A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching In Children 13 To 16 Years Of Age With Amblyopia

Abstract

Purpose : To compare visual acuity (VA) improvement in teenagers with amblyopia treated with a binocular iPad game versus part-time patching.

Methods : One hundred participants aged 13 to <17 years (mean 14.3 years) with amblyopia (20/40 to 20/200, mean ~20/80) resulting from strabismus, anisometropia, or both were enrolled into a randomized clinical trial. Participants were randomly assigned to treatment for 16 weeks of either a binocular iPad game prescribed for 1 hour per day (N=40) or patching of the fellow eye prescribed for 2 hours per day (N=60). The main outcome measure was change in amblyopic eye VA from baseline to 16 weeks, assessed by a masked observer.

Results : Mean amblyopic eye VA improved from baseline by 3.5 letters (2-sided 95% confidence interval (CI): 1.3 to 5.7 letters) in the binocular group and by 6.5 letters (2-sided 95% CI: 4.4 to 8.5 letters) in the patching group. After adjusting for baseline VA, the treatment group difference was -2.7 letters (95% CI: -5.7 to 0.3 letters) or 0.5 lines, favoring patching treatment. 62% of participants in the binocular group and 75% of participants in the patching group reported completing >75% of prescribed treatment. However, objectively recorded compliance data in the binocular group revealed that only 13% of participants actually completed >75% of the prescribed treatment (median percentage of prescribed treatment completed 21%, interquartile range 13% to 38%).

Conclusions : In teenagers aged 13 to <17 years, amblyopic eye VA improved minimally with the binocular iPad game used in this randomized clinical trial, but treatment adherence was poor.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.