Multimodal Therapy in Anisometropic Amblyopia

Visual acuity (VA) was assessed using a standard Snellen chart under both monocular and binocular viewing conditions. Participants were instructed to read optotypes from a distance of 6 meters for distance vision and 40 cm for near vision. Each eye was tested separately, followed by binocular testing. The smallest optotype correctly identified was recorded as the VA score. Results were documented in Snellen fractions and converted to decimal values for statistical analysis (e.g., 20/20 = 1.0; 20/40 = 0.5; 20/100 = 0.2). Higher decimal values represented better visual acuity.

Stereoscopic vision was assessed using the Titmus Stereo Test. Participants wore polarized glasses and viewed the test booklet from a distance of approximately 40 cm. The test required identification of three-dimensional figures, including the fly, animal shapes, and Wirt circles. The stereoacuity threshold was recorded in arc seconds (arc-sec) based on the smallest disparity level correctly perceived. Scores were categorized as gross stereopsis (3600 arc-sec), moderate stereoacuity (800-200 arc-sec), and fine stereoacuity (100-40 arc-sec). Lower arc-sec values indicated better depth perception.

Oculomotor function was assessed through clinical observation of saccadic eye movements, smooth pursuit tracking, and fixation stability. Participants were asked to follow visual targets in various directions to evaluate the speed, accuracy, and coordination of eye movements. Abnormalities were noted using qualitative grading criteria. Assessments were conducted under standardized conditions at all time points.

Postural stability was assessed using the Sensory Organization Test (SOT) module of the computerized dynamic posturography (CDP) system. The test evaluated balance control under six sensory conditions by measuring sway and equilibrium scores. Participants stood barefoot on a force platform while visual and somatosensory inputs were altered. Composite and condition-specific balance scores were recorded. Higher scores indicated better postural stability.

Visual-motor integration skills were evaluated using selected subtests from the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Subtests included fine motor precision, fine motor integration, and manual coordination. Participants performed drawing, tracing, and object manipulation tasks. Standardized scores were calculated and compared across time points to assess changes in visual-motor performance.