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Aveen Kadhum, Emily T.C. Tan, Gerdien Holtslag, Huibert Jan Simonsz, Sjoukje E Loudon; Comparing the effect of patching therapy with gaming for amblyopia. Invest. Ophthalmol. Vis. Sci. 2019;60(9):216.
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© ARVO (1962-2015); The Authors (2016-present)
To make a valid comparison between patching therapy and dichoptic video gaming after adequate spectacle correction in children with amblyopia.
In this ongoing prospective RCT all newly diagnosed amblyopic children with interocular visual acuity (VA) difference ≥0.2 logMAR were recruited. Exclusion criteria: previous amblyopia treatment, non-concomitant or constant angle strabismus >30PD, neurological disorder, nystagmus, other eye disorders and diminished VA due to medication, brain damage or trauma. After referral standard orthoptic examination was conducted by the research orthoptist. The examinations included VA with tumbling E-chart, stereo acuity with Randot stereotest and contrast sensitivity with Pelly-Robson or CSV-1000E in younger ones. After informed consent they were randomised to standard patching therapy: 2 hours/day; compliance was monitored electronically using the Occlusion Dose Monitor; or dichoptic video game therapy: 1 hour/week at the out-patient clinic under direct supervision. If necessary, refractive adaptation period of 16 weeks was carried out prior to randomisation. Spectacle wearing was monitored electronically for 1 week. VA was assessed every 6 weeks during the study period of 24 weeks. After completing the study period children were discharged to standard clinical care. Main outcome measure is VA improvement (logMAR units/time period) in children with amblyopia treated with patching therapy vs dichoptic video gaming.
So far, 47 children were eligible; 12 subjects refused participation. Mean compliance with spectacle wearing was 76%±8%. After refractive adaptation period, 7 subjects attained interocular VA <0.2 logMAR; 1 subject was excluded. There were 27 included for randomisation; 13 were boys (48%). Mean age at start of treatment was 5.6±1.9 years; 22 had anisometropia, 2 strabismus and 3 combined mechanism. Mean VA at start of treatment was 0.33±0.24 logMAR in the amblyopic eye and 0.07±0.15 logMAR in the fellow eye. Mean compliance with patching in the first 6 weeks was 80%±46%. There were 2 dropouts in the patching group and 7 in the gaming group. Mean VA after 6 weeks of treatment was 0.16±0.14 logMAR for the amblyopic eye and 0.05±0.11 logMAR in the fellow eye, meaning an improvement of 0.17 logMAR in the amblyopic eye.
Overall, a mean improvement of 1.7 logMAR line was found after 6 weeks of treatment. A higher drop-out rate was seen in the gaming group.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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