Evaluation of the clinical effect of 4D digital strabismus and amblyopia visual function correction system combined with traditional comprehensive treatment methods on anisometropic amblyopia

Evaluation of the clinical effect of 4D digital strabismus and amblyopia visual function correction system combined with traditional comprehensive treatment methods on anisometropic amblyopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the clinical effect of 4D digital strabismus and amblyopia visual function correction system combined with traditional comprehensive treatment methods on anisometropic amblyopia Huangen Li, Ting Peng, Yinyan Qin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4398992/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Oct, 2024 Read the published version in BMC Ophthalmology → Version 1 posted 4 You are reading this latest preprint version Abstract Purpose The objective of this study is to evaluate the clinical efficacy of the 4D digital strabismus and amblyopia visual function correction system(4D-DSAAVFCS) in combination with conventional modalities compared to conventional modalities alone in children with anisometropic amblyopia. Methods This is a non-randomized controlled study that collected data on best-corrected visual acuity (BCVA), simultaneous vision, fusion vision, near stereoscopic vision, P100 amplitude (graphic evoked visual potentials), and P100 latency from both eyes at the beginning of the treatment and one year later. The study used the Mann-Whitney U test to compare BCVA contrasts in different subgroups and the independent samples t-test to compare P100 wave amplitude and latency contrasts in different subgroups. The study compared the basic cure rate, simultaneous visual function recovery rate, fusion vision recovery rate, and near stereoscopic recovery rate contrasts in different subgroups using the chi-square test. Results This study included 393 children (217 males and 176 females) aged 3 to 12 years with anisometropic amblyopia who attended the Aier Eye Hospital of Wuhan University from January 2020 to December 2022. The children were divided into two groups: the 4D group (263 cases) and the traditional group (130 cases) based on the treatment modality. The children in the traditional group received treatment through the conventional method of masking and regular training. Meanwhile, the children in the 4D group received treatment through the traditional method and the 4D-DSAAVFCS. The study divided the 4D group of children into two age groups: 3–6 years old (161 cases) and 6 ~ 12 years old (102 cases). The basic cure rate of the 4D group was significantly better than that of the traditional group (χ2 = 4.318, P < 0.05). There were no statistically significant differences found in the comparison of BCVA, latency period of the P100 wave, and amplitude of the P100 wave between the 4D group and the traditional group before treatment (U=-0.117, t=-0.05, P > 0.05 for all). After one year of treatment, a statistically significant difference was observed between the 4D group and the conventional group in terms of BCVA, P100 wave latency, and P100 wave amplitude (U=-1.243, t=-0.853, t=-1.546, P all < 0.05). These results suggest that the 4D group experienced a better therapeutic effect compared to the conventional group. The recovery rates of simultaneous vision, convergent fusion, divergent fusion, and near stereoscopic were significantly higher in the 4D group compared to the conventional group (χ2 = 4.344, 4.726, 5.123, 2.036, all P < 0.05). Additionally, the basic cure rate of children aged 3 ~ 6 years in the 4D group was significantly higher than that of children aged 6 ~ 12 years (χ2 = 2.365, P < 0.05). In the study, BCVA was found to be significantly lower in the 3 ~ 6 years old group compared to the 6 ~ 12 years old group (U = -1.267, P < 0.05). Similarly, P100 wave amplitude was also significantly higher in the 3 ~ 6 years old group compared to the 6 ~ 12 years old group (t = -1877, P < 0.05). The latency of the P100 wave was lower in the 3 ~ 6 years old group compared to the 6 ~ 12 years old group (t=-0.998, P < 0.05). Additionally, the recovery rate of near stereoscopic function was higher in the 3 ~ 6 years old group than in the 6 ~ 12 years old group, with a statistically significant difference (χ2 = 4.534, P < 0.05). Conclusion The study demonstrated that the combination of the traditional method with the 4D-DSAAVFCS was more effective than the traditional method alone in treating amblyopic children. This approach was particularly helpful in improving the visual acuity of the children and restoring their optic nerve conduction function, simultaneous vision, fusion vision, and near stereoscopic vision. The combination of the traditional method and the 4D-DSAAVFCS is more effective for younger children. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Amblyopia is a prevalent cause of visual impairment in children, with a prevalence of up to 1% ~ 4%. It is a disease that has no apparent organic pathology. Without accurate, effective, and consistent treatment during visual development, amblyopia can lead to irreversible visual damage, including vision loss and impaired visual function [1–4] . Amblyopia is a condition that encompasses four types: anisometropia, refractive errors, strabismus, and visual deprivation. Anisometropia is the most prevalent type. Currently, there are various methods for treating amblyopia, such as masking and photoinhibition. These methods aim to enhance the vision of the amblyopic eye by forcing it to work harder. However, blurring the dominant eye can significantly impact a child's learning and daily life, leading to low cooperation and poor compliance during treatment. Previous studies [5] have shown that poor compliance is the most critical factor affecting the treatment effect of anisometropic amblyopia, so these methods have certain limitations in the treatment of anisometropic amblyopia. With the advancement of comprehensive amblyopia treatment, emerging methods such as medication [6] and behavioral treatment have gradually been applied to treat amblyopic children. Behavioral treatments include visual perception training, video game training, binocular vision training, and transcranial magnetic stimulation training [7] . These treatments are gaining more attention due to their fewer side effects. The 4D digital strabismus and amblyopia visual function correction system (4D-DSAAVFCS)is a behavioral treatment developed based on modern neuropsychological theory of visual attention cognition and neurobiological mechanisms of synaptic plasticity [8–11] . It provides personalized training based on children's visual condition using 3D technology. The program aims to enhance visual stimulation through a variety of training games. These games are designed to be enjoyable, with diverse training modes and short treatment times. This approach aims to improve children's treatment adherence and dependence on their visual condition. This study aimed to analysis the clinical effect of the emerging the 4D-DSAAVFCS combined with traditional methods in treating children with anisometropia who were also treated for amblyopia in our hospital. We compared the results with those who were only treated with traditional masking and prescription glasses. The study collected data on children with anisometropia and aimed to provide a comprehensive analysis of the clinical outcomes. 