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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. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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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