2013國際眼科雜誌論文: 兒童“單眼弱視”的治療新方法..

刊載於： 國際眼科雜誌(英文版)  收錄於SCIE科學文獻引用索引資料庫及PubMed生物醫學資料庫  ISSN 2222-3959  Vol.6, No. 4, Aug. 18^th 2013: 487-491INTERNATIONAL JOURNAL OF OPHTHALMOLOGY 

標題：“以旋轉式稜鏡與近距離用眼活動來改善兩眼不等視性弱視兒童的視力”

作者：林超群醫師，陳柏良醫師

 

摘要中文翻譯

目的：評估一新物理療法對於改善兩眼不等視弱視兒童視覺敏銳度的效力。

 

方法：追朔介入案例系列。分析2008年一月至2012年一月間360位兩眼不等視性弱視兒童以旋轉式稜鏡、凸透鏡配合近距離用眼活動為治療方式的醫療紀錄。評估弱視眼的視力和視覺敏銳度的改善，以及弱視是否得到解決（達到視力0.8以上或兩眼視力差距小於對數視力表兩行）。

 

結果：在患者中，弱視眼視力的平均VA從0.35（SD=0.16），提高至0.85（SD= 0.16），而視力VA的改善則平均為0.45（SD= 0.10，P<0.001）。360例中的233例（64.72％）弱視得到解決。解決弱視的平均時間為8.05週（SD= 4.83）或14.14堂訓練（SD=8.76）。案例當中，治療後屈光度誤差並沒有明顯改變（P =0.437）。研究發現，較佳的基礎VA可能與成功解決弱視及縮短其時間有關。

 

結論：兩眼不等視性弱視兒童，以旋轉式稜鏡、凸透鏡配合近距離用眼為治療方式後，其視力VA和對比敏感度均得到改善。通過這種治療方式，所得到的VA改善可與其他方法相媲美。然而，用這種治療方法比用其他方式解決弱視所需的時間較短。旋轉式稜鏡與近距離用眼工作相結合，可以對無法接受傳統治療方式，例如遮眼治療，的兩眼不等視性弱視兒童提供一種替代的治療方法。

 

英文論文全文

Published in: “International Journal of Ophthalmology” (English edition)

                        Indexed in SCI expanded and PubMed/PubMed central

ISSN 2222-3959

Vol.6, No. 4, Aug. 18^th 2013: 487-491

“Improvement of Visual Acuity in Children with Anisometropic

Amblyopia Treated with Rotated Prisms Combined with Near Activity”

 

Chao-Chyun Lin, MD1, Po-Liang Chen, MD2

英文摘要

ABSTRACT

Aim: To evaluate the efficacy of a new modality for improving visual acuity (VA) in pediatric patients with anisometropic amblyopia.

 

Methods: Retrospective and interventional case series. Medical records of 360 children with anisometropic amblyopia treated with a modality that included rotated prisms, plus lenses, and near activities from January 2008 through January 2012 were analyzed. Characteristics such as improvement of VA and contrast sensitivity in amblyopic eyes and resolution of amblyopia (VA ≤0.1 logMAR or a difference of ≤2 lines in logMAR between the eyes) were assessed.

 

Results: Among the patients, the mean VA of the amblyopic eyes improved from 0.48 logMAR (SD = 0.16) to 0.12 logMAR (SD = 0.16) and the mean VA improvement was 0.36 logMAR (SD = 0.10, P < 0.001). Resolution of amblyopia was achieved in 233 of 360 patients (64.72%). The mean time for resolution of amblyopia was 8.05 weeks (SD = 4.83) or 14.14 sessions (SD = 8.76). Among the study group, refraction error did not change significantly after treatment (P = 0.437). We found that better baseline VA may be related to success and shorten the time to amblyopic resolution.

 

Conclusions: VA and contrast sensitivity improved with rotated prisms, correcting lenses, and near activities in children with anisometropic amblyopia. The VA improvement by this modality was comparable to other methods. However, the time to resolution of amblyopia was shorter with this method than with other modalities. Rotated prisms combined with near acuity could provide an alternative treatment in children with anisometropic amblyopia who can’t tolerant traditional therapy method like patching.