1. Information and methodology 1. Information A non-randomized controlled method was utilized in this study. We included 393 children with anisometropic amblyopia who attended our hospital between January 2020 and December 2022, comprising 217 males and 176 females aged between 3 and 12 years old. The inclusion criteria were as follows: 1. According to the 2021 Amblyopia Expert Consensus [12] criteria, children with monocular amblyopia have a difference of two rows in best corrected visual acuity between their eyes, with the amblyopic eye having the lower visual acuity while the normal eye corresponds to the age of the child. anisometropic Parallax Amblyopia was diagnosed according to the 2021 Amblyopia Expert Consensus [12] criteria. The difference in spherical lens between both eyes was 1.5D, and the difference in column lens was 1.0D. Exclusion criteria were applied. Children with any of the following conditions should be included in the study: binocular amblyopia, anisometropic interstitial clouding, nystagmus, ptosis, fundus abnormality, history of previous ocular trauma, history of surgery, combined systemic diseases, and children too young to cooperate with the examinations. Additionally, only children with a follow-up time of at least 1 year should be included in the study. The study adhered to the requirements of the Declaration of Helsinki, and the Ethics Committee of Aier Eye Hospital of Wuhan University approved the study protocol. The subjects' families comprehended the study's purpose and significance and signed the informed consent form. 2. Methods 2.1 Data collection function and examination methods Record the basic information of the children, including their age and gender. 1. BCVA (best corrected visual acuity). The children's visual acuity was recorded in decimals using the international standard visual acuity chart at 5 m and then converted into logarithm of the minimum angle of resolution(LogMAR) visual acuity standard for statistical purposes. 2. P100 wave (graphically induced visual potential). The amplitude of the P100 wave of the children was checked and recorded using the visual electrophysiological system. The amplitude and latency of the P100 wave were recorded using a visual electrophysiological system, specifically the graphically induced visual potential. 3. Binocular visual function. Binocular visual function was assessed in children by measuring their simultaneous vision and fusion vision (collection and separation functions) using a synoptiscope. Normal simultaneous vision was defined as between + 5° and − 5°, normal collection function was defined as between + 25° and + 30°, and normal separation function was defined as between − 4° and − 6°. Near stereoscopic vision was assessed using the Titmus stereogram, with normal near stereoscopic vision defined as ≤ 60" and values > 80" considered abnormal. The evaluation of BCVA efficacy is based on three criteria: basic cure, effectiveness, and ineffectiveness. Basic cure is achieved when visual acuity increases to 0.9 or above, there is a significant improvement in the anisometropic amblyopia, and there is no recurrence within 6 months. Effectiveness is achieved when visual acuity increases by 2 rows or more. Ineffectiveness is when visual acuity and anisometropia do not improve significantly, or even decrease, and the recurrence rate is high within 1 year. 2.2 Grouping method 2.2.1 Classified into conventional group and 4D group according to different treatment modalities All children in the study underwent a conventional slit lamp examination, fundus examination, and eye position examination. After the children's ciliary muscle paralysis, the optometrist should perform an eye exam on the children, recording their spherical lens degrees, lens degrees, and axial position. The optometrist should then correct the children's refractive errors according to standard prescription principles. The children's degrees should be retested every 3 to 6 months using the same method. If there are significant changes in the children's refractive errors, the optometrist should replace their spectacles or adjust their refractive errors correction method based on the children's specific situation. The treatment is divided into two groups based on the child's condition: traditional group and 4D group. The traditional group involves daily masking and fine training based on the degree of amblyopia. The 4D group involves examining the child for unstable central gaze, paracentral gaze, paracentral macular gaze, peripheral gaze, etc. after the conventional masking method. The child underwent 3D digital corrective training for strabismus and amblyopia to shift the amblyopic eye to macular central gaze. Subsequently, the child received 4D training, which included visual perception, binocular vision, and monocular vision training, as well as binocular distraction and monocular enhancement training, 3 ~ 4 times per week. 2.2.2 The children included in this study were aged 3 ~ 12 years old and were divided into 3 ~ 6 years old and 6 ~ 12 years old groups according to their ages. 3. Statistical methods SPSS version 25.0 was utilized to analyze the data. The mean ± standard deviation of the normally distributed data was determined using the Kolmogorov-Smirnov test, while the independent samples t-test was used to compare the measured data between the two groups. The M (P25 ~ P75) was used to indicate the skewed distribution of the data, and the Mann-Whitney U test was used to compare the measured data between the two groups. The chi-square test was used to analyze differences in the two count data. A p-value of less than 0.05 was considered statistically significant. 2. Results This study included 130 children with amblyopia in the traditional group (130 cases) and 263 children with amblyopia in the 4D group (263 cases). Pre-treatment abnormalities of simultaneous vision, collection function, separation function, near stereoscopic, BCVA, P100 wave amplitude, and P100 wave latency did not differ significantly between the two groups. The comparative results and associations of the pre-treatment data are shown below Table 1 . After one year of treatment, the 4D group showed lower BCVA and higher basic cure rates, simultaneous vision recovery rates, collection function recovery rates, separation function recovery rates, and near stereoscopic function recovery rates compared to the conventional group. The results and associations of the various data between the two groups after treatment are presented in Fig. 1 and Fig. 2 . After simultaneous treatment, the P100 wave amplitude was 13.61 ± 4.83 (µV) in the conventional group and 14.65 ± 4.83 (µV) in the 4D group. The P100 wave amplitude was enhanced in the 4D group, with a statistically significant difference (t=-0.853, P < 0.05), while there was no difference in the amplitude before treatment between the two groups. There was no difference in the P100 wave latency before treatment between the two groups. However, after treatment, the P100 wave latency in the 4D treatment group (107.59 ± 11.83 ms) was significantly shorter compared to the traditional group (109.09 ± 9.29 ms), with statistically significant (t=-1.546, P < 0.05). This suggests that the 4D treatment was more effective in shortening the P100 wave latency than the conventional treatment. Meanwhile, in the 4D group, the children were divided into 3 ~ 6 years old group (161 cases) and 6 ~ 12 years old group (102 cases), and it was found that the basic cure rate