A binocular iPad treatment for amblyopic children

Li, S L; Jost, Reed M.; Morale, Sarah E.; Dao, Lori; Stager, David R.; Birch, Eileen E.

doi:10.1038/eye.2014.165

Cited by 105 publications

(144 citation statements)

References 23 publications

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“…The visual acuity improvement of 0.07 logMAR is less than the 0.18 which we had observed previously but is similar to the 0.1 improvement reported by Li et al 17 It was an unexpected finding that the non-I-BiT game showed some improvement in visual acuity and the reason is not clear. It is possible that use of the shutter glasses alone may have improved amblyopic vision.…”

Section: Discussionsupporting

confidence: 73%

“…The total treatment time of only 3 h is very short when compared with patching where the Monitored Occlusion Treatment of Amblyopia (MOTAS) group recommended at least 150 h and showed a linear response for up to 400 h. 18 The study by Li et al used an I-Pad delivery system with 16 h of game play >4 weeks and with no extra benefit from a further 16 h over a further 4 week period. 17 Hess's group, using an I-Pad at home 19 showed that 1-2 h per day for 1-3 weeks can improve acuity, restore binocularity and restore stereopsis in adults. 20 Vedamurthy et al also developed a dichoptic action videogame and with 40 h of treatment in adults showed improvements in both anisometropic and strabismic amblyopes of logMAR 0.14.…”

Section: Discussionmentioning

confidence: 99%

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Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

et al. 2016

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BackgroundTraditional treatment of amblyopia involves either wearing a patch or atropine penalisation of the better eye. A new treatment is being developed on the basis of virtual reality technology allowing either DVD footage or computer games which present a common background to both eyes and the foreground, containing the imagery of interest, only to the amblyopic eye.MethodsA randomised control trial was performed on patients with amblyopia aged 4–8 years with three arms. All three arms had dichoptic stimulation using shutter glass technology. One arm had DVD footage shown to the amblyopic eye and common background to both, the second used a modified shooter game, Nux, with sprite and targets presented to the amblyopic eye (and background to both) while the third arm had both background and foreground presented to both eyes (non-interactive binocular treatment (non-I-BiT) games).ResultsSeventy-five patients were randomised; 67 were residual amblyopes and 70 had an associated strabismus. The visual acuity improved in all three arms by approximately 0.07 logMAR in the amblyopic eye at 6 weeks. There was no difference between I-BiT DVD and non-I-BiT games compared with I-BiT games (stated primary outcome) in terms of gain in vision.ConclusionsThere was a modest vision improvement in all three arms. Treatment was well tolerated and safe. There was no difference between the three treatments in terms of primary stated outcomes but treatment duration was short and the high proportion of previously treated amblyopia and strabismic amblyopia disadvantaged dichoptic stimulation treatment.Trial registration numberNCT01702727, results.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

et al. 2016

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“…Previous studies of dichoptic game play with reduced fellow-eye contrast in a supervised setting have shown similar improvements in visual acuity in adults and children. 24,25 In the present study stereoacuity did not improve significantly in amblyopic children whose visual acuity improved while playing binocular iPad games. Prior studies of dichoptic game play by amblyopic adults have reported improvements in stereoacuity.…”

Section: Discussionmentioning

confidence: 73%

“…Data from a larger sham iPad group (n = 25) have been previously reported. 25 Because the prior sham iPad had no significant improvement in visual acuity in the prior study, only a small concurrent sham iPad group was included in the present study.…”

Section: Methodsmentioning

confidence: 99%

Binocular iPad treatment for amblyopia in preschool children

Birch¹,

Li²,

Jost³

et al. 2014

Journal of American Association for Pediatric Ophthalmology and

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“…Third was extent of suppression scotoma using the Worth 4-dot test at 7 different distances. 25 Fourth was depth of suppression for children younger than 7 years using a dichoptic motion coherence test that determines the maximum contrast of randomly moving dots in the fellow eye that still allows the child to discriminate the direction of coherent motion dots in the amblyopic eye, 16,26 or for children at least 7 years old using a dichoptic eye chart adapted from work by Kwon et al 27 that determines the contrast ratio at which the child reports letters presented to each eye with equal likelihood. 28 …”

Section: Methodsmentioning

confidence: 99%

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Kelly

Jost

Dao³

et al. 2016

JAMA Ophthalmol

161

209

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IMPORTANCE Fellow eye patching has long been the standard treatment for amblyopia, but it does not always restore 20/20 vision or teach the eyes to work together. Amblyopia can be treated with binocular games that rebalance contrast between the eyes so that a child may overcome suppression. However, it is unclear whether binocular treatment is comparable to patching in treating amblyopia.OBJECTIVES To assess the effectiveness of a binocular iPad (Apple Inc) adventure game as amblyopia treatment and compare this binocular treatment with patching, the current standard of care. DESIGN, SETTING, AND PARTICIPANTSThis investigation was a randomized clinical trial with a crossover design at a nonprofit eye research institute. Between February 20, 2015, and January 4, 2016, a total of 28 patients were enrolled in the study, with 14 randomized to binocular game treatment and 14 to patching treatment.INTERVENTIONS Binocular game and patching as amblyopia treatments. MAIN OUTCOMES AND MEASURESThe primary outcome was change in amblyopic eye best-corrected visual acuity (BCVA) at the 2-week visit. Secondary outcomes were change in stereoacuity and suppression at the 2-week visit and change in BCVA at the 4-week visit. RESULTS Among 28 children, the mean (SD) age at baseline was 6.7 (1.4) years (age range, 4.6-9.5 years), and 7 (25%) were female. At baseline, the mean (SD) amblyopic eye BCVA was 0.48 (0.14) logMAR (approximately 20/63; range, 0.3-0.8 logMAR [20/40 to 20/125]), with 14 children randomized to the binocular game and 14 to patching for 2 weeks. At the 2-week visit, improvement in amblyopic eye BCVA was greater with the binocular game compared with patching, with a mean (SD) improvement of 0.15 (0.08) logMAR (mean [SD], 1.5 [0.8] lines) vs 0.07 (0.08) logMAR (mean [SD], 0.7 [0.8] line; P = .02) after 2 weeks of treatment. These improvements from baseline were significant for the binocular game (mean [SD] improvement, 1.5 [0.8] lines; P < .001) and for patching (mean [SD] improvement, 0.7 [0.8] line; P = .006). Depth of suppression improved from baseline at the 2-week visit for the binocular game (mean [SD], 4.82 [2.82] vs 3.24 [2.87]; P = .03) and for patching (mean [SD], 4.77 [3.10] vs 2.57 [1.67]; P = .004). Patching children crossed over to binocular game treatment, and all 28 children played the game for another 2 weeks. At the 4-week visit, no group difference was found in BCVA change, with children who crossed over to the binocular games catching up with children treated with binocular games, for a mean (SD) improvement of 0.17 (0.10) logMAR (mean [SD], 1.7 [1.0] lines) for the binocular game vs a mean (SD) improvement of 0.16 (0.12) logMAR (mean [SD], 1.6 [1.2] lines) for the patching crossover (P = .73). CONCLUSIONS AND RELEVANCEA binocular iPad game was effective in treating childhood amblyopia and was more efficacious than patching at the 2-week visit. Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.TRIAL REGISTRATION clinicaltrials....

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A binocular iPad treatment for amblyopic children

Cited by 105 publications

References 23 publications

Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

Binocular iPad treatment for amblyopia in preschool children

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

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