 

英文論文全文：

INTRODUCTION

Amblyopia is a disorder that consists of functional abnormalities, such as visual acuity (VA) reduction, contrast sensitivity impairment, spatial distortion, abnormal spatial interaction, and contour interaction. Refractive amblyopia, either anisometropia or isometropia, results from relative high refractive errors in one or both eyes that cause blurred retinal images. The presumed mechanism is vision pattern deprivation. The affected eye provides a more blurred image to the retina and brain and amblyopia develops. Children carry the risk of developing amblyopia if the condition is untreated within their critical period. Previous studies show optimal spectacle correction is a major component in improving visual function in patients with anisometropic amblyopia.1,2 In addition, patching, or penalization of the sound eye, is a major used as an adjunct to the anisometropic amblyopia therapy.

 

In addition to patching, penalization, and refractive correction, there are a handful of methods to treat anisometropic amblyopia. Perceptual learning improves visual performance by repeating basic tasks3,4 and showed comparable effects in amblyopic therapy with patching.5–9

 

However, the social stigma and anxiety of patching in elder children limited its compliance and thus its useful application. On the contrast, perceptual learning would be less efficient in younger children than elders. Therefore, in this study, we evaluated the efficacy of a new modality that combines rotated prisms, lenses, and near activities treating pediatric patients with anisometropic amblyopia.

 

 

MATERIALS AND METHODS

The study protocol complied with the requirements of the Institutional Review Board. Medical records of pediatric patients who underwent amblyopic therapy by this modality between January 2008 and January 2012 in the ophthalmology department of Lin Amblyopic Eye Center were reviewed.

 

Patients were recruited into this study if they met the inclusion criteria. The major inclusion criteria were age from 3 to 11 years, visual acuity (VA) worse than 0.3 logMAR or at least two lines of difference between the eyes in children with anisometropic amblyopia, and without existence of strabismus or other ocular diseases that could result in reduced VA. Anisometropia was defined as a difference of ≥1.00 D in the myopic, hyperopic, or astigmatic refractive error between the patient’s eyes. Correction of refractive error was accepted in this study. Spectacles were prescribed by two ophthalmologists (Chao-Chyun Lin, MD and Po-Liang Chen, MD). We excluded patients if they did not meet the definition for amblyopia or failure during the follow-up period, and concurrent amblyopia treatment, such as cycloplegics, patching, or other perceptual learning tasks.

 

The new modality we used contains two sets of lenses for “flippers” in our visual training program. Set A was constructed with a 0.5 D plus lens and a 5.0 D prism (alternative base-in or base-down); set B included a +1.0 D plus lens with a 2.0 D basein prism.

 

When eligible patients performed their training for near activities at a distance between 2.5 and 3.0 meters, such as watching television, this modality switched to only set A for function. The training program, which lasted for 50 minutes, consisted of using the 0.5 D plus lens and 5.0 D base-down prism for six seconds followed by the 0.5 D plus lens and 5.0 D base-in prism for another nine seconds (Table 1; Figure 1).

 

In another type of training performed at closer distances ranging from 30 to 60 cm, sets A and B were worked together for 50 minutes while we added a 1.50 D plus lens in front of the eye for reading or doing homework (distance 30 cm) and a 0.5 D plus lens for playing computer games (distance 60 cm). In the initial six seconds of this training, there was only the set A lens with a 0.5 D plus lens and 5.0 D base-down cylinders. In the following 14 seconds, sets A and B were used together with a 1.5 D plus lens with 7.0 D base-in prism (0.5 D plus lens with 2.0 D base-in prism in set A and +1.0 D plus lens with 5.0 D base-in prism in set B). Net effects for different purposes differed according to the additional plus lens (Table 1).

