Barriers to successful dichoptic treatment for amblyopia in young children

Abstract

Purpose In an ongoing randomised clinical trial comparing dichoptic VR video games with patching for amblyopia, we evaluated any potential barriers to successful use of this novel amblyopia treatment method. Methods From December 2017, all newly diagnosed amblyopic children were recruited. Excluded were children under age 4 and patients with strabismus exceeding 30PD. The video game was played for 1 h per week at the outpatient clinic under direct supervision. Records were kept of difficulties encountered during treatment and categorised into domains. Factors influencing the successful completion of this treatment were identified and related to patient characteristics. Results Ninety-one children were recruited for the trial, 20 parents refused participation before randomisation, because of the logistical challenges the outpatient dichoptic treatment would cause them. Of the 17 children who commenced dichoptic treatment (median age 6.2 years; IQR 4.9–8.4 years), 10 did not complete treatment. Children under age 5.5 years were unable to comprehend the game settings or the game itself. Older children (N = 7; 41%) were less willing to comply with the video game. Loss of interest in the game (N = 8; 47%) was found to be a limiting factor at all ages. Conclusion Half of the children failed to complete VR dichoptic treatment, mainly due to young age. In countries with nationwide screening where amblyopia is detected before age 6, the applicability of such dichoptic treatment is limited.

Report: EUSCREEN final dissemination meeting in Zaandam on Monday, June 28th and Tuesday 29th

“…Sjoukje Loudon (Erasmus MC, Rotterdam) presented the first results of a randomized controlled trial comparing treatment of amblyopia with dichoptic games with conventional treatment with occlusion therapy, carried out by Aveen Kadhum (Erasmus MC, Rotterdam). 12 In this study among children with newly detected amblyopia, half of the children failed to complete the treatment with dichoptic games, mainly due to their young age. In countries with nationwide vision screening with high coverage such as the Netherlands, amblyopia is detected at age 4 or 5 and, hence, the applicability of treatment of amblyopia with dichoptic games is limited.…”

Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): A protocol for a crossover randomized controlled trial

“…The study population will include 30 individuals with residual amblyopia (strabismus, anisometropic and mixed types) and 30 age-matched normally sighted individuals between 6-35 years old, as younger children seem to have di culties in understanding the games [37]. General exclusion criteria are the presence of (i) auditory de cits or loss, (ii) uncorrected visual disorder, (iii) coexistence of ocular or neurological disease, and (iv) developmental, psychological, or sensorimotor disorder.…”

“…The games are aimed at training anti-suppression/fusion (Hoopie, Ring Runner, Breaker, Pepper Picker), stereopsis (Bubbles, Bullseye), and visual processing (Flash Match). Such game variability will improve the compliance among the older participants [37]. The prescribed dosage for game playing is 30 minutes per day, 5 days per week, over 8 weeks, with a total game time of 20h.…”

Applications and implications for extended reality to improve binocular vision and stereopsis

“…A particular challenge with the use of VR HMDs for binocular training in young children is the choice of content. For example, children may grow bored with videogames ( Kadhum et al, 2021 ) and simply give up. On the other hand, as noted elsewhere ( Levi, 2022 ), dichoptic or 3D contrast-balanced video content (e.g., movies, TV shows) result in good compliance and outcomes ( Xiao et al, 2020 ; Xiao et al, 2022 ).…”