Improvement of Adherence with Occlu-Pad Therapy for Pediatric Patients with Amblyopia

Abstract

We aimed to examine visual acuity improvement effect and adherence in amblyopia training using tablet type vision training equipment (Occlu-pad). The subjects were 138 patients with amblyopia (average age of 5.5 ± 1.6 years old); their amblyopic visual acuity at the start of training was logMAR 0.15 to 1.3. Occlu-pad is a device that processes images such that amblyopic eyes can only view the image as it passes through polarized glasses; this is achieved by peeling off the polarizing film layer in the liquid crystal display of an iPad (Apple). Amblyopia training comprised either the instructional training with Occlu-pad or the eye patch (Patching) as a family training, after wearing perfectly corrected glasses. Visual acuity improvement following amblyopia training by Occlu-pad and Patching was significantly different after 6 months in patients with anisometropic amblyopia (p <0.05). In patients with strabismic amblyopia, a significant difference between training methods was observed after 9 months (p <0.05). Use of the Occlu-pad resulted in better adherence for patients with either anisometropic amblyopia or strabismic amblyopia; a significant difference in adherence was observed after 3 months, compared with Patching (p <0.05). Amblyopia training with Occlu-pad supports greater visual acuity improvement and adherence than Patching.

Active Vision Therapy for Anisometropic Amblyopia in Children: A Systematic Review

“…According to the results of this systematic review, three main aspects should be analyzed in studies evaluating the effect of active vision therapy in amblyopia due to its importance in daily practice: visual acuity improvement, dose-response ratio, and adherence to treatment. Active visual therapy with dichoptic therapy, perceptual learning, anaglyph glasses, or some specific video games is effective in the treatment of anisometropic amblyopia to improve visual acuity [21][22][23][24][25][26][27][28] when it is compared with only glasses [24,26], patching [23,28], or placebo [21]. According to some authors, this improvement seems to be similar to patching [24,26,27], without a clear evidence confirming that vision therapy is more or less effective than patching for the treatment of anisometropic amblyopia in children.…”

“…For instance, Singh et al reported significant differences in their RCT, since the group that received dichoptic therapy and patching improved 2.4 lines in VA, while the patching group enhanced 1.8 lines [ 23 ]. In addition, good treatment compliance (mean of 69% or more) with visual therapy was reported by many authors [ 24 – 28 ], except a rate of 50% of compliance reported by Birch et al [ 21 ]. This is an important advantage compared to patching, as its compliance ranges from 44% to 57% [ 31 ].…”

“…As can be observed in the studies, frequency and duration of the vision therapy sessions differ among authors. For example, Singh et al [ 23 ] and Totsuka et al [ 28 ] prescribed 1 hour of training per day, Deshpande et al [ 25 ] up to 2 hours per day, and Kuruca et al [ 22 ] 15 minutes per day 6 times a week. While Birch et al [ 21 ] prescribed 4 hours per week, Iwata et al [ 24 , 26 ] prescribed 2 sessions per week (30 minutes per day), and Gambacorta et al prescribed 20 hours of training with no specific time per day [ 27 ].…”

Stimuli Characteristics and Psychophysical Requirements for Visual Training in Amblyopia: A Narrative Review

“…Additionally, there are experiences reported with the use of the forced-choice response method [ 67 ] that is mainly useful in discrimination and orientation tasks, as well as with the use of predefined interval increases not following a specific psychophysical methodology [ 15 ]. In addition, there are studies not mentioning or describing in detail this issue [ 13 ]. However, among the variety of psychophysical methodologies that are available, adaptative methods, such as the Best-PEST or QUEST, seem to be an appropriate option for sequential visual trainings in amblyopia, but this should be investigated further.…”

“…Over the last few years, vision therapy has been suggested to be an effective option to promote visual rehabilitation and even to accelerate recovery when combined with patching [ 8 ]. New trends in computer-based active vision therapy have been developed for amblyopia treatment, such as the use of perceptual learning environments [ 9 , 10 , 11 ], dichoptic stimulation [ 12 , 13 , 14 ] and binocular training [ 15 , 16 ]. These video games use visual and perceptual tasks, such as orientation discrimination or letter recognition, among others, to cause a response in neuro-modulatory pathways and the enhancement of attentional skills, according to neurophysiological studies [ 17 , 18 ].…”