Sex as a biological variable in amblyopia: implications for developmental plasticity and treatment

Amblyopia is a common childhood visual disorder caused by abnormal visual experience that drives visual cortical plasticity during the sensitive period. The timing and forms of treatment with patching therapy and other therapeutic interventions have been extensively studied; however, sex has not been a primary focus in studies examining amblyopia. This mini-review synthesizes evidence for sex differences across levels of analysis, from typical visual development to animal models of amblyopia and human studies of amblyopia incidence and treatment. In addition, it highlights latent sex differences in plasticity mechanisms that may provide insights for future visual neuroscience studies of amblyopia. These findings highlight a key concept: visual outcomes may appear similar yet depend on different mechanisms in females and males, potentially influencing the durability of recovery. We discuss a framework to advance a sex-aware research pipeline for amblyopia, spanning basic, preclinical, and clinical/translational research.