Short- and long-term outcomes of binocular gaming versus patching in childhood amblyopia: a systematic review and meta-analysis.

UNLABELLED: The aim of this study is to systematically compare binocular gaming with conventional occlusion therapy for visual acuity improvement in childhood amblyopia. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines (PROSPERO CRD420251080735). PubMed, Scopus, Cochrane Library, and Google Scholar were searched through June 2025 for randomized controlled trials in children aged 3-18 years with unilateral amblyopia. The primary outcome was best-corrected visual acuity improvement, expressed as standardized mean difference (SMD). A random-effects model was applied with subgroup analyses by treatment duration, sample size, and patient characteristics. Nine RCTs, including 986 children, met the inclusion criteria. Pooled analysis showed no significant difference between binocular gaming and patching (SMD 0.05, 95% CI - 0.2 to 0.3, p = 0.68) with substantial heterogeneity (I2 = 65%). Subgroup analyses revealed time-dependent effects: short-duration trials (≤ 6 weeks) favored binocular gaming (SMD 0.35, 95% CI 0.05-0.65, p = 0.02), medium-duration trials (8-12 weeks) showed no significant benefit, while long-duration trials (> 12 weeks) favored patching (SMD - 0.47, 95% CI - 0.72 to - 0.22, p < 0.001). Larger, high-quality trials consistently supported patching. Publication bias analysis indicated small-study effects, with trim-and-fill suggesting the true effect may favor patching (adjusted SMD - 0.15).

CONCLUSION

Binocular gaming may provide short-term benefits, but robust evidence indicates patching is superior for long-term outcomes. After adequate refractive correction, conventional occlusion therapy remains the recommended first-line active treatment for amblyopia. Binocular gaming may be considered as an adjunct or alternative for children who are unable to comply with patching.

WHAT IS KNOWN: • Patching is an effective standard treatment for childhood amblyopia. • Evidence for binocular gaming compared with patching has been inconsistent.

WHAT IS NEW: • Binocular gaming shows short-term benefit, but patching is superior long term. • High-quality trials support patching as first-line; gaming may be an adjunct.