# Binocular Vision, Amblyopia, and Refractive Development

> **NIH NIH R01** · RETINA FOUNDATION OF THE SOUTHWEST · 2024 · $506,265

## Abstract

Amblyopia is a common disorder of neurodevelopment resulting from discordant binocular visual experience
during the first years of life, affecting 2-3% of children. Randomized clinical trials (RCTs) show that current
approaches to amblyopia treatment, most often patching the fellow eye, are effective in improving visual
acuity. However, full recovery occurs in less than 50% of children. Standard-of-care patching treatment of
amblyopia is effective but suffers from poor adherence, exhibits significant individual differences in response
even when adherence is good, and fails to address the binocular dysfunction that is fundamental to amblyopia.
There is a need for an alternative approach to occlusion therapy that improves adherence to maximize visual
outcomes. Aim 1 will evaluate a novel, patch-free approach to occlusion therapy and determine whether it
results in better adherence and visual acuity outcomes compared with patching in an RCT. Our patch-free
treatment provides access to a variety of engaging activities for the child during occlusion time. Our
hypothesis is that patch-free occlusion will lead to better adherence and better visual acuity improvement than
standard-of-care patching. However, even excellent patching adherence does not ensure a good outcome;
objectively monitored patching for200 hours resulted in visual acuity improvements ranging from 0.15-0.8
logMAR. Clearly, poor adherence is not the only factor influencing visual acuity outcome—other unidentified
factors must contribute to individual differences. This argues for a personalized approach to amblyopia
treatment, choosing among a variety of effective approaches to determine which works best for each child. In
Aim 2, we propose to evaluate an alternative treatment approach based on spike-timing dependent plasticity
(STDP) to shift the modification threshold for long-term potentiation (LTP). This neuroplasticity-based
approach, prioritized in the NEI Strategic Plan, is targeted to strengthen amblyopic eye input to binocular
neurons and improve not only visual acuity but also binocular function. In an RCT, we will determine whether
this treatment results in better visual acuity and binocular outcomes compared with standard-of-care patching.
Ourproposed clinical trials include anumber of technological innovations. Our conceptual approach is novel in
that we not only evaluate vision outcomes, but also look at the effects of treatment on the whole child,
including motor skills, self-perception, and quality of life.

## Key facts

- **NIH application ID:** 10794071
- **Project number:** 2R01EY022313-11A1
- **Recipient organization:** RETINA FOUNDATION OF THE SOUTHWEST
- **Principal Investigator:** Eileen Elizabeth Birch
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $506,265
- **Award type:** 2
- **Project period:** 2012-05-01 → 2028-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10794071

## Citation

> US National Institutes of Health, RePORTER application 10794071, Binocular Vision, Amblyopia, and Refractive Development (2R01EY022313-11A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10794071. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*