BackgroundIntermittent exotropia impairs binocular vision and stereopsis in children, and visual perceptual learning (VPL) with dichoptic stimulation offers a potential therapy. This prospective exploratory study aimed to evaluate the efficacy of an 8-week at-home dichoptic VPL program delivered through virtual reality (VR)-based digital therapy in improving stereopsis and binocular sensory function in children with intermittent exotropia.MethodChildren aged 6–16 years diagnosed with intermittent exotropia (n = 18) completed training at least 10 min per day, five days per week, using VR content tailored to their deviation angle. Outcomes included near stereoacuity (Titmus Stereo Test) and distance binocular sensory status (Worth 4 Dot test), measured at baseline and 8 weeks.ResultStereoacuity improved significantly across all participants [mean change: −0.21 log arcsec; 95% confidence interval (CI), −0.28 to −0.13; P < 0.001], with greater improvement in a subgroup with subnormal baseline stereoacuity (mean change: −0.31 log arcsec; 95% CI, −0.39 to −0.23; P < 0.001). The odds of achieving sensory fusion increased significantly [odds ratio (OR) = 5.50; 95% CI, 1.38–22.0; P = 0.016], and 44.4% of participants showed transition to fusion. In the subnormal subgroup, 62.5% achieved fusion (OR = 21.0; 95% CI, 1.72–258.0; P = 0.017).ConclusionThese findings suggest VR-based dichoptic VPL as a promising and personalized digital therapy to enhance binocular vision in pediatric intermittent exotropia, particularly in cases with subnormal stereoacuity.