and BCVA of the children in the 3 ~ 6 years old group were lower than that of the 6 ~ 12 years old group, and the comparison of the data of the two groups is shown in Fig. 3 and Fig. 4 . Meanwhile, the P100 wave amplitude of the children in the 3 ~ 6 years old group was 14.98 ± 2.22 (µV), and that in the 6 ~ 12 years old group was 14.33 ± 4.31 (µV), the difference was statistically different (t=-1.877, P < 0.05), indicating that the enhancement of P100 wave amplitude after treatment was higher in the 3 ~ 6 years old group than in the 6 ~ 12 years old group, and the latency of the P100 wave wave in the 3 ~ 6 years old group was 107.11 ± 7.39 (ms), and in the 6 ~ 12 years old group was 108.02 ± 12.34 (ms), and the difference had a statistically different (t=-0.998, P < 0.05), indicating that the shortening of P100 wave latency after treatment was higher in the 3 ~ 6 year old group than in the 6 ~ 12 year old group. Table 1 Comparison of various baseline data of children in the two groups Groups Number of cases SVA(cases/%) CFA (cases/%) SFA(cases/%) NSA(cases/%) BCVA P-100 wave amplification (µV) P-100 wave Latency (ms) Traditional Group 130 80(61.54) 84(64.62) 82(63.08) 91(70.00) 0.6(0.52, 0.91) 11.19 ± 5.17 117.19 ± 10.56 4D Group 263 168(63.88) 180(68.44) 181(68.82) 197(74.90) 0.6(0.50, 0.90) 11.82 ± 6.06 117.38 ± 10.75 χ2/U/t 0.445 0.349 0.098 0.298 -0.117 -0.837 -1.225 P 0.213 0.324 0.162 0.446 0.673 0.443 0.245 Table 1 . SVA is simultaneous vision abnormality. CFA is collection function Abnormality. SFA is separation function function abnormality. NSA is near stereoscopic abnormality. 3. Discussion In this study, the cure rate of amblyopia and improvement of visual acuity were better when the traditional treatment was combined with the 4D-DSAAVFCS, compared to traditional treatment alone. The visual acuity improvement effect of children with anisometropic amblyopia who were treated with traditional prescription glasses and masking treatment was not very satisfactory, which was mainly due to poor cooperation and compliance during treatment. The 4D-DSAAVFCS utilizes Internet and virtual reality technology. It can be combined with personalized training backgrounds based on children's visual acuity, fine resolution, stimulation thresholds, or age. The system conducts fine eye training, binocular vision training, and visual perception training through training games and 3D near stereoscopic videos. Binocular vision training involves providing different contrast images to the dominant and amblyopic eyes, constantly adjusting the contrast to achieve the same clarity of binocular stimuli. This balances the visual input signals of both eyes, enhances binocular connection, and stimulates neurons receiving stimuli and excitation input from both eyes [13–14] . Additionally, visual perceptual training encompasses fusion, fine vision, balance, motor, and bilateral body coordination training. This training combines newly learned visual functions with other functions to improve binocular visual function through the cooperation of the brain, eyes, and hands. It enhances the plasticity of the visual cortex and improves visual acuity [15] . This study found that the cure rate and visual acuity of amblyopic children significantly improved after adding the treatment method of 4D digital amblyopia strabismus correction system training. These results suggest that the 4D digital amblyopia strabismus correction system has a positive impact on the treatment of anisometropic amblyopic children, which is consistent with previous studies. Clinical studies have shown [16] that children with amblyopia have lower visual acuity, simultaneous vision, fusion vision, and near stereoscopic vision than their normal peers. The degree of visual function impairment is higher in anisometropic amblyopia than in other types of amblyopia. Therefore, when treating anisometropic amblyopia in children, it is important to focus not only on improving visual acuity but also on improving visual function. The traditional method for treating anisometropic amblyopia involves correcting the anisometropic error of amblyopic children and then covering the eye. This method can improve the visual acuity of the amblyopic eye to a certain extent, but has limited effect on improving near stereoscopic vision and other visual functions of the children [17–19] . This is because after treating amblyopia with monocular cover, the signal strength of both eyes remains unbalanced, and visual function remains defective, which may easily hinder the improvement of visual function of both eyes. After treating amblyopia with monocular masking, the signal strength from both eyes remains unbalanced and the visual function of both eyes remains defective. This can lead to a recurrence of amblyopia after treatment. The P100 wave reflects the potential generated by the visual cortex in response to image stimulation of a certain intensity. The retina is stimulated by alternating images of appropriate spatial and temporal frequencies, and the potential changes of visual conduction from the retina to any part of the visual cortex are recorded. Clinically, the P100 wave is primarily recorded to measure nerve conduction. It reflects the speed of photochemical signal transduction from the retina to the optic cortex, while its amplitude reflects visual sensitivity and the number and function of ganglion cells. This makes it an important index for detecting macular function and the state of optic nerve conduction [20–21] . In the present study, the traditional modality was combined with the 4D-DSAAVFCS. The results showed an increase in P100 wave amplitude and a shortening of P100 wave latency. These findings suggest that the addition of the 4D-DSAAVFCS not only improves children's visual acuity but also enhances their optic nerve conduction function. The previous treatment, which involved masking the dominant eye to blur the healthy eye and improve visual acuity, is not very effective in establishing simultaneous vision, fusion vision, and near stereoscopic vision in children with amblyopia. On the other hand, the 4D-DSAAVFCS, which is based on binocular division of vision, starts training simultaneous vision and fusion vision at the early stage of amblyopia treatment. This approach theoretically avoids the negative effect of masking the dominant eye on the restoration of binocular visual function. The study revealed that the recovery rates of simultaneous vision, fusion vision, and near stereoscopic vision were higher than those of the traditional modality when the 4D-DSAAVFCS was added to the traditional modality for 1 year, which is consistent with previous studies on the treatment with the 4D-DSAAVFCS [22] . Previous studies [23–24] have concluded that the sensitive period for children's visual development is between the ages of 3 and 6. In the presented study, the cure rate of amblyopia, the improvement of visual acuity, and the reconstruction rate of near stereoscopic vision in the 3 ~ 6 years old group were significantly better than those in the 6 ~ 12 years old group, The results of this study suggest that the traditional modality combined with the treatment of 4D-DSAAVFCS had a greater effect on younger children, as indicated by the increase in P100 wave amplitude and shortening of the latency period. The study focused on anisometropic difference type of strabismus and provides evidence for the early treatment of children with anisometropia. In summarize, when treating amblyopic children, it is important to combine traditional methods with the 4D-DSAAVFCS, in addition to prescription glasses, masking, and other treatments. This combination has been shown to be more effective than traditional methods alone, and can help improve children's visual acuity as well as restore simultaneous vision, fusion vision, and near stereoscopic vision. Additionally, it is worth noting that traditional methods and the 4D-DSAAVFCS tend to be more effective when used on younger children. Declarations 1. all participating authors in this study agreed to contribute to the manuscript 2、This study is not supported by any funding program 3. Human ethics and consent to participate have been stated in the methodology of the article. 