A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in Children Aged 13 to 16 Years With Amblyopia

Manh, Vivian; Holmes, Jonathan M.; Lazar, Elizabeth L.; Kraker, Raymond T.; Wallace, David K.; Kulp, Marjean Taylor; Galvin, Jennifer A.; Shah, Birva; Davis, Patricia L.

doi:10.1016/j.ajo.2017.11.017

Cited by 88 publications

(107 citation statements)

References 20 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…In their similarly designed level III study of younger subjects, no significant improvement in stereopsis was found in the treatment or control group. 27 In the PEDIG studies reported by Holmes et al 29 and Manh et al, 30 there were no significant differences in stereoacuity outcomes between the dichoptic therapy and patching groups. In a similar study by Gao et al, 36 there was no significant difference between the active therapy and placebo game groups.…”

Section: Binocularity and Sensory Outcomes Such As Stereopsismentioning

confidence: 88%

“…Furthermore, 2 large randomized controlled trials have shown inferior performance of binocular treatment relative to standard treatment (patching). 29,30 One potential difficulty in obtaining positive results may be a lack of engaging games in the largest studies, especially compared with video game units that are currently available. There is sufficient evidence to advocate for well-designed studies using more engaging technologies; however, should such studies yield beneficial results, cost and availability may limit the use of these technologies, especially when compared with the proven efficacy, low cost, and high availability of patching and atropine 1% eye drops.…”

Section: Discussionmentioning

confidence: 99%

“…In the most recent PEDIG study of the Dig Rush game, there was also no significant change in stereoacuity in either treatment group. 30 In the 2016 level I study of the I-BiT treatment by Herbison et al, 23 there was no significant improvement in stereoacuity among the 3 study arms (I-BiT game, I-BiT movie, sham game). In the level III study of the I-BiT by Cleary et al, 17 stereoacuity outcomes were improved.…”

Section: Binocularity and Sensory Outcomes Such As Stereopsismentioning

confidence: 97%

“…The results of this study were similar to PEDIG's previous study of the younger cohort, showing a mean improvement of 3.5 letters in the dichoptic game group and 6.5 letters in the patching group after 16 weeks. 30 After adjusting for baseline VA, the authors reported that the difference between the groups was 0.5 lines (2.7 letters) with a 95% CI of e5.7 to 0.3 letters (P ¼ 0.082), favoring patching. Adherence was again a limitation in the study.…”

Section: Amblyopic Eye Visual Acuitymentioning

confidence: 99%

See 3 more Smart Citations

Binocular Treatment of Amblyopia

Pineles¹,

Aakalu

Hutchinson

et al. 2020

Ophthalmology

Self Cite

View full text Add to dashboard Cite

Purpose: To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.Methods: Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.Results: Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.Conclusions: There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future. Ophthalmology 2020;127:261-272 ª 2019 by the American Academy of OphthalmologyThe American Academy of Ophthalmology prepares Ophthalmic Technology Assessments to evaluate new and existing procedures, drugs, and diagnostic and screening tests. The goal of an Ophthalmic Technology Assessment is to systematically review the available research for clinical efficacy, effectiveness, and safety. After review by members of the Ophthalmic Technology Assessment Committee, other assessments by Academy committees, relevant subspecialty societies, and legal counsel are submitted to the Academy's Board of Trustees for consideration as official Academy statements. The purpose of this assessment by the Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel was to review the publis...

show abstract

Section: Binocularity and Sensory Outcomes Such As Stereopsismentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Binocularity and Sensory Outcomes Such As Stereopsismentioning

confidence: 97%

Section: Amblyopic Eye Visual Acuitymentioning

confidence: 99%

See 2 more Smart Citations

Binocular Treatment of Amblyopia

Pineles¹,

Aakalu

Hutchinson

et al. 2020

Ophthalmology

Self Cite

View full text Add to dashboard Cite

show abstract

“…It improves not only binocular vision Hess and Thompson, 2015;Webber et al, 2016;Kelly et al, 2018) but also monocular acuity (Hess et al, 2010bTo et al, 2011;Li et al, 2013Li et al, , 2014Mansouri et al, 2014;Birch et al, 2015). Despite ongoing debate concerning which therapeutic approach is more effective (Holmes et al, 2016;Kelly et al, 2016;Gao et al, 2018;Manh et al, 2018;Pineles et al, 2019), one should bear in mind the possibility that the visual improvements from both approaches might involve the same mechanisms in the brain. If both approaches involve similar neural mechanisms, convenience and efficacy might determine which one to use.…”

Section: Introductionmentioning

confidence: 99%

Patching and Suppression in Amblyopia: One Mechanism or Two?

Chen

Mao

et al. 2020

Front. Neurosci.

View full text Add to dashboard Cite

Purpose: To determine if benefits from occlusion therapy are due to decreased suppression from the fellow eye in children with amblyopia.Methods: Ten newly diagnosed amblyopes (7.2 ± 1.4 years old), two with strabismus and eight with anisometropia, participated. Patients were first given a 2-month period of refractive adaptation, followed by occlusion therapy (i.e., patching their fellow eye with an opaque patch for 4 h/day). Visual acuity of the amblyopic eye and interocular suppression were measured before and after 0.5, 1, 2, 4, and 6 months of occlusion therapy. We quantified interocular suppression with a binocular phase combination task.Results: Visual acuity (in logMAR) improved from 0.50 ± 0.22 (mean ± SD) to 0.33 ± 0.20 for patients who finished a short-term (2 months) occlusion (A1-A10), from 0.53 ± 0.20 to 0.32 ± 0.22 for patients who finished a medium-term (4 months) occlusion (A1-A9), and from 0.48 ± 0.19 to 0.22 ± 0.10 for patients who finished a long-term (6 months) occlusion (A1-A8). Although their visual acuity significantly improved, their degree of suppression, which was abnormal in all cases, did not change consistently. This was true in all durations of occlusion therapy.Conclusion: Reduced suppression from the fixing eye might not be result from occlusion therapy.

show abstract

Amblyopia

Reznick

2022

Albert and Jakobiec's Principles and Practice of Ophthalmology

View full text Add to dashboard Cite

A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in Children Aged 13 to 16 Years With Amblyopia

Cited by 88 publications

References 20 publications

Binocular Treatment of Amblyopia

Binocular Treatment of Amblyopia

Patching and Suppression in Amblyopia: One Mechanism or Two?

Amblyopia

Contact Info

Product

Resources

About