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Ganesh S, Lusobya RC, Balasubramanian J, Jogitha, Narendran K, Uduman MS, Mukisa J. Effectiveness of Dichoptic Therapy for Treating Mild to Moderate Amblyopia in a Tertiary Eye Care Center in South India. J Pediatr Ophthalmol Strabismus 2024:1-9. [PMID: 38940308 DOI: 10.3928/01913913-20240521-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
PURPOSE To contribute evidence about the effectiveness of dichoptic therapy in patients with mild to moderate amblyopia. METHODS A retrospective study was conducted in patients enrolled for dichoptic therapy on the Bynocs AmblyGo platform (Kanohi Eye Pvt Ltd) from January to August 2023. Data collected included logarithm of the minimum angle of resolution best corrected visual acuity, anterior and posterior segment examination, fixation pattern, dynamic and cycloplegic refraction, orthoptic evaluation, and number of dichoptic therapy sessions. Visual acuity, binocularity, and stereopsis before and after therapy were analyzed. RESULTS Of 59 patients (median age: 11 years, range: 5 to 30 years) enrolled, 34 (57.6%) had anisometropic amblyopia, 12 (20.3%) had ametropic amblyopia, 10 (17.0%) had strabismic amblyopia, and 3 (5.1%) had deprivation amblyopia. All 6 (10.2%) and 15 (22.4%) patients who had no binocular single vision for near and distance before therapy, respectively, attained normal binocular single vision on completion, except one who suppressed at distance. Twenty-one (75.0%) had improved near stereopsis, and 21 (60.0%) had improved distance stereopsis. Of 74 eyes treated, 61 (82.4%) had improved visual acuity and 73 (98.6%) improved in at least one tested parameter. A majority of these eyes had residual amblyopia after occlusion therapy. CONCLUSIONS Dichoptic therapy improves visual acuity, binocularity, and stereoacuity in patients with amblyopia, including those older than 8 years, especially in partial deprivation, ametropic, and anisometropic amblyopia. {J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XX-XX.].
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Meqdad Y, El-Basty M, Awadein A, Gouda J, Hassanein D. Randomized Controlled Trial of Patching versus Dichoptic Stimulation Using Virtual Reality for Amblyopia Therapy. Curr Eye Res 2024; 49:214-223. [PMID: 37878538 DOI: 10.1080/02713683.2023.2275531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
Purpose: To compare the outcomes of patching to dichoptic stimulation using virtual reality (VR) in moderate and severe amblyopia.Methods: This study was conducted on 86 subjects with unilateral anisometropic and mixed amblyopia. The subjects were randomized to the VR or patching group. The VR group received treatment using the Vivid Vision software (Vivid Vision Inc., San Francisco, USA) with each subject receiving weekly 2 h-sessions for 10 weeks. The patching group was prescribed patching for 10 weeks. Best-corrected visual acuity (BCVA) was measured using a single crowded letter in an ETDRS chart before, after 10 weeks of treatment, and after another 10 weeks of cessation of treatment. Near stereoacuity was measured using the TNO test.Results: Forty-two patients were randomized to the patching group and 44 to the VR group. The median age of the subjects was 12.0 (range 6.0 to 37.0) years. In the VR group, mean amblyopic eye BCVA showed statistically significant improvement by 0.89 line (95% confidence interval {CI}, 0.73 to 1.35 lines; p < 0.001) after 10 weeks of therapy, and after another 10 weeks of follow-up by 1.32 lines from baseline (95% CI, 1.15 to 1.7 lines; p < 0.001). Regarding the patching group, mean BCVA showed statistically significant improvement after 10 weeks by 1.38 lines (95% CI, 0.82 to 1.8 lines; p < 0.001), and after another 10 weeks by 1 line from baseline (95% CI, 0.06-0.147; 0.6 to 1.47 lines; p < 0.001). There was no significant difference between both groups at any time-point (p values >0.05). No serious adverse events were noted. Adults and severe amblyopes in the VR group showed more significant VA improvement than their counterparts in the patching group.Conclusions: Amblyopes treated using VR dichoptic treatment demonstrated statistically significant VA improvement after 10 and 20 weeks of follow-up that is comparable to patching.
