Purchase this article with an account.
Aveen Kadhum, Emily Tan, Maria Fronius, Maurits V. Joosse, Huibert Jan Simonsz, Sjoukje E Loudon; Dose-response relationship and treatment efficiency for patching vs gaming therapy for amblyopia. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2286.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare the dose-response rate and treatment efficiency between occlusion therapy and dichoptic video gaming using VR goggles in children with amblyopia.
In this prospective Randomized Clinical Trial (NCT 03767985) newly diagnosed children with amblyopia were recruited. Visual Acuity (VA) was measured using the crowded tumbling E-chart. After informed consent they were randomized to patching therapy: 2 hrs/day; compliance was monitored electronically using the Occlusion Dose Monitor; or dichoptic video game therapy using VR goggles: 1 hr/wk under direct supervision. The dose-response rate and treatment efficiency were calculated for both groups using VA gains and objectively monitored treatment hours. Mann-Whitney U test was used to investigate differences in dose-response and treatment efficiency between the two treatment groups.
Ninety-four children were recruited; 29 subjects refused and 2 were excluded. After refractive adaptation period, 23 subjects (24%) attained interocular VA <0.2 logMAR rendering them ineligible for the RCT; another 7 dropped out. Thirty-three children were included; median age was 5.4 (IQR 4.5-6.7) years. Mean compliance with occlusion therapy was 81±42%. Nine (56%) dropped out of the gaming group compared to 3 (18%) in the occlusion group. Reasons for drop-out in the gaming group were primarily due to young age (i.e. difficulties comprehending the game settings and the game itself) and logistic problems. After 24 weeks of treatment the median dose-response relationship for occlusion therapy was 71.78h/0.1 logMAR VA gain. For the gaming group this was 8.00h/0.1 logMAR VA gain. Median treatment efficiency was 0.08 (-0.19 – 0.68) VA gain/100 h in the occlusion group and 1.25 (0.42 – 2.08) VA gain/100 h in the gaming group (p<0.001).
Treatment efficiency and dose-response were significantly more favorable with gaming therapy compared to occlusion therapy after 24 weeks of treatment. However, more than half of the children from the gaming group failed to complete the treatment. Dichoptic video gaming using VR goggles seems to be most applicable in children older than 5.5 years of age with anisometropic amblyopia in whom the amblyopia persists after refractive adaptation.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
This PDF is available to Subscribers Only