4、The data in this study are available 5. There is no competition in this study. Author Contribution Huangen Li and Yinyan Qin were responsible for data collection, statistics of data, and writing of the article.Ting Peng is responsible for part of the data collection, part of the data statistics.All authors reviewed the manuscript. Data Availability The authors of the data for this study collected information from the patients and then assembled it in the form of a data table, which can be provided by the authors if desired References M. H. Sharif, M. R. Talebnejad, K. Rastegar, M. R. Khalili and M. H. Nowroozzadeh, "Oral fluoxetine in the management of amblyopic patients aged between 10 and 40 years old: a randomized clinical trial," Eye vol. 33, no. 7, pp. 1060-1067, 2019. M. Dirani, B. Zhou, D. Hornbeak, B. C. Chang, G. Gazzard, A. Chia, Y. Ling, P. Selvaraj, T. L. Young, R. Varma, T. Y. Wong and S. M. Saw, "Prevalence and causes of decreased visual acuity in Singaporean Chinese preschoolers," Br. J. 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Cite Share Download PDF Status: Published Journal Publication published 04 Oct, 2024 Read the published version in BMC Ophthalmology → Version 1 posted Editorial decision: Revision requested 30 May, 2024 Submission checks completed at journal 16 May, 2024 Editor assigned by journal 16 May, 2024 First submitted to journal 10 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4398992","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306393007,"identity":"c39dc68c-6d22-40d5-9f34-c8af0d471630","order_by":0,"name":"Huangen Li","email":"","orcid":"","institution":"Aier Eye Hospital of Wuhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huangen","middleName":"","lastName":"Li","suffix":""},{"id":306393008,"identity":"44903915-6e39-479b-81d6-82921887b6ee","order_by":1,"name":"Ting Peng","email":"","orcid":"","institution":"Aier Eye Hospital of Wuhan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"Peng","suffix":""},{"id":306393009,"identity":"c6076abd-f139-406c-b692-c02a3d7d2dce","order_by":2,"name":"Yinyan Qin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDACdiDmMWCr52dmPnDgww9itDCDtFTwJUi2syUenNlDtJYzcgkG53mMD3OwEaGDv5n5mMTbNrM8hsM8Hw4z8DDI84sdwK9F4jBbmuTctrRixmbeDYcLLBgMZ85OwK/FgJnHTJq37RhjMzNQywwehgSD28Rp+c/Yxszz4DAPG7FaeM6wJfYw8zAQpwXol2TLORVsxhLMbAbAQJYg7Bf+9uaDN94YsMnZnz/8+MOHHzby/NIEtGDYSpryUTAKRsEoGAXYAQDWMj1zdoA/IgAAAABJRU5ErkJggg==","orcid":"","institution":"Aier Eye Hospital of Wuhan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yinyan","middleName":"","lastName":"Qin","suffix":""}],"badges":[],"createdAt":"2024-05-10 07:40:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4398992/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4398992/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12886-024-03703-3","type":"published","date":"2024-10-04T15:58:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57449381,"identity":"cd9f31b0-a39e-4e18-b4e6-e22c7f6c0223","added_by":"auto","created_at":"2024-05-30 20:10:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44083,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of basic cure rate, simultaneous vision abnormality, fusion vision abnormality, and near stereoscopic abnormality between the two groups after 1 year of treatment.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4398992/v1/3d0c0be2088cf78c3ad9ccf2.png"},{"id":57449382,"identity":"dabe7ac1-87b3-4794-a726-37fa0888fc79","added_by":"auto","created_at":"2024-05-30 20:10:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17445,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of BCVA between the two groups after 1 year of treatment.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4398992/v1/2ab17abefb42e2798af676df.png"},{"id":57449383,"identity":"5e444ee6-a077-4cd2-90bf-8039f19955d7","added_by":"auto","created_at":"2024-05-30 20:10:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28376,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of basic cure rate, simultaneous vision abnormality, fusion vision abnormality, and near stereoscopic abnormality between the 3~6 years old group and the 6~12 years old group after 1 year of treatment.\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4398992/v1/f73cc3bc85718dff35e24f0f.png"},{"id":57449384,"identity":"fa31af13-9844-4905-8f98-a7fa8eb18b80","added_by":"auto","created_at":"2024-05-30 20:10:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":17324,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of BCVA between the 3~6 years old group and the 6~12 years old group after 1 year of treatment.\u003c/p\u003e","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-4398992/v1/55110a1dfc2234dfca9c84d1.png"},{"id":66097541,"identity":"49654add-449b-4273-9886-fa21c4504fa7","added_by":"auto","created_at":"2024-10-07 16:14:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":470401,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4398992/v1/d55263a4-ddd7-49e5-847a-44d86862ec3a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the clinical effect of 4D digital strabismus and amblyopia visual function correction system combined with traditional comprehensive treatment methods on anisometropic amblyopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAmblyopia is a prevalent cause of visual impairment in children, with a prevalence of up to 1% ~ 4%. It is a disease that has no apparent organic pathology. Without accurate, effective, and consistent treatment during visual development, amblyopia can lead to irreversible visual damage, including vision loss and impaired visual function\u003csup\u003e[1\u0026ndash;4]\u003c/sup\u003e. Amblyopia is a condition that encompasses four types: anisometropia, refractive errors, strabismus, and visual deprivation. Anisometropia is the most prevalent type.\u003c/p\u003e \u003cp\u003eCurrently, there are various methods for treating amblyopia, such as masking and photoinhibition. These methods aim to enhance the vision of the amblyopic eye by forcing it to work harder. However, blurring the dominant eye can significantly impact a child's learning and daily life, leading to low cooperation and poor compliance during treatment. Previous studies \u003csup\u003e[5]\u003c/sup\u003e have shown that poor compliance is the most critical factor affecting the treatment effect of anisometropic amblyopia, so these methods have certain limitations in the treatment of anisometropic amblyopia.