 

Visual training using this modality was conducted twice a week in our outpatient department. The VA, contrast sensitivity, and cycloplegic refraction error were recorded for each patient at the beginning of the study, every four sessions during the study and at the end of the study.

 

The primary endpoint in this study was a difference in VA of less than 2 lines difference or a VA better than 0.1 logMAR in amblyopic eye. The secondary endpoint was that the amblyopic eye did not gain >0.1 logMAR improvement in six consecutive sessions.

 

Reliable measurements of VA, refraction error, and contrast sensitivity were recorded. VA was measured by logMAR VA testing (Chart 2210; Precision Vision, La Salle, IL, USA). Refraction error was checked by retinoscopy after the instillation of 0.1% cyclopentolate eye drops. Contrast sensitivity was recorded at the beginning and end of the study.

 

Data were analyzed using SPSS software (version 13.0 for Windows; SPSS Inc., Chicago, IL, USA). Student’s t-test was used for comparing characteristics before and after treatment. P < 0.05 was considered significant. Regression analysis was adopted to evaluate the factors concordant with improvement of the VA and amblyopia resolution among the patients.

 

RESULTS

There were 380 children who attended this study. Twelve children were excluded because they could not complete training course and six children loss of follow-up. In total, we report the results of 360 children with anisometropic amblyopia. In the group, there were 20 children with myopic amblyopia, 60 with hypermetropic amblyopia, 75 with astigmatic amblyopia, and 205 with mixed refractive amblyopia. In our study, the mean age was 6.43 years (SD = 1.40) and the baseline mean refraction error in spherical equivalent was –1.06 D (SD = 0.67). The mean VA of the amblyopic eyes at baseline was 0.48 logMAR (SD = 0.16). The baseline characteristics of these patients are listed in Table 2.

 

Patients were classified into success or failure groups according to the resolution of their amblyopia. The criteria for success were amblyopia that resolved with a final VA ≤0.1 logMAR in the amblyopic eye or an interocular VA difference ≤2 lines in logMAR. As a result, there were 233 patients in the success group. The overall success rate in this new modality was 64.72%. The mean VA of the amblyopic eyes improved significantly from 0.48 logMAR at baseline to 0.12 logMAR after VA stabilized with a mean improvement of 0.36 logMAR (SD = 0.10). The mean time to resolution of amblyopia was 8.05 weeks ranging from 5.0 to 24.0 weeks (SD = 4.83). The mean number of sessions of visual training to resolution was 14.14 sessions (ranging from 6 to 50 sessions, SD = 8.76) (Table 3). The mean difference in refraction error before and after treatment was –0.39 D without significance (SD = 0.67, P = 0.437). The better baseline VA was related to success and shorter of the time to amblyopic resolution (P = 0.001).

 

Before treatment, contrast sensitivity in these patients was below the normal limit and the peak baseline contrast sensitivity shifted to a lower frequency (Figure 2). The contrast sensitivity showed significant improvement after therapy for all spatial frequencies and improved by factors of 2.11, 1.95, 2.79, 5.20, and 4.14 at spatial frequencies of 1.5, 3. 6, 12, and 18 cycles per degree, respectively. The correlation between improvements in contrast sensitivity and VA was a factor of 0.28. Among all patients, we found that the baseline VA was the only significant factor to predict the success or failure of treatment (negative correlation, P < 0.001, R2 = 0.291). Baseline VA was also a factor for predicting faster improvement (<8 weeks).

 

DISCUSSION

The modality used in this retrospective study was initially designed for myopia control.10 In our prior study evaluating the short-term effect of this modality, mean reduction in refraction error of 0.28 D (SD = 0.03) was shown in the test group.10 In addition to the refraction change, we found that the contrast sensitivity also improved in our patients. Prior studies found that perceptual learning improves visual performance in amblyopic eyes4,7 and VA may also improve after contrast sensitivity improvement.8 In this study of the long-term effects of the treatment, we designed a training program that consisted of 50 minutes a session for two sessions a week. VA, contrast sensitivity, and refraction error change after treatment were analyzed.

