Binocular treatment of amblyopia using videogames (BRAVO): study protocol for a randomised controlled trial

Guo, Cindy X.; Babu, Raiju J.; Black, Joanna; Bobier, William R.; Lam, Carly Siu Yin; Dai, Shuan; Gao, Tina; Hess, Robert F.; Jenkins, Michelle; Jiang, Yannan; Kowal, Lionel; Parag, Varsha; South, Jayshree; Staffieri, Sandra E; Walker, Natalie; Wadham, Angela; Thompson, Benjamin

doi:10.1186/s13063-016-1635-3

Cited by 35 publications

(34 citation statements)

References 64 publications

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“…Acuity is a critical measure of visual function for preschool vision screening (Simons, 1996;Cotter et al, 2015), clinical eye care (Donahue & Baker, 2016), and research (Tsirlin, Colpa, Goltz, & Wong, 2015;Guo et al, 2016). Current acuity measurements are limited by test-retest variability (Beck et al, 2003;Rozhkova, Podugolnikova, & Vasiljeva, 2005), patient's familiarity with letters, the ease or difficulty with which individual letters may be recognized (Strong & Woo, 1985;Ferris et al, 1993;Alexander et al, 1997), and for picture optotypes, copyright limitations.…”

Section: Discussionmentioning

confidence: 99%

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity

et al. 2018

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When measuring recognition acuity in a research setting, the most widely used symbols are the Early Treatment of Diabetic Retinopathy Study (ETDRS) set of 10 Sloan letters. However, the symbols are not appropriate for patients unfamiliar with letters, and acuity for individual letters is variable. Alternative pictogram sets are available, but are generally comprised of fewer items. We set out to develop an open-access set of 10 pictograms that would elicit more consistent estimates of acuity across items than the ETDRS letters from visually normal adults. We measured monocular acuity for individual uncrowded optotypes within a newly designed set (The Auckland Optotype [TAO]), the ETDRS set, and Landolt Cs. Eleven visually normal adults were assessed on regular and vanishing formats of each set. Inter-optotype reliability and ability to detect subtle differences between participants were assessed using intraclass correlations (ICC) and fractional rank precision (FRP). The TAO vanishing set showed the strongest performance (ICC = 0.97, FRP = 0.90), followed by the other vanishing sets (Sloan ICC = 0.88, FRP = 0.74; Landolt ICC = 0.86, FRP = 0.80). Within the regular format, TAO again outperformed the existing sets (TAO ICC = 0.77, FRP = 0.75; Sloan ICC = 0.65, FRP = 0.64; Landolt ICC = 0.48, FRP = 0.63). For adults with normal visual acuity, the new optotypes (in both regular and vanishing formats) are more equally legible and sensitive to subtle individual differences than their Sloan counterparts. As this set does not require observers to be able to name Roman letters, and is freely available to use and modify, it may have wide application for measurement of acuity.

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Section: Discussionmentioning

confidence: 99%

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity

et al. 2018

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“…Amblyopia was defined as an interocular visual acuity difference of at least 2 logMAR lines and a fellow fixing eye visual acuity 0.02 logMAR. Anisometropia was defined as an interocular refractive error difference of !1.50DS (Gao et al, 2018;Guo et al, 2016). The visual stimuli were the same as in Experiment 1 and were presented dichoptically.…”

Section: Experiments 3 Methodsmentioning

confidence: 99%

Binocular vision and fixational eye movements

2019

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The aim of this study was to assess the relationship between binocular vision and fixation stability (FS). Across three experiments, we investigated (a) whether fixation was more stable during binocular versus monocular viewing across a range of stimulus contrasts in normal observers (n ¼ 11), (b) whether binocular rivalry affected FS in normal observers (n ¼ 14), and (c) whether FS was affected by interocular contrast differences in normal observers (n ¼ 8) and patients with anisometropic amblyopia (n ¼ 5). FS was quantified using global bivariate contour ellipse area, and microsaccades were detected using an unsupervised cluster-detection method. In normal observers, binocular viewing showed more stable fixation at all stimulus contrasts, and binocular rivalry did not affect FS. When interocular contrast was manipulated under dichoptic viewing conditions, normal observers exhibited less stable fixation for an eye that viewed 0% contrast (no fixation target). In anisometropic amblyopia, fixation was less stable in both eyes when the fellow eye viewed at 0% contrast. No effects were observed at other interocular contrast differences. Overall, binocular FS was impaired in both eyes in anisometropic amblyopia compared to normal observers. We conclude that binocular vision influences FS in normal observers but in an all-or-nothing fashion, whereby the presence or absence of a binocular target is important rather than the relative contrast of the targets in each eye. In anisometropic amblyopia, the fellow eye appears to control FS of both eyes under dichoptic viewing conditions.

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“…In the Binocular Treatment of Amblyopia Using Videogames study, no diplopia was reported. 32 In the study of the I-BiT by Cleary et al, 17 3 subjects were found to have diminished depth of suppression that was found to be temporary and not associated with diplopia. In the Herbison et al 22 study of the I-BiT, there were 2 cases of diplopia in the I-BiT groups (1 each in the movie and game groups) that resolved after treatment cessation.…”

Section: Adverse Eventsmentioning

confidence: 97%

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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Binocular treatment of amblyopia using videogames (BRAVO): study protocol for a randomised controlled trial

Cited by 35 publications

References 64 publications

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity

The Auckland Optotypes: An open-access pictogram set for measuring recognition acuity

Binocular vision and fixational eye movements

Binocular Treatment of Amblyopia

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