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Affiliation(s)
- Yasmine Meqdad
- Department of Ophthalmology, Cairo University, Cairo, Egypt
| | | | - Ahmed Awadein
- Department of Ophthalmology, Cairo University, Cairo, Egypt
| | - Jylan Gouda
- Department of Ophthalmology, Cairo University, Cairo, Egypt
| | - Dina Hassanein
- Department of Ophthalmology, Cairo University, Cairo, Egypt
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Zhao J, Luo W, Pang S, Hu B, Shui D, Bin L, Mao K, Hao G, Liu Z, Wiederhold BK, Wiederhold M. Digital Therapy for Visual Acuity and Binocular Function in Children with Anisometropic Amblyopia. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:924-929. [PMID: 37883183 DOI: 10.1089/cyber.2022.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Amblyopia affects development of children's monocular vision and binocular function and becomes a largely intractable problem with increasing aging. This study is to investigate the binocular function and evaluate efficacy of digital therapy in children 8-13 years of age with anisometropic amblyopia. The patients in the digital therapy group performed the training with the digital amblyopia therapeutic software. The visual acuity and binocular function (perceptual eye position [PEP], suppression, and stereopsis) were examined at the first visit and 3-month post-treatment. Twenty-three cases in the control group and 25 cases in the digital therapy group were enrolled. The results revealed that 3-month digital therapy can effectively improve corrected distance visual acuity (CDVA) and improve the binocular function, including PEP, suppression, and second-order stereopsis in children with anisometropic amblyopia, 8-13 years of age. Digital therapy for amblyopia can effectively improve monocular CDVA of amblyopic eyes and binocular function in older children with anisometropic amblyopia.
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Affiliation(s)
- Jiao Zhao
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Wuqiang Luo
- Visual Science and Optometry Center, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shasha Pang
- National Engineering Research Center for Healthcare Devices, Guangzhou, China
| | - Budan Hu
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Dan Shui
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Li Bin
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Ke Mao
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Gensheng Hao
- Department of Refractive Surgery, Aier Eye Hospital, Leshan, China
| | - Zongshun Liu
- Department of Refractive Surgery, Aier Eye Hospital, Leshan, China
| | - Brenda K Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, La Jolla, California, USA
| | - Mark Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, La Jolla, California, USA
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Chaturvedi I, Jamil R, Sharma P. Binocular vision therapy for the treatment of Amblyopia-A review. Indian J Ophthalmol 2023; 71:1797-1803. [PMID: 37203032 PMCID: PMC10391509 DOI: 10.4103/ijo.ijo_3098_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Amblyopia is a monocular or binocular reduction in visual acuity that results from prolonged visual deprivation in the early years of life. It is second only to refractive error as a cause of poor vision in children. The gold standard treatment of amblyopia includes patching and, less commonly, atropine penalization and filters. These therapies are aimed at improvements in the visual acuity of the amblyopic eye alone. They have compliance and psychosocial issues and gains are accrued after prolonged periods. Experimental studies have demonstrated the presence of binocular cortical communication even in amblyopes and neural plasticity in late childhood as well as adulthood. On this basis, binocular vision therapy aimed at the stimulation of both eyes rather than forced use of the amblyopic eye was developed. Such therapies involve visual tasks designed in such a way that they can be completed only by binocular viewing. These tasks vary from simple game play using red-green glasses, to engaging 3D games and movie viewing. Preliminary data suggest that binocular vision therapy has led to lasting improvements in visual acuity and can be a useful adjunct, if not replacement, to the conventional treatment of amblyopia. In this article, we aim to describe the various binocular vision therapies and review the available literature on the same.
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Affiliation(s)
- Isha Chaturvedi
- Comprehensive Services, Centre for Sight Eye Institute, Dwarka, New Delhi, India
| | - Rana Jamil
- Comprehensive Services, Centre for Sight Eye Institute, Dwarka, New Delhi, India
| | - Pradeep Sharma
- Strabismus Pediatric and Neuro-Ophthalmology Services, Centre for Sight, Safdarjung Enclave, New Delhi, India
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Abstract
Extended reality (XR) devices, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) devices, are immersive technologies that can swap or merge the natural environment with virtual content (e.g., videogames, movies, or other content). Although these devices are widely used for playing videogames and other applications, they have one distinct feature that makes them potentially very useful for the measurement and treatment of binocular vision anomalies-they can deliver different content to the two eyes simultaneously. Indeed, horizontally shifting the images in the two eyes (thereby creating binocular disparity) can provide the user with a compelling percept of depth through stereopsis. Because these devices are stereoscopic, they can also be used as high-tech synoptophores, in which the images to the two eyes differ in contrast, luminance, size, position, and content for measuring and treating binocular anomalies. The inclusion of eye tracking in VR adds an additional dimension to its utility in measuring and treating binocular vision anomalies, as well as other conditions. This paper describes the essential requirements for testing and treating binocular anomalies and reviews current studies in which XR devices have been used to measure and treat binocular vision anomalies.