\u003c/p\u003e \u003cp\u003eWith the advancement of comprehensive amblyopia treatment, emerging methods such as medication \u003csup\u003e[6]\u003c/sup\u003e and behavioral treatment have gradually been applied to treat amblyopic children. Behavioral treatments include visual perception training, video game training, binocular vision training, and transcranial magnetic stimulation training \u003csup\u003e[7]\u003c/sup\u003e. These treatments are gaining more attention due to their fewer side effects. The 4D digital strabismus and amblyopia visual function correction system (4D-DSAAVFCS)is a behavioral treatment developed based on modern neuropsychological theory of visual attention cognition and neurobiological mechanisms of synaptic plasticity \u003csup\u003e[8\u0026ndash;11]\u003c/sup\u003e. It provides personalized training based on children's visual condition using 3D technology. The program aims to enhance visual stimulation through a variety of training games. These games are designed to be enjoyable, with diverse training modes and short treatment times. This approach aims to improve children's treatment adherence and dependence on their visual condition.\u003c/p\u003e \u003cp\u003eThis study aimed to analysis the clinical effect of the emerging the 4D-DSAAVFCS combined with traditional methods in treating children with anisometropia who were also treated for amblyopia in our hospital. We compared the results with those who were only treated with traditional masking and prescription glasses. The study collected data on children with anisometropia and aimed to provide a comprehensive analysis of the clinical outcomes.\u003c/p\u003e "},{"header":"1. Information and methodology","content":"\u003ch2\u003e1. Information\u003c/h2\u003e\u003cp\u003eA non-randomized controlled method was utilized in this study. We included 393 children with anisometropic amblyopia who attended our hospital between January 2020 and December 2022, comprising 217 males and 176 females aged between 3 and 12 years old. The inclusion criteria were as follows: 1. According to the 2021 Amblyopia Expert Consensus \u003csup\u003e[12]\u003c/sup\u003e criteria, children with monocular amblyopia have a difference of two rows in best corrected visual acuity between their eyes, with the amblyopic eye having the lower visual acuity while the normal eye corresponds to the age of the child. anisometropic Parallax Amblyopia was diagnosed according to the 2021 Amblyopia Expert Consensus \u003csup\u003e[12]\u003c/sup\u003e criteria. The difference in spherical lens between both eyes was 1.5D, and the difference in column lens was 1.0D. Exclusion criteria were applied. Children with any of the following conditions should be included in the study: binocular amblyopia, anisometropic interstitial clouding, nystagmus, ptosis, fundus abnormality, history of previous ocular trauma, history of surgery, combined systemic diseases, and children too young to cooperate with the examinations. Additionally, only children with a follow-up time of at least 1 year should be included in the study. The study adhered to the requirements of the Declaration of Helsinki, and the Ethics Committee of Aier Eye Hospital of Wuhan University approved the study protocol. The subjects' families comprehended the study's purpose and significance and signed the informed consent form.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2. Methods\u003c/h2\u003e \u003cp\u003e2.1 Data collection function and examination methods\u003c/p\u003e \u003cp\u003eRecord the basic information of the children, including their age and gender. 1. BCVA (best corrected visual acuity). The children's visual acuity was recorded in decimals using the international standard visual acuity chart at 5 m and then converted into logarithm of the minimum angle of resolution(LogMAR) visual acuity standard for statistical purposes. 2. P100 wave (graphically induced visual potential). The amplitude of the P100 wave of the children was checked and recorded using the visual electrophysiological system. The amplitude and latency of the P100 wave were recorded using a visual electrophysiological system, specifically the graphically induced visual potential. 3. Binocular visual function. Binocular visual function was assessed in children by measuring their simultaneous vision and fusion vision (collection and separation functions) using a synoptiscope. Normal simultaneous vision was defined as between +\u0026thinsp;5\u0026deg; and \u0026minus;\u0026thinsp;5\u0026deg;, normal collection function was defined as between +\u0026thinsp;25\u0026deg; and +\u0026thinsp;30\u0026deg;, and normal separation function was defined as between \u0026minus;\u0026thinsp;4\u0026deg; and \u0026minus;\u0026thinsp;6\u0026deg;. Near stereoscopic vision was assessed using the Titmus stereogram, with normal near stereoscopic vision defined as \u0026le;\u0026thinsp;60\" and values\u0026thinsp;\u0026gt;\u0026thinsp;80\" considered abnormal. The evaluation of BCVA efficacy is based on three criteria: basic cure, effectiveness, and ineffectiveness. Basic cure is achieved when visual acuity increases to 0.9 or above, there is a significant improvement in the anisometropic amblyopia, and there is no recurrence within 6 months. Effectiveness is achieved when visual acuity increases by 2 rows or more. Ineffectiveness is when visual acuity and anisometropia do not improve significantly, or even decrease, and the recurrence rate is high within 1 year.\u003c/p\u003e \u003cp\u003e2.2 Grouping method\u003c/p\u003e\u003cp\u003e2.2.1 Classified into conventional group and 4D group according to different treatment modalities\u003c/p\u003e \u003cp\u003eAll children in the study underwent a conventional slit lamp examination, fundus examination, and eye position examination. After the children's ciliary muscle paralysis, the optometrist should perform an eye exam on the children, recording their spherical lens degrees, lens degrees, and axial position. The optometrist should then correct the children's refractive errors according to standard prescription principles. The children's degrees should be retested every 3 to 6 months using the same method. If there are significant changes in the children's refractive errors, the optometrist should replace their spectacles or adjust their refractive errors correction method based on the children's specific situation. The treatment is divided into two groups based on the child's condition: traditional group and 4D group. The traditional group involves daily masking and fine training based on the degree of amblyopia. The 4D group involves examining the child for unstable central gaze, paracentral gaze, paracentral macular gaze, peripheral gaze, etc. after the conventional masking method. The child underwent 3D digital corrective training for strabismus and amblyopia to shift the amblyopic eye to macular central gaze. Subsequently, the child received 4D training, which included visual perception, binocular vision, and monocular vision training, as well as binocular distraction and monocular enhancement training, 3\u0026thinsp;~\u0026thinsp;4 times per week.\u003c/p\u003e \u003cp\u003e2.2.2 The children included in this study were aged 3\u0026thinsp;~\u0026thinsp;12 years old and were divided into 3\u0026thinsp;~\u0026thinsp;6 years old and 6\u0026thinsp;~\u0026thinsp;12 years old groups according to their ages.\u003c/p\u003e\u003cp\u003e3. Statistical methods\u003c/p\u003e \u003cp\u003eSPSS version 25.0 was utilized to analyze the data. