Refractive surgery for refractive amblyopia and amblyogenic refractive errors
In children with significant refractive errors who cannot successfully wear spectacles or contact lenses, refractive surgery is an option.[92]Daoud YJ, Hutchinson A, Wallace DK, et al. Refractive surgery in children: treatment options, outcomes, and controversies. Am J Ophthalmol. 2009 Apr;147(4):573-82.
http://www.ncbi.nlm.nih.gov/pubmed/19327445?tool=bestpractice.com
[93]Simons K, Preslan M. Natural history of amblyopia untreated owing to lack of compliance. Br J Ophthalmol. 1999 May;83(5):582-7.
https://bjo.bmj.com/content/83/5/582.long
http://www.ncbi.nlm.nih.gov/pubmed/10216059?tool=bestpractice.com
[94]Cavuoto KM, Chang MY, Heidary G, et al. Effectiveness of laser refractive surgery to address anisometropic amblyogenic refractive error in children: a report by the American Academy of Ophthalmology. Ophthalmology. 2022 Nov;129(11):1323-31.
https://www.aaojournal.org/article/S0161-6420(22)00481-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/35987663?tool=bestpractice.com
[95]Tychsen L, Hoekel J, Ghasia F, et al. Phakic intraocular lens correction of high ametropia in children with neurobehavioral disorders. J AAPOS. 2008 Jun;12(3):282-9.
http://www.ncbi.nlm.nih.gov/pubmed/18589386?tool=bestpractice.com
[96]Ali A, Packwood E, Lueder G, et al. Unilateral lens extraction for high anisometropic myopia in children and adolescents. J AAPOS. 2007 Apr;11(2):153-8.
http://www.ncbi.nlm.nih.gov/pubmed/17140827?tool=bestpractice.com
[97]Pirouzian A, Ip KC. Anterior chamber phakic intraocular lens implantation in children to treat severe anisometropic myopia and amblyopia: 3-year clinical results. J Cataract Refract Surg. 2010 Sep;36(9):1486-93.
http://www.ncbi.nlm.nih.gov/pubmed/20692559?tool=bestpractice.com
One meta-analysis of children ages 7-17 years undergoing refractive surgery for accommodative esotropia found improvement in both uncorrected and corrected visual acuity after refractive surgery.[98]Alió JL, Wolter NV, Piñero DP, et al. Pediatric refractive surgery and its role in the treatment of amblyopia: meta-analysis of the peer-reviewed literature. J Refract Surg. 2011 May;27(5):364-74.
http://www.ncbi.nlm.nih.gov/pubmed/20839663?tool=bestpractice.com
Corneal haze was the most common complication.[98]Alió JL, Wolter NV, Piñero DP, et al. Pediatric refractive surgery and its role in the treatment of amblyopia: meta-analysis of the peer-reviewed literature. J Refract Surg. 2011 May;27(5):364-74.
http://www.ncbi.nlm.nih.gov/pubmed/20839663?tool=bestpractice.com
Binocular therapy
Luminopia One®, a dichoptic digital therapeutic, has received Food and Drug Administration (FDA) approval for the treatment of amblyopia associated with anisometropia and/or mild strabismus in children ages 4-12 years, as an adjunct treatment to full-time refractive correction. Approval was premised on the results of a phase 3 trial comparing treatment and control (spectacle-only) groups, and on real-world evidence (RWE) generated through the Patients Using Prescription Luminopia (PUPiL) Registry.[99]Xiao S, Angjeli E, Wu HC, et al. Randomized controlled trial of a dichoptic digital therapeutic for amblyopia. Ophthalmology. 2022 Jan;129(1):77-85.
https://www.aaojournal.org/article/S0161-6420(21)00682-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34534556?tool=bestpractice.com
[100]ClinicalTrials.gov. Clinical data registry of amblyopia patients on luminopia treatment. Sep 2025 [internet publication].
https://www.clinicaltrials.gov/study/NCT06429280
Further research comparing binocular therapy with patching or atropine is warranted.[99]Xiao S, Angjeli E, Wu HC, et al. Randomized controlled trial of a dichoptic digital therapeutic for amblyopia. Ophthalmology. 2022 Jan;129(1):77-85.
https://www.aaojournal.org/article/S0161-6420(21)00682-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34534556?tool=bestpractice.com
[101]Roda M, Pellegrini M, Di Geronimo N, et al. Binocular treatment for amblyopia: a meta-analysis of randomized clinical trials. PLoS One. 2021;16(10):e0257999.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257999
http://www.ncbi.nlm.nih.gov/pubmed/34624028?tool=bestpractice.com
Liquid crystal glasses
Liquid crystal glasses combine refractive correction and occlusion via a liquid crystal shutter that is electronically controlled by a microprocessor. Considered an alternative therapy by the American Academy of Ophthalmology.[1]American Academy of Ophthalmology. Amblyopia PPP 2022 - updated 2024. Dec 2022 [internet publication].
https://www.aao.org/education/preferred-practice-pattern/amblyopia-ppp-2022
Further research is required.
Transcranial electromagnetic stimulation
Transcranial electromagnetic stimulation of the visual cortex may alter the excitability of neurons and affect neuroplasticity, potentially offering a viable treatment option for young adults with amblyopia when treatment is needed outside the critical period for normal visual development. Several reviews have reported on the effect of transcranial electromagnetic stimulation in adult amblyopia.[102]Thompson B, Mansouri B, Koski L, et al. Brain plasticity in the adult: modulation of function in amblyopia with rTMS. Curr Biol. 2008 Jul 22;18(14):1067-71.
http://www.ncbi.nlm.nih.gov/pubmed/18635353?tool=bestpractice.com
[103]Lin Y, Cai K. Transcranial magnetic stimulation-based neuroplasticity in the treatment of amblyopia. J Neurosci Methods. 2025 Jul;419:110464.
http://www.ncbi.nlm.nih.gov/pubmed/40315924?tool=bestpractice.com
[104]Householder N, Simonyan A, Park W, et al. Electromagnetic stimulation for amblyopia: a systematic review of emerging techniques and their efficacy. Vision Res. 2025 Jun 6;234:108639.
http://www.ncbi.nlm.nih.gov/pubmed/40482570?tool=bestpractice.com
[105]Tuna AR, Pinto N, Fernandes A, et al. Can repetitive transcranial magnetic stimulation influence the visual cortex of adults with amblyopia? - systematic review. Clin Exp Optom. 2024 Sep;107(7):691-7.
http://www.ncbi.nlm.nih.gov/pubmed/39025787?tool=bestpractice.com