La eficacia del aprendizaje perceptual como tratamiento de la ambliopía en la infancia, frente a otros tratamientos convencionales

Resum

Amblyopia is a disorder associated with abnormal responses of the affected eye, in the visual cortex (Mansouri, Thompson, & Hess, 2008) reducing visual acuity (VA), and affecting spatial, object and movement perception. Occlusion, covering the dominant eye, is the classical treatment. Perceptual learning has shown positive results but further studies are necessary, at the visuo perceptual, psychomotor and psychoeducational levels. Objective To analyze the effect of treatment in children from 4 to 12 years old, in terms of VA, stereopsis, contrast sensitivity (CS), visual-perceptual skills, psychomotor and school and psychosocial aspects. The treatments studied are patching (P), monocular perceptual learning (MPL), patching and near vision activities (PA) and binocular perceptual learning (BPL). Methodology The sample was children in the 4-12 age range, compensated with ophthalmic or contact lenses, with monocular or binocular amblyopia, a spherical equivalent below 3D and no surgery, except for strabismus. Controls were age matched non-amblyopic children. Subjects under medication affecting visual or cognitive functions, suffering from neurological and developmental disorders or any ocular pathology were excluded. Amblyopes were randomized into four treatment groups: patch group (P); monocular perceptual learning group (MPL); patch plus near vision activities group (PA); and perceptual learning binocular group (BPL). An exercise routine for the PA group and a monocular perceptual task favoring the parvocellular achromatic pathway for the MPL group were designed. Results and Conclusions Analysis of PEDIG data confirms that spectacles should be the first step in amblyopia treatment, but rates of amblyopia solution are low. In our sample, the more active treatments (PA and MPL) improve VA and stereopsis more than patching, and transfer their results to improvement in binocular functions, but MPL fails to improve CS as much as the other treatments. Children found the MPL boring and this affected treatment compliance. We suggest combining near vision activities along with 2 hours of patch, to shorten the duration of the occlusion and improve results. Our amblyopic sample has losses in spatial relationships and sequential visual memory, which have improved with the three treatments close to non-amblyopic level. Amblyopia affects hand-eye coordination and reading. Although this could make school adaptation difficult, the absence of differences in social adaptation skills may indicate that the deficits detected are not enough to influence the psychosocial adaptation of children.