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation of the normally distributed data was determined using the Kolmogorov-Smirnov test, while the independent samples t-test was used to compare the measured data between the two groups. The M (P25\u0026thinsp;~\u0026thinsp;P75) was used to indicate the skewed distribution of the data, and the Mann-Whitney U test was used to compare the measured data between the two groups. The chi-square test was used to analyze differences in the two count data. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Results","content":"\u003cp\u003eThis study included 130 children with amblyopia in the traditional group (130 cases) and 263 children with amblyopia in the 4D group (263 cases). Pre-treatment abnormalities of simultaneous vision, collection function, separation function, near stereoscopic, BCVA, P100 wave amplitude, and P100 wave latency did not differ significantly between the two groups. The comparative results and associations of the pre-treatment data are shown below Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAfter one year of treatment, the 4D group showed lower BCVA and higher basic cure rates, simultaneous vision recovery rates, collection function recovery rates, separation function recovery rates, and near stereoscopic function recovery rates compared to the conventional group. The results and associations of the various data between the two groups after treatment are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. After simultaneous treatment, the P100 wave amplitude was 13.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83 (\u0026micro;V) in the conventional group and 14.65\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83 (\u0026micro;V) in the 4D group. The P100 wave amplitude was enhanced in the 4D group, with a statistically significant difference (t=-0.853, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while there was no difference in the amplitude before treatment between the two groups. There was no difference in the P100 wave latency before treatment between the two groups. However, after treatment, the P100 wave latency in the 4D treatment group (107.59\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83 ms) was significantly shorter compared to the traditional group (109.09\u0026thinsp;\u0026plusmn;\u0026thinsp;9.29 ms), with statistically significant (t=-1.546, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This suggests that the 4D treatment was more effective in shortening the P100 wave latency than the conventional treatment.\u003c/p\u003e \u003cp\u003eMeanwhile, in the 4D group, the children were divided into 3\u0026thinsp;~\u0026thinsp;6 years old group (161 cases) and 6\u0026thinsp;~\u0026thinsp;12 years old group (102 cases), and it was found that the basic cure rate and BCVA of the children in the 3\u0026thinsp;~\u0026thinsp;6 years old group were lower than that of the 6\u0026thinsp;~\u0026thinsp;12 years old group, and the comparison of the data of the two groups is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Meanwhile, the P100 wave amplitude of the children in the 3\u0026thinsp;~\u0026thinsp;6 years old group was 14.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22 (\u0026micro;V), and that in the 6\u0026thinsp;~\u0026thinsp;12 years old group was 14.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31 (\u0026micro;V), the difference was statistically different (t=-1.877, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that the enhancement of P100 wave amplitude after treatment was higher in the 3\u0026thinsp;~\u0026thinsp;6 years old group than in the 6\u0026thinsp;~\u0026thinsp;12 years old group, and the latency of the P100 wave wave in the 3\u0026thinsp;~\u0026thinsp;6 years old group was 107.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.39 (ms), and in the 6\u0026thinsp;~\u0026thinsp;12 years old group was 108.02\u0026thinsp;\u0026plusmn;\u0026thinsp;12.34 (ms), and the difference had a statistically different (t=-0.998, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that the shortening of P100 wave latency after treatment was higher in the 3\u0026thinsp;~\u0026thinsp;6 year old group than in the 6\u0026thinsp;~\u0026thinsp;12 year old group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of various baseline data of children in the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSVA(cases/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCFA (cases/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSFA(cases/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNSA(cases/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBCVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-100 wave amplification (\u0026micro;V)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP-100 wave\u003c/p\u003e \u003cp\u003eLatency (ms)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80(61.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84(64.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e82(63.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e91(70.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.6(0.52, 0.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.19\u0026thinsp;\u0026plusmn;\u0026thinsp;5.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e117.19\u0026thinsp;\u0026plusmn;\u0026thinsp;10.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4D Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e168(63.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e180(68.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e181(68.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e197(74.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.6(0.50, 0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e117.38\u0026thinsp;\u0026plusmn;\u0026thinsp;10.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eχ2/U/t\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.837\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. SVA is simultaneous vision abnormality. CFA is collection function Abnormality. SFA is separation function function abnormality. NSA is near stereoscopic abnormality.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eIn this study, the cure rate of amblyopia and improvement of visual acuity were better when the traditional treatment was combined with the 4D-DSAAVFCS, compared to traditional treatment alone. The visual acuity improvement effect of children with anisometropic amblyopia who were treated with traditional prescription glasses and masking treatment was not very satisfactory, which was mainly due to poor cooperation and compliance during treatment. The 4D-DSAAVFCS utilizes Internet and virtual reality technology. It can be combined with personalized training backgrounds based on children's visual acuity, fine resolution, stimulation thresholds, or age. The system conducts fine eye training, binocular vision training, and visual perception training through training games and 3D near stereoscopic videos. Binocular vision training involves providing different contrast images to the dominant and amblyopic eyes, constantly adjusting the contrast to achieve the same clarity of binocular stimuli. This balances the visual input signals of both eyes, enhances binocular connection, and stimulates neurons receiving stimuli and excitation input from both eyes\u003csup\u003e[13\u0026ndash;14]\u003c/sup\u003e. Additionally, visual perceptual training encompasses fusion, fine vision, balance, motor, and bilateral body coordination training. This training combines newly learned visual functions with other functions to improve binocular visual function through the cooperation of the brain, eyes, and hands. It enhances the plasticity of the visual cortex and improves visual acuity\u003csup\u003e[15]\u003c/sup\u003e. This study found that the cure rate and visual acuity of amblyopic children significantly improved after adding the treatment method of 4D digital amblyopia strabismus correction system training. These results suggest that the 4D digital amblyopia strabismus correction system has a positive impact on the treatment of anisometropic amblyopic children, which is consistent with previous studies.