching treatment or dichoptic action video gaming is used as an amblyopia treatment for their child.
A qualitative study was carried out on parents whose newly diagnosed amblyopic children participated in a randomised controlled trial (RCT) comparing the effects of dichoptic action video gaming versus patching. A purposive heterogenic sample was selected for an additional interview after the study period. Semi-structured interviews were conducted with one or both parents and transcribed verbatim, and a thematic analysis was performed.
Ten families agreed to participate: seven in the patching group and three in the gaming group. Two themes emerged from the data exploring experiences with treatment: (1) factors influencing compliance and (2) burden with treatment. Parents reported creating a routine which improved compliance with patching, as opposed to gaming where parents felt less need to conduct the treatment themselves as it was performed in the outpatient clinic. In both groups, parents experienced an information hiatus regarding the role of refractive error. In deciding the type of treatment to be used, parents preferred to deliberate the choice with the healthcare professional and discuss considerations resulting in shared decisions. The emerging themes were (1) effect and efficiency of treatment, (2) organisational aspects of treatments and (3) their child\'s traits.
This study provides insight into the experiences of parents whose children underwent different types of amblyopia therapy. Both treatments have their own advantages and disadvantages. For parents, the effectiveness and efficiency of treatment were the most important aspects when deciding the method of management. Parents wish to come to a well-informed, shared decision regarding the type of amblyopia treatment.