 

The mainstream of refractive amblyopia therapy is refractive correction with patching, penalization, or their combination. Refractive correction alone has been proven to offer 3.9 lines of improvement during the first year in patients with bilateral moderate and severe refractive amblyopia.2 Patching and penalization are well-known adjuncts for amblyopia treatment. Although study have reviewed the efficacy and frequency of patching to increase its compliance in such patients.11However, the social stigma and anxiety of patching in elder children limited its compliance and thus its useful application. Our prior study showed comparable results between patching and perceptual learning, but most younger children felt bored when doing training.5. Therefore, we conducted this new training method for younger and older children.

 

The mean VA improvement in our study was 0.36 logMAR, which was compatible with previous studies. In our prior study on VA improvement by perceptual learning or patching in anisometropic amblyopic eyes, VA improvement by perceptual learning was 2.5 lines5,6 in amblyopic eyes. We believe that the different outcome in our study is attributable to different modality of visual training, or to different inclusion criteria.

 

Stewart and his coworkers proposed that the dose-response rate for patching in patients aged between 3 and 8 years is around 0.1 logMAR for every 120 hours of patching,13 and later they suggested that age may influence the dose-response rate in amblyopia therapy.14 According to this conclusion, it may take about 420 hours of patching to achieve a mean improvement of 0.32 logMAR. From the patching strategy in PEDIG studies, patients with moderate amblyopia (VA range from 20/80 to 20/40) should undergo a patching dose of two hours per day.11 That regimen would require nearly seven months of patching to achieve an improvement of 0.36 logMAR such as found in our study. Patients receiving the current treatment modality spent 8.05 weeks to reach resolution of refractive amblyopia. We believe that the faster resolution of five months over patching treatment is mostly attributable to this new modality.

 

Compliance in amblyopia therapy remains the major concern regarding its success. Loudon et al. stated that poor parental fluency in the national language, a low level of education, and poor baseline VA may lead to low compliance and then failure of therapy.15 Intense supervision of occlusion treatment and parental education greatly help to improve success rates.16 Traditional patching failed in some patients due to social stigma or anxiety, but perceptual learning may also fail because the simple tasks are too boring.5 Our treatment provided relative high compliance using this modality because of interesting tasks like playing interactive computer games, watching TV.

 

We thought that improvement in VA may result from several causes. First, similarly to other studies of perceptual learning, improved contrast sensitivity played a major role in improvement VA. Second, interactive activities consisting of watching favorite television programs, playing interactive computer games, and doing homework increased compliance compared with repetitive simple tasks.

 

Since myopia has a relatively high prevalence in East Asians of 22.4% at the age of six years and 64.1% at 12 years,17 several factors including genes, environment, or near work are thought to be involved. Near work (<30 cm) and longer working time (>30 minutes) were related to more refraction changes toward myopia18. In our study, although amblyopia treatment was performed in near activities at a distance from 30 cm to 3.0 meters, there was no significant refraction error addition noted after long-term treatment.

 

There were some limitations in our study. First, there was absence of a control group. Most parents requested this therapy after the failure of other therapies and were not willing to participate in the control group. Second, because this study was a retrospective, therefore, the data to do detail analysis were limited. Third, most patients enrolled in our study with moderate to mild amblyopia (most baseline VA ranged from 0.4 to 0.80 logMAR) compared with moderate to severe amblyopia in previous studies. Further perspective studies with more patients should be needed to solve these problems.

 

In conclusion, our study showed good results for this modality in anisometropic amblyopia therapy. VA and contrast sensitivity improved after a biweekly training program. Patients aged from 3 to 11 years with anisometroic amblyopia could achieve improvement of visual acuity or resolution of their amblyopia. This modality, which combines rotated prisms, lenses, and near activities, may provide an effective alternative for treating anisometropic amblyopia.

