Amblyopia, a common developmental eye disorder, is standardly treated with a combination of refractive correction and necessary occlusion therapy (Figure 1). However, even with adherence to this gold-standard treatment, patients may still experience residual visual impairment. In recent years, the emergence of digital therapeutics (DTx) (Figure 2) has opened new prospects for amblyopia treatment, demonstrating the potential for comprehensive visual function recovery. Nevertheless, the long-term effects of digital therapy have raised concerns – particularly, the patterns of ocular growth during treatment have not been fully explored.
Figure 1. Conventional treatment for amblyopia
Figure 2. Digital therapeutics for amblyopia
A study by Professor Li Jinrong's team from Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, published on January 13, 2025, in the top-tier journal Ophthalmology, provides the first evidence that DTx may be associated with an increased risk of rapid axial elongation in children with amblyopia. The paper is titled “Factual Evidence on Digital Therapeutics in Pediatric Amblyopia: Insights into Rapid Axial Elongation Risk.”
This study utilized real-world data from ZOC's Visual Rehabilitation and Reconstruction Platform. After applying strict screening criteria, a total of 1,394 children aged 3 to 12 years with amblyopia, who were treated at the center between January 2019 and January 2024, were included in the analysis (Figure 3). Of these, 477 children underwent daily 30-minute DTx sessions. Axial length was measured at baseline and during follow-up visits for all children. A Cox proportional hazards model was employed to evaluate the association between DTx use and the risk of rapid axial elongation.
Figure 3. Flowchart detailing the inclusion and exclusion criteria used for the selection of participants in the cohort.
The results indicated that children treated with DTx for amblyopia had a 65% higher risk of rapid axial elongation compared to those who did not receive such intervention (Figure 4). This tendency was more pronounced in children with hyperopia.
Figure 4. Adjusted cumulative incidence curves for the two groups.
The findings underscore the importance of close axial length monitoring in the clinical application of DTx for amblyopia. A critical balance must be struck between improving visual function and managing refractive development: In hyperopic children with slower axial growth, DTx may not only enhance visual acuity in the amblyopic eye but also facilitate axial elongation, thereby supporting both vision rehabilitation and emmetropization. However, for children in the pre-myopic stage, DTx should be combined with myopia control strategies to mitigate the potential risk of accelerated ocular growth. These conclusions hold significant implications for guiding the safe and effective implementation of DTx in amblyopia treatment.
About the Research Team
This study was conducted by Professor Li Jinrong's team at Zhongshan Ophthalmic Center. YAO Ying (Master's student), HE Yunsi (PhD student), and WEN Yun (Attending Physician) are co-first authors. Professor LI Jinrong is the corresponding author. The research was supported by grants from the National Natural Science Foundation of China and the Fundamental Research Funds for the Central Universities. Zhongshan Ophthalmic Center of Sun Yat-sen University / the State Key Laboratory of Ophthalmology is the sole affiliations of the authors.
Link to original article:
https://www.aaojournal.org/article/S0161-6420(25)00031-4/abstract