\u003c/p\u003e \u003cp\u003eClinical studies have shown\u003csup\u003e[16]\u003c/sup\u003e that children with amblyopia have lower visual acuity, simultaneous vision, fusion vision, and near stereoscopic vision than their normal peers. The degree of visual function impairment is higher in anisometropic amblyopia than in other types of amblyopia. Therefore, when treating anisometropic amblyopia in children, it is important to focus not only on improving visual acuity but also on improving visual function. The traditional method for treating anisometropic amblyopia involves correcting the anisometropic error of amblyopic children and then covering the eye. This method can improve the visual acuity of the amblyopic eye to a certain extent, but has limited effect on improving near stereoscopic vision and other visual functions of the children\u003csup\u003e[17\u0026ndash;19]\u003c/sup\u003e. This is because after treating amblyopia with monocular cover, the signal strength of both eyes remains unbalanced, and visual function remains defective, which may easily hinder the improvement of visual function of both eyes. After treating amblyopia with monocular masking, the signal strength from both eyes remains unbalanced and the visual function of both eyes remains defective. This can lead to a recurrence of amblyopia after treatment.\u003c/p\u003e \u003cp\u003eThe P100 wave reflects the potential generated by the visual cortex in response to image stimulation of a certain intensity. The retina is stimulated by alternating images of appropriate spatial and temporal frequencies, and the potential changes of visual conduction from the retina to any part of the visual cortex are recorded. Clinically, the P100 wave is primarily recorded to measure nerve conduction. It reflects the speed of photochemical signal transduction from the retina to the optic cortex, while its amplitude reflects visual sensitivity and the number and function of ganglion cells. This makes it an important index for detecting macular function and the state of optic nerve conduction\u003csup\u003e[20\u0026ndash;21]\u003c/sup\u003e. In the present study, the traditional modality was combined with the 4D-DSAAVFCS. The results showed an increase in P100 wave amplitude and a shortening of P100 wave latency. These findings suggest that the addition of the 4D-DSAAVFCS not only improves children's visual acuity but also enhances their optic nerve conduction function.\u003c/p\u003e \u003cp\u003eThe previous treatment, which involved masking the dominant eye to blur the healthy eye and improve visual acuity, is not very effective in establishing simultaneous vision, fusion vision, and near stereoscopic vision in children with amblyopia. On the other hand, the 4D-DSAAVFCS, which is based on binocular division of vision, starts training simultaneous vision and fusion vision at the early stage of amblyopia treatment. This approach theoretically avoids the negative effect of masking the dominant eye on the restoration of binocular visual function. The study revealed that the recovery rates of simultaneous vision, fusion vision, and near stereoscopic vision were higher than those of the traditional modality when the 4D-DSAAVFCS was added to the traditional modality for 1 year, which is consistent with previous studies on the treatment with the 4D-DSAAVFCS \u003csup\u003e[22]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePrevious studies\u003csup\u003e[23\u0026ndash;24]\u003c/sup\u003e have concluded that the sensitive period for children's visual development is between the ages of 3 and 6. In the presented study, the cure rate of amblyopia, the improvement of visual acuity, and the reconstruction rate of near stereoscopic vision in the 3\u0026thinsp;~\u0026thinsp;6 years old group were significantly better than those in the 6\u0026thinsp;~\u0026thinsp;12 years old group, The results of this study suggest that the traditional modality combined with the treatment of 4D-DSAAVFCS had a greater effect on younger children, as indicated by the increase in P100 wave amplitude and shortening of the latency period. The study focused on anisometropic difference type of strabismus and provides evidence for the early treatment of children with anisometropia.\u003c/p\u003e \u003cp\u003eIn summarize, when treating amblyopic children, it is important to combine traditional methods with the 4D-DSAAVFCS, in addition to prescription glasses, masking, and other treatments. This combination has been shown to be more effective than traditional methods alone, and can help improve children's visual acuity as well as restore simultaneous vision, fusion vision, and near stereoscopic vision. Additionally, it is worth noting that traditional methods and the 4D-DSAAVFCS tend to be more effective when used on younger children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e1. all participating authors in this study agreed to contribute to the manuscript\u003c/p\u003e \u003cp\u003e2、This study is not supported by any funding program\u003c/p\u003e \u003cp\u003e3. Human ethics and consent to participate have been stated in the methodology of the article.\u003c/p\u003e \u003cp\u003e4、The data in this study are available\u003c/p\u003e \u003cp\u003e5. There is no competition in this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHuangen Li and Yinyan Qin were responsible for data collection, statistics of data, and writing of the article.Ting Peng is responsible for part of the data collection, part of the data statistics.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe authors of the data for this study collected information from the patients and then assembled it in the form of a data table, which can be provided by the authors if desired\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eM. H. Sharif, M. R. Talebnejad, K. Rastegar, M. R. Khalili and M. H. 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Fakhry, \u0026quot;Changes in binocular function in anisometropic nonstrabismic children with optical correction and occlusion therapy,\u0026quot; \u003cem\u003eJournal of American Association for Pediatric Ophthalmology and Strabismus\u003c/em\u003e vol. 15, no. 6, pp. 545-550, 2011.\u003c/li\u003e\n\u003cli\u003eA. M. F. Wong, \u0026quot;New concepts concerning the neural mechanisms of amblyopia and their clinical implications,\u0026quot; \u003cem\u003eCanadian Journal of Ophthalmology\u003c/em\u003e vol. 47, no. 5, pp. 399-409, 2012.\u003c/li\u003e\n\u003cli\u003eD. K. Wallace, E. L. Lazar, M. Melia, E. E. Birch, J. M. Holmes, K. B. Hopkins, R. T. Kraker, M. T. Kulp, Y. Pang, M. X. Repka, S. M. Tamkins and K. K. Weise, \u0026quot;Stereoacuity in children with anisometropic amblyopia,\u0026quot; \u003cem\u003eJournal of American Association for Pediatric Ophthalmology and Strabismus\u003c/em\u003e vol. 15, no. 5, pp. 455-461, 2011.\u003c/li\u003e\n\u003cli\u003eB.-B. Niu, N. Tang, Q. Xu and P.