  

論文全文中文翻譯

(論文中的視力檢測均以” logMAR對數視力表”方式表示，為方便閱讀，翻譯文中將對照以一般常用的小數點方式改寫。)

 

引言

弱視是一種疾病，由眼睛的功能異常所造成，如視力（VA）減低、對比敏感度減弱、空間扭曲、空間互動異常、影像輪廓互動異常。屈光不正性弱視，無論是有無兩眼不等視，均是一眼或兩眼的高度屈光不正，導致視網膜圖像模糊的結果。造成弱視的機制推測為視覺圖像的被剝奪。因為此高度屈光不正的患眼，提供給視網膜及大腦的是一個較為模糊的圖像，因此產生弱視。如果此狀況在兒童的黃金成長期未得到改善處理，則有發展成為弱視的風險。過往的研究顯示，改善不等視性弱視患者的視覺功能的最主要方式為，將眼鏡度數完全配足。此外，過往的不等視性弱視的主要輔助治療方式則是對健康眼進行遮眼或處罰性處置。

 

(所謂的”處罰性處置”是對健康眼以點眼藥水(如散瞳劑等)，或是配戴不正確度數或模糊的鏡片，來使其視力低於患眼；因而達到強迫患眼的使用。)

 

除了遮眼、處罰性處置、和屈光矯正之外，尚有少數幾種治療不等視性弱視的方法。重複簡單動作的知覺性學習能夠提高弱視眼的視覺表現，其效果堪比遮眼式的弱視療法。

 

然而，遮眼治療於年齡較大的兒童所產生的羞恥感及焦慮，使之無法持續療程，因此限制了遮眼治療的有效應用。而另一方面，知覺性學習則對幼齡兒童來說效率較低。因此，在這項研究中，我們評估了一個新模式的療效，結合旋轉式稜鏡、透鏡和近距離用眼活動，來治療兒童不等視性弱視患者。

 

材料與方法

此研究的protocol定義，符合機構審查委員會的研究協議要求。 審查了2008年一月至2012年一月間，於林超群兒童眼科弱視治療中心眼科部門中以此種方式進行弱視治療的小兒患者的醫療記錄。

 

符合入選標準的患者才能選進此項研究。主要的入選標準為年齡介於3到11歲間，視力（VA）低於0.5或兩眼視差超過兩行以上的不等式性弱視患者，而且須沒有斜視或其他可能導致VA降低的眼部疾病。兩眼不等視的定義是，兩隻眼睛的近視、遠視或散光等屈光不正間的差距為≥1.00 D。此項研究接受矯正過屈光不正的患者。眼鏡處方由兩名眼科醫生（林超群醫師和陳柏良醫師）開出。本研究排除沒有符合弱視條件或無法完成後續追蹤的患者，還有排除合併使用其他弱視治療，如點睫狀肌麻痺劑、遮眼或其他知覺學習的患者。

 

這個新的治療方式，包含兩組鏡片。A組鏡片的構造為0.5 D凸透鏡和5.0D稜鏡（基底朝內或朝下，二擇一）；B組則包括一個1.0 D凸透鏡與2.0 D基底朝內的稜鏡。

 

當符合條件的患者進行2.5至3公尺的用眼活動訓練，例如看電視時，切換至A組訓練模式。此訓練療程歷時50分鐘，包括使用0.5 D凸透鏡和5.0D基底朝下之稜鏡6秒，然後使用0.5 D凸透鏡和5.0D基底朝內之稜鏡9秒。

 

在另一種更近距離約30至60公分的訓練模式中，同時使用A組和B組鏡片50分鐘；如是距離約30公分的閱讀或做功課，則在眼前加上1.50 D的凸透鏡；如是距離約60公分的玩桌上型電腦遊戲，則是加上0.5D的凸透鏡。在訓練的最初6秒，只有A組鏡片的0.5 D凸透鏡和5.0D基底朝下稜鏡。接下來的14秒，A組和B組鏡片同時使用，等於1.5 D凸透鏡和7.0D基底朝內之稜鏡（A組的0.5 D凸透鏡和2.0D基底朝內稜鏡，加上B組的1.0D凸透鏡和5.0D基底朝內稜鏡）。依據不同用途增加的額外凸透鏡，會造成不同的加總影響。（表1）。

