Combined Occlusion Therapy and Home-Based Perceptual Learning in Children with Persistent Amblyopia: A Longitudinal Case Series

Objectives: Persistent amblyopia often shows limited response to occlusion therapy once visual acuity improvement plateaus. This study evaluated the efficacy of a two-phase protocol combining occlusion therapy and home-based perceptual learning (PL) in children with persistent amblyopia, including those with congenital pathology. Methods: This longitudinal case series included 40 patients (mean age 9.4 ± 3.4 years). Phase I consisted of occlusion therapy until best-corrected visual acuity (BCVA) plateaued. Phase II combined continued occlusion with home-based PL training until BCVA in amblyopic eye reached 0.00 logMAR or treatment was discontinued. BCVA and stereoacuity (TNO test) were assessed at baseline, after Phase I, after Phase II when applicable, and at a prospective evaluation visit. Treatment success was defined as a gain of ≥2 logMAR lines or a final BCVA ≤0.10 logMAR. Patients were stratified according to cumulative training exposure (<10 h vs. ≥10 h). Results: After Phase I, mean BCVA improved from 0.45 ± 0.23 to 0.26 ± 0.19 logMAR (p < 0.01). After Phase II, BCVA further improved to 0.13 ± 0.16 logMAR (p < 0.01). Stereoacuity showed a modest but significant improvement, from 928 ± 505 to 748 ± 558 arcsec (p = 0.01). Treatment success was achieved in 72% of patients completing ≥10 h of perceptual learning compared with 40% in those completing <10 h (RR = 1.94, 95% CI 1.01–3.73). Patients with non-pathological amblyopia achieved greater final BCVA than those with congenital pathology. Conclusions: The combination of occlusion therapy and home-based PL was associated with further improvement in visual acuity and modest gains in stereoacuity in children with persistent amblyopia. Greater cumulative training exposure was associated with higher treatment success, supporting PL as a clinically valuable adjunct to standard amblyopia management.