September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Binocular iPad game treatment for amblyopia is more successful than patching
Author Affiliations & Notes
  • Krista R Kelly
    Retina Foundation of the Southwest, Dallas, Texas, United States
  • Reed M Jost
    Retina Foundation of the Southwest, Dallas, Texas, United States
  • Lori Dao
    Pediatric Ophthalmology, PA, The Center for Adult Strabismus, Dallas, Texas, United States
  • Cynthia L Beauchamp
    Pediatric Ophthalmology, PA, The Center for Adult Strabismus, Dallas, Texas, United States
  • Joel N Leffler
    Children’s Eye Care of North Texas, PA, Dallas, Texas, United States
  • Eileen E Birch
    Retina Foundation of the Southwest, Dallas, Texas, United States
    Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
  • Footnotes
    Commercial Relationships   Krista Kelly, None; Reed Jost, None; Lori Dao, None; Cynthia Beauchamp, None; Joel Leffler, None; Eileen Birch, None
  • Footnotes
    Support  Thrasher Research Fund Early Career Award #12954, NIH Grant EY022313
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3078. doi:
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    • Get Citation

      Krista R Kelly, Reed M Jost, Lori Dao, Cynthia L Beauchamp, Joel N Leffler, Eileen E Birch; Binocular iPad game treatment for amblyopia is more successful than patching. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3078.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Childhood amblyopia can be treated with binocular iPad games that rebalance contrast between the eyes, allowing the child to overcome suppression and experience binocular vision (Birch et al., 2015; Li et al., 2014). Yet, previous rudimentary games yielded low compliance, and no randomized clinical trials have compared binocular treatment to the standard monocular treatment of fellow eye patching. In this randomized clinical trial, we compared a more engaging, binocular iPad action game and patching as treatments for amblyopia.

Methods : Amblyopic children (4-9y) were randomly assigned to 2 weeks of at-home game play while wearing red/green anaglyph glasses (1 hr/day, 5 days/week) or patching (2hrs/day). At 2 weeks, children who patched crossed-over to the game, and all children played the game until the 4-week visit. Amblyopic eye best-corrected visual acuity (BCVA) was assessed at baseline, 2- and 4-week visits. Compliance was logged with the iPad (game) or calendar (patching). Inclusion criteria: ≥8 weeks spectacle wear, aligned within 4PD, ≥0.3 logMAR interocular difference, fellow eye BCVA ≤0.1 logMAR.

Results : Interim results are presented. Baseline: Mean BCVA±SD was 0.48±0.13 (n=23). 2-weeks: Mean BCVA improved from baseline by 0.16±0.07 logMAR for game first (9.9±0.7 hrs, n=12, p=0.012) and 0.07±0.08 logMAR for patching first (27.4±2.8 hrs, n=11, p<0.001). Game treatment was more successful than patching (p=0.010). BCVA improved by 0.1-0.2 logMAR in 17 children [11(92%) game first, 6(55%) patching first]. 4-weeks: Mean BCVA improved from the 2-week visit by 0.08±0.09 logMAR for cross-over children (9.1±3.6 hrs, p=0.022), resulting in catching up to game first children (4-week improvement from baseline: game first, 0.18±0.10 logMAR, n=11, p<0.001; patch first, 0.15±0.10 logMAR n=10, p<0.001). Poor game play compliance (<50% of prescribed time) was found in 9% (n=2/22) of children, compared with 40% (n=18/45) of children previously reported for the rudimentary games.

Conclusions : Our highly-compliant binocular iPad game was successful at treating childhood amblyopia, and was more effective than the current standard monocular treatment of patching following 2 weeks of treatment. Dichoptic, contrast rebalancing games provide a promising additional option for treating amblyopia.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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