A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years

Holmes, Jonathan M.; Manny, Ruth E.; Lazar, Elizabeth L.; Birch, Eileen E.; Kelly, Krista R.; Summers, Allison I.; Martinson, Stacy R.; Raghuram, Aparna; Colburn, Jeffrey D.; Law, Christine; Marsh, Justin D.; Bitner, Derek P.; Kraker, Raymond T.; Wallace, David K.

doi:10.1016/j.ophtha.2018.10.032

Cited by 87 publications

(96 citation statements)

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“…A variety of binocular, dichoptic, and virtual reality perceptual learning tasks and games have been developed as potential treatments for amblyopia. [17][18][19][20][21][22] Some authors have hypothesized that action video games may provide the best approach because they are not only highly engaging, requiring attention to identify and track potential targets, but they also trigger arousal via time constraints, decision making, and task performance and provide immediate feedback on success or failure. 22,33 The current study provides evidence for visual acuity improvement as a result of passive exposure to dichoptic contrast-rebalanced video content, in the absence of the requirement to perform any task and without any feedback.…”

Section: Discussionmentioning

confidence: 99%

“…Binocular amblyopia treatments promote simultaneous use of both eyes by rebalancing the strength of each eye's image with high-contrast or high-luminance input to the amblyopic eye and low-contrast or lowluminance input to the fellow eye. [17][18][19][20][21][22] Currently, most binocular treatments require active participation by the amblyopic child: playing a game or performing a repetitive psychophysical task. We recently reported our results of a passive binocular treatment, where the subject watches contrast-rebalanced dichoptic movies in which reciprocal blob-shaped parts of the image are presented to each eye to promote binocular combination.…”

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Binocular amblyopia treatment with contrast-rebalanced movies

Birch

Jost

Cruz

et al. 2019

Journal of American Association for Pediatric Ophthalmology and

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Background-Binocular amblyopia treatments promote visual acuity recovery and binocularity by rebalancing the signal strength of dichoptic images. Most require active participation by the amblyopic child to play a game or perform a repetitive visual task. The purpose of this study was to investigate a passive form of binocular treatment with contrast-rebalanced dichoptic movies. Methods-A total of 27 amblyopic children, 4-10 years of age, wore polarized glasses to watch 6 contrast-rebalanced dichoptic movies on a passive 3D display during a 2-week period. Amblyopic eye contrast was 100%; fellow eye contrast was initially set to a lower level (20% −60%), which allowed the child to overcome suppression and use binocular vision. Fellow eye contrast was incremented by 10% for each subsequent movie. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and at 2 weeks. Results-Amblyopic eye best-corrected visual acuity improved from 0.57 ± 0.22 at baseline to 0.42 ± 0.23 logMAR (t 26 = 8.09; P < 0.0001; 95% CI for improvement, 0.11-0.19 logMAR). Children aged 3-6 years had more improvement (0.21 ± 0.11 logMAR) than children aged 7-10 years (0.11 ± 0.06 logMAR; t 25 = 3.05; P = 0.005). Children with severe amblyopia (≥0.7 logMAR) at baseline experienced greater improvement (0.24 ± 0.12 logMAR) than children with moderate amblyopia at baseline (0.12 ± 0.06 logMAR; t 25 = 3.49; P = 0.002). Conclusions-In this cohort, passive viewing of contrast-rebalanced dichoptic movies effectively improved visual acuity in amblyopic subjects. The degree of improvement observed was similar to that previously reported for 2 weeks of binocular games treatment and with 3-4 months of occlusion therapy.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Binocular amblyopia treatment with contrast-rebalanced movies

Birch

Jost

Cruz

et al. 2019

Journal of American Association for Pediatric Ophthalmology and

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“… 20 As well as limiting stereopsis by preventing sensory fusion, 21 the role that suppression plays in causing or limiting amblyopia recovery is yet to be fully determined. Novel treatments for amblyopia are aimed at reducing suppression of the amblyopic visual pathway to improve binocularity 22 – 25 ; however, the relative contribution of interocular differences in visual acuity and depth of suppression in determining the limit of stereoacuity is unclear. For example, it has been believed for some time that amblyopia (reduced acuity in one eye) is the primary problem and loss of binocularity, the consequence.…”

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Suppression Rather Than Visual Acuity Loss Limits Stereoacuity in Amblyopia

Webber

Schmid

Baldwin

et al. 2020

Invest. Ophthalmol. Vis. Sci.

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In amblyopic observers, stereoacuity significantly correlated with CR (P < 0.001), but not with interocular VA difference (P = 0.863). In participants with normal vision development, stereoacuity, VA, and CR declined with introduction of monocular Bangerter filter (P < 0.001), and stereoacuity reduced with monocular attenuation of stimulus contrast (P < 0.001). Reduction in stereoacuity correlated with both VA decrement and degraded CR. Stereoacuity significantly improved in amblyopic observers when the contrast to the dominant eye was adjusted based on the contrast ratio. CONCLUSIONS. Suppression rather than visual acuity loss limits stereoacuity in observers with abnormal vision development. Stereopsis can be improved when interocular sensory dominance is neutralized.

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“…Most recently, in 2019, PEDIG published the results of its study of Dig Rush, which was found to be a more engaging game for children. 31 This report detailed the results of an older cohort, ages 7 to 13 years, who were randomized to 1 hour of daily dichoptic game play (Dig Rush, n ¼ 69) or continued spectacle wear (n ¼ 69) for 8 weeks. The VA results were similar to PEDIG's previous studies; after adjusting for baseline VA, the mean amblyopic eye letter score at 8 weeks improved by 2.3 letters (95% CI, 0.7e3.9 letters) for the dichoptic group and 2.4 letters (95% CI, 0.8e4.0 letters) for the control group.…”

Section: Amblyopic Eye Visual Acuitymentioning

confidence: 99%

Binocular Treatment of Amblyopia

Pineles¹,

Aakalu

Hutchinson

et al. 2020

Ophthalmology

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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...

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A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years

Abstract: Purpose: To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad ® game plus continued spectacle correction versus continued spectacle correction alone.

Cited by 87 publications

References 18 publications

Binocular amblyopia treatment with contrast-rebalanced movies

Binocular amblyopia treatment with contrast-rebalanced movies

Suppression Rather Than Visual Acuity Loss Limits Stereoacuity in Amblyopia

Binocular Treatment of Amblyopia

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