Quantifying Suppression in Anisometropic Amblyopia With VTS4 (Vision Therapy System 4)

PURPOSE: Visual acuity (VA) of the amblyopic eye is usually considered for monitoring improvement with therapy. However, participation of the amblyopic eye under binocular viewing conditions is also important. This study investigated the use of a clinically available tool VTS4 (Vision Therapy System 4) to quantify the participation or suppression of the amblyopic eye under binocular viewing conditions. METHODS: A cross-sectional study on patients with anisometropic amblyopia was undertaken. Monocular VA was thresholded. Stereo acuity was measured with Randot stereo test. Simultaneous macular perception (SMP) targets in VTS4 were dichoptically presented. SMP target size was reduced till the amblyopic eye's target disappeared (suppression scotoma size). An average of three measurements was taken for the suppression scotoma size. RESULTS: Twenty-eight patients participated (aged 6 to 21 years). The mean interocular VA difference was 0.50 ± 0.27 logMAR. The mean scotoma size was 8.2° ± 5.4°. Mean stereo acuity was 2.06 ± 0.34 log arc seconds from 21 patients on whom stereopsis could be measured. Suppression scotoma size showed a significant (P < 0.001) positive correlation with both interocular VA difference (r = 0.59) and stereoacuity (r = 0.72). CONCLUSIONS: Participation of the amblyopic eye under binocular viewing condition can be assessed by measuring the suppression scotoma size in VTS4, even when stereoacuity is poor or not measurable. Smaller the suppression scotoma, better is the amblyopic eye's participation. TRANSLATIONAL RELEVANCE: VTS4 can be used in monitoring amblyopia therapy by quantifying suppression of the amblyopic eye.