-W. Chai, \u0026quot;Genomic Disruption of FOXL2 in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome Type 2: A Novel Deletion-Insertion Compound Mutation,\u0026quot; \u003cem\u003eChinese Medical Journal\u003c/em\u003e vol. 131, no. 19, pp. 2380-2383, 2018.\u003c/li\u003e\n\u003cli\u003eK. W. Wright, K. J. Eriksen and T. J. Shors, \u0026quot;Detection of Amblyopia With P-VEP During Chloral Hydrate Sedation,\u0026quot; \u003cem\u003eJournal of Pediatric Ophthalmology \u0026amp;amp; Strabismus\u003c/em\u003e vol. 24, no. 4, pp. 170-175, 1987.\u003c/li\u003e\n\u003cli\u003eC. Williams and D. Papakostopoulos, \u0026quot;Electro-oculographic abnormalities in amblyopia,\u0026quot; \u003cem\u003eBritish Journal of Ophthalmology\u003c/em\u003e vol. 79, no. 3, pp. 218, 1995.\u003c/li\u003e\n\u003cli\u003eW. G. Ondo, K. Dat Vuong and Q. Wang, \u0026quot;Restless legs syndrome in monozygotic twins: Clinical correlates,\u0026quot; \u003cem\u003eNeurology\u003c/em\u003e vol. 55, no. 9, pp. 1404-1407, 2000.\u003c/li\u003e\n\u003cli\u003eM. F. Marmor, G. E. Holder, M. W. Seeliger and S. Yamamoto, \u0026quot;Standard for clinical electroretinography (2004 update),\u0026quot; \u003cem\u003eDocumenta Ophthalmologica\u003c/em\u003e vol. 108, no. 2, pp. 107-114, 2004.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4398992/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4398992/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe objective of this study is to evaluate the clinical efficacy of the 4D digital strabismus and amblyopia visual function correction system(4D-DSAAVFCS) in combination with conventional modalities compared to conventional modalities alone in children with anisometropic amblyopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis is a non-randomized controlled study that collected data on best-corrected visual acuity (BCVA), simultaneous vision, fusion vision, near stereoscopic vision, P100 amplitude (graphic evoked visual potentials), and P100 latency from both eyes at the beginning of the treatment and one year later. The study used the Mann-Whitney U test to compare BCVA contrasts in different subgroups and the independent samples t-test to compare P100 wave amplitude and latency contrasts in different subgroups. The study compared the basic cure rate, simultaneous visual function recovery rate, fusion vision recovery rate, and near stereoscopic recovery rate contrasts in different subgroups using the chi-square test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThis study included 393 children (217 males and 176 females) aged 3 to 12 years with anisometropic amblyopia who attended the Aier Eye Hospital of Wuhan University from January 2020 to December 2022. The children were divided into two groups: the 4D group (263 cases) and the traditional group (130 cases) based on the treatment modality. The children in the traditional group received treatment through the conventional method of masking and regular training. Meanwhile, the children in the 4D group received treatment through the traditional method and the 4D-DSAAVFCS. The study divided the 4D group of children into two age groups: 3\u0026ndash;6 years old (161 cases) and 6\u0026thinsp;~\u0026thinsp;12 years old (102 cases). The basic cure rate of the 4D group was significantly better than that of the traditional group (χ2\u0026thinsp;=\u0026thinsp;4.318, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There were no statistically significant differences found in the comparison of BCVA, latency period of the P100 wave, and amplitude of the P100 wave between the 4D group and the traditional group before treatment (U=-0.117, t=-0.05, P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all). After one year of treatment, a statistically significant difference was observed between the 4D group and the conventional group in terms of BCVA, P100 wave latency, and P100 wave amplitude (U=-1.243, t=-0.853, t=-1.546, P all \u0026lt;\u0026thinsp;0.05). These results suggest that the 4D group experienced a better therapeutic effect compared to the conventional group. The recovery rates of simultaneous vision, convergent fusion, divergent fusion, and near stereoscopic were significantly higher in the 4D group compared to the conventional group (χ2\u0026thinsp;=\u0026thinsp;4.344, 4.726, 5.123, 2.036, all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the basic cure rate of children aged 3\u0026thinsp;~\u0026thinsp;6 years in the 4D group was significantly higher than that of children aged 6\u0026thinsp;~\u0026thinsp;12 years (χ2\u0026thinsp;=\u0026thinsp;2.365, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the study, BCVA was found to be significantly lower in the 3\u0026thinsp;~\u0026thinsp;6 years old group compared to the 6\u0026thinsp;~\u0026thinsp;12 years old group (U = -1.267, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Similarly, P100 wave amplitude was also significantly higher in the 3\u0026thinsp;~\u0026thinsp;6 years old group compared to the 6\u0026thinsp;~\u0026thinsp;12 years old group (t = -1877, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The latency of the P100 wave was lower in the 3\u0026thinsp;~\u0026thinsp;6 years old group compared to the 6\u0026thinsp;~\u0026thinsp;12 years old group (t=-0.998, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, the recovery rate of near stereoscopic function was higher in the 3\u0026thinsp;~\u0026thinsp;6 years old group than in the 6\u0026thinsp;~\u0026thinsp;12 years old group, with a statistically significant difference (χ2\u0026thinsp;=\u0026thinsp;4.534, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study demonstrated that the combination of the traditional method with the 4D-DSAAVFCS was more effective than the traditional method alone in treating amblyopic children. This approach was particularly helpful in improving the visual acuity of the children and restoring their optic nerve conduction function, simultaneous vision, fusion vision, and near stereoscopic vision. The combination of the traditional method and the 4D-DSAAVFCS is more effective for younger children.\u003c/p\u003e","manuscriptTitle":"Evaluation of the clinical effect of 4D digital strabismus and amblyopia visual function correction system combined with traditional comprehensive treatment methods on anisometropic amblyopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-30 20:10:02","doi":"10.21203/rs.3.rs-4398992/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-30T09:11:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-16T13:25:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-16T13:25:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2024-05-10T07:39:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bc7ea54e-2372-42b4-a4db-07a2e31ae4f2","owner":[],"postedDate":"May 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-07T16:09:25+00:00","versionOfRecord":{"articleIdentity":"rs-4398992","link":"https://doi.org/10.1186/s12886-024-03703-3","journal":{"identity":"bmc-ophthalmology","isVorOnly":false,"title":"BMC Ophthalmology"},"publishedOn":"2024-10-04 15:58:24","publishedOnDateReadable":"October 4th, 2024"},"versionCreatedAt":"2024-05-30 20:10:02","video":"","vorDoi":"10.1186/s12886-024-03703-3","vorDoiUrl":"https://doi.org/10.1186/s12886-024-03703-3","workflowStages":[]},"version":"v1","identity":"rs-4398992","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4398992","identity":"rs-4398992","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}