 

患者在我們的門診部門每週進行兩次此種模式的視覺訓練。每位患者在研究開始前、每四次訓練後、以及研究結束後，均會記錄其視力、對比敏感度、及散瞳後屈光度的變化。

 

本研究的主要成功案例終點是弱視眼VA的差距小於2行，或弱視眼的視力達到VA優於0.8以上。失敗的案例是在連續六次的訓練中，弱視眼沒有獲得大於VA 0.8以上的視力改善。

 

VA、屈光度、對比敏感度等，均被詳細的測量與紀錄。VA用logMAR視力表測試。屈光度的測量，是在點入0.1％cyclopentolate散瞳劑之後。對比敏感度則是在研究的開始與結束時紀錄。

 

數據分析採用SPSS程式系統。 療程前後特點的分析，則是用Student’s t-test。 若P <0.05則認為是有顯著的不同。患者的弱視是否得到改善、與VA有否進步，則是通過回歸分析來評估。

 

結果

共有380名兒童參與本研究。有12名兒童因無法完成訓練療程被排除，還有6名兒童因沒回來追蹤檢查而被排除。我們總共報告了360名不等視性弱視兒童的訓練結果。其中，有20名兒童有近視性弱視、60名有遠視性弱視、75名散光性弱視、和205名混合的屈光不正性弱視。本研究中，平均年齡為6.43歲（SD= 1.40）；而以球面度數來算，平均屈光不正的基準則是-1.06 D（SD= 0.67）。弱視眼的平均VA基準則是矯正視力0.3左右（SD=0.16）。這些患者的基準特徵在表2中列出。

 

患者依照其弱視的是否得到改善，分為成功與失敗組兩組。成功組的標準是弱視眼的最終視力≤0.1 logMAR或兩眼視差小於兩行 logMAR視力表。結果，成功組中有233名患者。此種新模式的總成功率是64.72％。弱視眼的平均VA，從0.3 (0.48 logMAR ) 進步到1.0 (0.12 logMAR )；平均進步VA為0.36 logMAR。達到弱視改善的平均時間為8.05週，最少5.0週，最多24.0週不等（SD= 4.83）。達到弱視改善的平均訓練次數為14.14次（範圍從6至50次訓練不等，SD=8.76）（見表3）。治療前後的屈光不正平均差異則為 -0.39Ð，無統計上的顯著意義（SD=0.67，P=0.437）。擁有較佳的基礎VA，與成功和在較短的時間內到弱視改善有關（P = 0.001）。

 

治療前，這些患者的對比敏感度低於正常值，且其基準線的頂峰轉移至較低的頻率（圖2）。治療後，對比敏感度有顯著的改善；統計上的空間頻率與因素分別為：因素2.11、1.95、2.79、5.20和4.14，和空間頻率每度1.5、3.6、12和18個週期。對比敏感度的改善和VA之間的相關性為0.28因素。在所有患者中，我們發現，基礎VA是唯一的一個用來預測治療的成功或失敗的顯著因素（負相關性，P <0.001，R2=0.291）。基礎VA也是預測更快得到弱視改善（<8週）的因素。

 

討論

在這項回顧性研究中所用的訓練模式，最初設計為近視的控制。在之前的研究中，我們評估此訓練模式的短期效果，試驗組達到平均減少0.28D屈光度（SD= 0.03）。除了屈光度的變化，我們發現患者的對比敏感度也有所改善。此前的研究發現，知覺性學習能提高弱視眼的視覺功能；而且當對比敏感度改善時，VA也會改善。在本長期治療效果的研究中，我們設計了一個療程為每星期兩次的50分鐘訓練。然後對療程後的VA、對比敏感度、和屈光不正的變化進行了分析。

 

