Perceptual Learning Therapy Using RevitalVision in Patching-Failed Amblyopia: Visual Outcomes, Predictors of Response, and Durability

Purpose: To evaluate the effectiveness, predictors, and durability of perceptual learning therapy using ReVitalVision in older children with amblyopia who had failed prolonged patching therapy. Methods: This prospective interventional study included children (≤18 years) and adults with amblyopia, with pediatric participants having failed ≥2 years of patching due to poor compliance or non-response. All participants completed a mandatory minimum of 40 ReVitalVision sessions; up to 80 sessions were optional. Vision (logMAR) and stereoacuity were assessed at baseline, after 40 and 80 sessions, and at 3, 6, and 12 months. Multivariable regression was performed to identify predictors of outcome. Results: Seventy-three participants (mean age 14.6 ± 5.5 years; 67% male) were included: anisometropic (n=34), strabismic (n=20), isometropic (n=6), deprivational (n=4), and other causes (n=9). After 40 sessions, significant visual improvement was observed across subtypes, greatest in anisometropic amblyopia (0.50 to 0.32 logMAR), with 40% achieving 20/40 or better. Strabismic amblyopia showed slower recovery (0.54 to 0.38 logMAR) and greater variability, while deprivational amblyopia showed limited response. Stereoacuity improved significantly in anisometropic (175 to 67 arcsec) and strabismic amblyopia (214 to 48 arcsec). Baseline BCVA was the strongest predictor of outcome (β = 0.061 per line worsening; p < 0.001), independent of amblyopia subtype and age. Time taken to complete 40 sessions did not influence outcomes. Eighty sessions produced marginally better vision but significantly greater stereoacuity improvement (p = 0.002). A subtle trend toward regression was observed at 6-12 months. Conclusion: ReVitalVision therapy produces clinically meaningful visual and binocular improvements in patching-failed amblyopia. Baseline visual acuity strongly predicts response and durability, and extended therapy may benefit patients with denser amblyopia, supporting individualized treatment duration.