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Affiliation(s)
- Dennis M. Levi
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, Berkeley, CA, USA,
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Bui Quoc E, Kulp MT, Burns JG, Thompson B. Amblyopia: A review of unmet needs, current treatment options, and emerging therapies. Surv Ophthalmol 2023; 68:507-525. [PMID: 36681277 DOI: 10.1016/j.survophthal.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Amblyopia is a global public health issue with extensive, multifaceted impacts on vision and quality of life (QoL) for both patients and families. Geographical variation exists in the management of amblyopia, with traditional mainstay treatments, optical correction, and fellow eye occlusion most successful when implemented at an early age. In recent years, however, studies demonstrating meaningful improvements in older children and adults have challenged the concept of a complete loss of visual processing plasticity beyond the critical period of visual development, with growing evidence supporting the potential efficacy of emerging, more engaging, binocular therapies in both adults and children. Binocular approaches aim to restore deficits in amblyopia that extend beyond monocular visual acuity impairment, including binocular fusion and visuomotor skills. In view of this, incorporating outcome measures that evaluate the visual performance and functional ability of individuals with amblyopia will provide a clearer understanding of the effect of amblyopia on QoL and a more comprehensive evaluation of amblyopia therapies.
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Affiliation(s)
- Emmanuel Bui Quoc
- Ophthalmology Department, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
| | | | | | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Canada; Centre for Eye and Vision Research, Hong Kong
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Chan HS, Tang YM, Do CW, Ho Yin Wong H, Chan LYL, To S. Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality. Digit Health 2023; 9:20552076231176638. [PMID: 37312939 PMCID: PMC10259136 DOI: 10.1177/20552076231176638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/02/2023] [Indexed: 06/15/2023] Open
Abstract
Background Virtual reality is a relatively new intervention that has the potential to be used in the treatment of eye and vision problems. This article reviews the use of virtual reality-related interventions in amblyopia, strabismus, and myopia research. Methods Sources covered in the review included 48 peer-reviewed research published between January 2000 and January 2023 from five electronic databases (ACM Digital Library, IEEE Xplore, PubMed, ScienceDirect and Web of Science). To prevent any missing relevant articles, the keywords, and terms used in the search included "VR", "virtual reality", "amblyopia", "strabismus," and "myopia". Quality assessment and data extraction were performed independently by two authors to form a narrative synthesis to summarize findings from the included research. Results Total number of 48 references were reviewed. There were 31 studies published on amblyopia, 18 on strabismus, and 6 on myopia, with 7 studies overlapping amblyopia and strabismus. In terms of technology, smartphone-based virtual reality headset viewers were utilized more often in amblyopia research, but commercial standalone virtual reality headsets were used more frequently in myopia and strabismus-related research. The software and virtual environment were mostly developed based on vision therapy and dichoptic training paradigms. Conclusion It has been suggested that virtual reality technology offers a potentially effective tool for amblyopia, strabismus, and myopia studies. Nonetheless, a variety of factors, especially the virtual environment and systems employed in the data presented, must be explored before determining whether virtual reality can be effectively applied in clinical settings. This review is significant as the technology in virtual reality software and application design features have been investigated and considered for future reference.
