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Ryan Gise, Steven Kane; Detection of Amblyopia in Young Children via Retinal Rivalry Using a Video Game Styled Interface on a Tablet Device. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
A great deal of time and effort had gone into developing new technologies to screen for amblyopia. Current photoscreeners are able to detect amblyopic risk factors but not quantify the degree or presence of amblyopia. The Snellen Eye Chart is both accurate and effective when used by a skilled ophthalmologist but there remains a great deal of inter-screener variability in the primary care setting between physicians and medical staff. We sought identify a screening method that would also be able to quantify the degree of amblyopia for children even before they can read letters on the Snellen Eye Chart. We performed a prospective, observational study of children with known amblyopia and without to determine if a test with a video game like interface could use retinal rivalry to detect and quantify amblyopia.
For this study, we tested 16 Normal and 16 amblyopic children aged 3 to 7. Each was presented with a staircase algorithm of image sets of differing log units of brightness (0 to 1.8). It was designed by AMA Optics, Inc. for use on the iPad. The images were stacked on top of each other and the child was asked to determine the brighter object while wearing polarized sunglasses in order to separate the two eyes. The test was performed on each child twice and the results were recorded along with the visual acuity obtained at the child's ophthalmologic appointment that day and whether or not the child had amblyopia or was receiving treatment. The degree of brightness deficit between the two eyes was then compared to the visual acuity difference between the eyes for children with amblyopia.
All 16 Amblyopes with greater than 1 line disparity on the Snellen Eye Chart were detected and there were no false positives for children without Amblyopia. Thus, the sensitivity of the test was 100%.The test scores were consistently repeatable as indicated by highly correlated test and retest scores. (r=0.99, p <0.00001) The depth of defect reported and lines of acuity disparity were also highly correlated. (r=0.85, p<0.0001)
The iPad can be used as a vehicle for a game-like program to accurately detect the presence of amblyopia in children, It may provide a useful tool for both screening in the primary care setting and for ophthalmologic professionals to follow the improvement of patients with amblyopia during treatment.
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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