Dichoptic Rescue for Spectacle-Flip Sabotage of Anisometropic Amblyopia Therapy

Background: To be successful, amblyopia therapeutic techniques must respond when ingenious (shrewd) amblyopic children sabotage treatment effect by discovering ways(1) to alter those therapy aspects they find frustrating.Methods: Her guardian consented to IRB-approved study outside typical FDA enrollment guidelines for CureSight dichoptic therapy.Acuity (EVA) and stereopsis was by PEDIG protocols.Results: A 6-year-old rural Alaska native girl in foster care had previously been diagnosed with anisometropic amblyopia and treated with spectacles and patching but had poor compliance with BCVA 0.9-1.0logMAR.She demonstrated exceptional creativity and hyperactivity but had no other medical issues.Atropine was prescribed in addition to her spectacles +5.50+1.00x90and +0.50+1.00x90,but the patient discovered the rare "Spectacle Flip" method that sabotaged therapeutic impact.She had EVA enrollment acuities of logMAR 0.9 right and -0.1 left with stereo 400 seconds of arc.After just one month dichoptic therapy 1.5 hours 6 days per week, acuity improved to logMAR 0.7 and -0.1 with stereo up to 140 second of arc.Four months later acuity was 0.6 right and -0.2 left.Stereoacuity improved from 400 to 200 arc seconds.Conclusion: Even when conventional compliance methods fail, dichoptic therapy with eye-tracking has the novel and unique potential to improve amblyopia treatment compliance with real-time monitored fixation compliance and confirmation of correct spectacle wear.Clinical Trial Registration: NCT06165705.Plain Language Summary: Dichoptic therapy with eye-tracking improved compliance and achieved de novo acuity and stereo gains in a girl with severe refractory anisometropic amblyopia compounded by the rare complication of topical atropine therapy called "spectacle-flip sabotage"