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Affiliation(s)
- Hoi Sze Chan
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yuk Ming Tang
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chi Wai Do
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Horace Ho Yin Wong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Lily YL Chan
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Suet To
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Ojiabo SN, Munsamy AJ. The Effect of Home-Based Dichoptic Therapy on Young Adults with Non-Strabismic Anisometropic Amblyopia on Stereo Acuity. CLINICAL OPTOMETRY 2022; 14:237-247. [PMID: 36466992 PMCID: PMC9718499 DOI: 10.2147/opto.s385845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
AIM To evaluate the effect of home-based dichoptic visual therapy using anaglyphic red-green filters on the stereo acuity in a sample of young adults with non-strabismic anisometropic amblyopia. METHODS The study was observational and cross-sectional in design. Two groups (experimental vs control) were sourced using purposive sampling of young adults with non-strabismic amblyopia (experimental group) in comparison to an age-match control group without amblyopia. For the purpose of refractive adaptation, all participants in both groups were asked to wear their spectacle correction constantly for at least 16 weeks prior to exposure to home-based dichoptic therapy. Stereo acuity measurements using the Stereo Fly test were obtained before and after 40 hours exposure to home-based dichoptic therapy. The changes in stereo acuity post eight weeks (40 hours) training from baseline measurements was obtained. The difference in medians between the experimental and control groups using the Mann-Whitney U-test was measured with significance set at P value of <0.05. RESULTS A total of 38 young adults (19 males, 19 females) with a mean age of 24.05 ± 5.66 years were enrolled in this study. Nineteen anisometropic amblyopes comprised the experimental group, fifteen of which were classified as moderate amblyopia (6/12-6/36) and 19 non-amblyopes comprised the control group. Home-based dichoptic therapy used on the experimental group after 8 weeks showed a significant improvement in stereo-acuity with a mean improvement of 345.26 ± 184.85 sec arc-1 [IQR:260;600; p<0.001] when compared to the control group. CONCLUSION Home-based dichoptic therapy improved stereo-acuity in non-strabismic anisometropic amblyopes (moderate) in young adults. Thus suggesting that binocularity can improve in anisometropic adult amblyopes with a treatment modality that may be a convenient option better suit the demanding lifestyle of economically active adults who may not be able to comply with clinic-based therapy.
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Affiliation(s)
- Sunday Nduka Ojiabo
- Department of Optometry, School of Health Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
| | - Alvin J Munsamy
- Discipline of Optometry, School of Health Science, University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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Shah S, Shah M, Purohit A, Khanguda V. Perceptual learning with hand - eye coordination as an effective tool for managing amblyopia: A prospective study. Indian J Ophthalmol 2022; 70:3630-3633. [PMID: 36190061 PMCID: PMC9789846 DOI: 10.4103/ijo.ijo_852_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Amblyopia is a serious condition resulting in monocular impairment of vision. Although traditional treatment improves vision, we attempted to explore the results of perceptual learning in this study. Methods This prospective cohort study included all patients with amblyopia who were subjected to perceptual learning. The presenting data on vision, stereopsis and contrast sensitivity were documented in a pretested online format, and the pre- and post-treatment information was compared using descriptive, cross-tabulation and comparative methods on SPSS 2.2. The mean values were obtained, and P < 0.05 was considered statistically significant. Results The cohort consisted of 47 patients (23 females and 24 males) with a mean age of 14.11 ± 7.13 years. A statistically significant improvement was detected in visual acuity after the perceptual learning session, and the median follow-up period was 17 days. Also, significant improvements were observed in stereopsis but not in the visual outcomes among the age groups. Conclusion Perceptual learning with hand-eye coordination is an effective method for managing amblyopia. This approach can improve vision in all age groups. However, visual improvement is significantly influenced by ocular alignment.
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Affiliation(s)
| | - Mehul Shah
- Drashti Netralaya, Dahod, Gujarat, India,Correspondence to: Dr. Mehul Shah, Drashti Netralaya, Chakalia Road, Dahod, Gujarat, India. E-mail:
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Yang X, Fan Y, Chu H, Yan L, Wiederhold BK, Wiederhold M, Liao Y. Preliminary Study of Short-Term Visual Perceptual Training Based on Virtual Reality and Augmented Reality in Postoperative Strabismic Patients. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2022; 25:465-470. [PMID: 35647873 DOI: 10.1089/cyber.2022.0113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study aimed to explore the potential effect of short-term visual perceptual training based on virtual reality (VR) and augmented reality (AR) platforms in postoperative strabismic patients. We enrolled 236 postoperative strabismic patients, among whom 111 patients received VR-based training, and 125 patients received AR-based training. The stereoacuity of 1.5 m and dynamic stereopsis were improved by VR training; meanwhile, AR training exhibited more improvement in stereoacuity of 0.8 and 1.5 m, dynamic and coarse stereopsis. It was suggested that the visual perceptual training based on VR and AR technology can be potentially applied in postoperative strabismus treatment to promote the recovery of binocular vision.
