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    Researchers make strides in amblyopia


    Perceptual learning still awaits validation with long-term randomised controlled trials, and research has not indicated whether one type of amblyopia might benefit more than another. Two studies have shown a decline in visual outcomes after 8–10 weeks, although this finding was less significant in a group that practiced binocular therapy than one that practiced monocular therapy.

    Researchers have also experimented with pharmacological treatments of amblyopia, with levodopa being the most commonly prescribed drug. It is a precursor to dopamine, a neurotransmitter shown in animal models to be reduced in amblyopia. Treatment with levodopa has shown good results in several studies, especially when combined with occlusion therapy and with carbidopa, which increases levodopa uptake across the blood-brain barrier.

    However, many patients lose visual acuity after they stop taking levodopa. And many researchers have reported side effects.

    Other molecules might prove beneficial. Discoveries in mice have shown that the lynx1 gene codes for a protein that suppresses acetylcholine receptor signalling in the brain and regulates plasticity of the mature brain. Research is underway on cholinesterase inhibitors that could prevent the expression of lynx1 to extend the period of plasticity in the brain.

    Finally, acupuncture has shown some promise, with two randomised controlled trials recording good results, including one in which patients improved more with acupuncture than with occlusion therapy. This approach may work by stimulating blood flow in the visual cortex. But Maconachie and Gottlob point out that a placebo effect could be particularly marked in acupuncture, which requires frequent clinic visits.

    They conclude that much research remains to be done.

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