屈光不正性弱視的主流治療方法，是利用對健康眼的遮眼、處罰性處置，或兩者互相配合來達到屈光矯正。單獨使用屈光矯正已被證明可以改善雙邊中度和嚴重的屈光不正性弱視患者在第一年內提供3.9行的視力進步。雖然研究證實遮眼的有效性和頻率增加了患者的配合度。然而，遮眼治療於年齡較大的兒童所產生的羞恥感及焦慮，使之無法持續療程，因此限制了遮眼治療的有效應用。我們的前期研究表明了遮眼治療和知覺性學習有相當的結果，但對幼齡兒童來說知覺性學習十分無聊。因此我們對幼齡和較大年齡的兒童進行此種新的訓練方法。

 

在此研究中，平均視力的改善為0.36 logMAR視力，這是與以前的研究可相並立的結果。在我們之前的研究，利用知覺性學習或遮眼來治療不等視性弱視時，弱視眼的VA進步為2.5行。我們相信，我們研究所得到的不同結果，須歸功於不同的視覺訓練方式，或是其不同的納入標準。

 

Stewart和他的同事提出，患者年齡介於3至8歲時，每120小時的遮眼，可改善視力約0.1 logMAR，其後他們又建議，年齡可能會影響遮眼在弱視治療中的成效。根據這一個結論，要達到平均0.32 logMAR視力改善，可能需約420小時的遮眼。從PEDIG研究的遮眼策略來說，中度弱視（VA介於20/80至20/40之間）的患者應接受每天2小時的遮眼。如要達到本研究中的0.36 logMAR視力改善，則約需要近7個月的遮眼治療。而以本研究來說，患者達到屈光不正性弱視的改善則只需8.05週。我們相信，本研究的特殊治療模式，正是能使弱視達到改善的時間比遮眼療法快上5個月的主要原因。

 

患者對於弱視治療方法的配合度，仍然是其成功與否的主要關鍵。Loudon等人認為，父母其本國語言的低流暢度、低教育程度、以及較低的VA基準，可能會導致低配合度，然後造成治療的失敗。治療的積極監督和對家長的教育，大大有利於提升治療的成功率。傳統的遮眼治療對某些患者會產生羞恥感及焦慮，造導致治療失敗；而知覺性學習療法則是因這些簡單的任務過於無趣，無法持續而失敗。我們的治療方式則因配合了較有趣味的任務，如玩電腦遊戲、看電視等，而使患者能有較高的配合度。

 

我們認為VA的改善可能有以下幾個因素。首先，與其他知覺性學習研究相同的是，對比敏感度的改善一項重要的因素。其二，較有互動的活動，包括觀看喜愛的電視節目、玩電腦互動遊戲、做功課等與重複簡單單調的任務相比，更能增加患者的配合度。

 

由於東方人的近視率較高：6歲約有22.4％近視，12歲則有64.1％近視；因此基因的影響、生活環境、以及較長的近距離工作時間，均被認為與高近視率有關。近距離的工作（<30公分）和較長的工作時間（>30分鐘），與眼球的屈光趨向為近視有關。在我們的研究中，雖然弱視治療是在30公分到3.0公尺的距離內進行，但長期治療後並沒有顯著的屈光不正增加。

 

我們的研究有受到一些限制。首先，沒有對照組。大多數父母因為參與其他的弱視療法失敗後，轉向本治療方法，因此並不願意參加對照組。第二，因本研究為回顧性研究，因此，能做詳細分析的數據是有限的。第三，相較於其他研究中的患者多為中度至重度弱視，我們的研究中大多數患者只是中度到輕度弱視（基礎VA介於0.4至0.80 logMAR）。要做更深入的前瞻性研究來解決這些問題，則需要更多的患者。

 

總之，我們的研究說明，本弱視治療方式，在兩眼不等視性弱視的治療有良好的效果。每週兩次的訓練療程，使得VA和對比敏感度達到改善。年齡介於3至11歲的兩眼不等視性弱視患者，可以達到視力的改善或弱視的解決。此種結合了旋轉稜鏡、透鏡和近工作的新治療模式，是治療兩眼不等視性弱視的一種替代療法。