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Affiliation(s)
- Xubo Yang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchen Fan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Chu
- National Engineering Research Center for Healthcare Devices, Guangzhou, China
| | - Li Yan
- National Engineering Research Center for Healthcare Devices, Guangzhou, China
| | - Brenda K Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, La Jolla, California
| | - Mark Wiederhold
- Virtual Reality Medical Center, Scripps Memorial Hospital, La Jolla, California
| | - Yongchuan Liao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Leal Vega L, Piñero DP, Hernández Rodríguez CJ, Molina Martín A, Morales-Quezada L, Vallelado Álvarez AI, Arenillas Lara JF, Coco Martín MB. Study protocol for a randomized controlled trial of the NEIVATECH virtual reality system to improve visual function in children with anisometropic amblyopia. BMC Ophthalmol 2022; 22:253. [PMID: 35672688 PMCID: PMC9172013 DOI: 10.1186/s12886-022-02466-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. METHODS We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. DISCUSSION The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. TRIAL REGISTRATION This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.
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Affiliation(s)
- L Leal Vega
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| | - D P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - C J Hernández Rodríguez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - A Molina Martín
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - L Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - A I Vallelado Álvarez
- Pediatric Ophthalmology Unit, Department of Ophthalmology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - J F Arenillas Lara
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain.
- Stroke Unit and Stroke Program, Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain.
| | - M B Coco Martín
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
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Abstract
Occlusion therapy has a long history as the gold standard treatment for amblyopia. Over the past two decades, large multicenter randomized controlled trials and objective dose-monitoring studies have characterized the effects of refractive correction, patching, and atropine penalization, providing insights into the impact of factors such as age and treatment dose. More recent approaches, whose development has been accelerated by advances in technology, are designed to provide different stimulation to the amblyopic eye and the fellow eye. This review explores a variety of such dichoptic approaches, categorized according to whether they primarily feature requisite use of the amblyopic eye in the face of fellow-eye masking, integration of visual information from both eyes, or reduction of stimulus salience in the fellow eye. It is still unclear whether dichoptic treatments are superior to traditional, low-cost treatment methods or whether their therapeutic mechanisms are fundamentally different from those of established treatments. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Kimberly Meier
- Department of Psychology, University of Washington, Seattle, Washington, USA;
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Tailor V, Ludden S, Bossi M, Bunce C, Greenwood JA, Dahlmann-Noor A. Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years. Cochrane Database Syst Rev 2022; 2:CD011347. [PMID: 35129211 PMCID: PMC8819728 DOI: 10.1002/14651858.cd011347.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current treatments for amblyopia, typically patching or pharmacological blurring, have limited success. Less than two-thirds of children achieve good acuity of 0.20 logMAR in the amblyopic eye, with limited improvement of stereopsis, and poor adherence to treatment. A new approach, based on presentation of movies or computer games separately to each eye, may yield better results and improve adherence. These treatments aim to balance the input of visual information from each eye to the brain. OBJECTIVES: To determine whether binocular treatments in children, aged three to eight years, with unilateral amblyopia result in better visual outcomes than conventional patching or pharmacological blurring treatment. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE, Embase, ISRCTN, ClinicalTrials.gov, and the WHO ICTRP to 19 November 2020, with no language restrictions. SELECTION CRITERIA Two review authors independently screened the results of the search for relevant studies. We included randomised controlled trials (RCTs) that enrolled children between the ages of three and eight years old with unilateral amblyopia. Amblyopia was classed as present when the best-corrected visual acuity (BCVA) was worse than 0.200 logMAR in the amblyopic eye, with BCVA 0.200 logMAR or better in the fellow eye, in the presence of an amblyogenic risk factor, such as anisometropia, strabismus, or both. To be eligible, children needed to have undergone cycloplegic refraction and ophthalmic examination, including fundal examination and optical treatment, if indicated, with stable BCVA in the amblyopic eye despite good adherence with wearing glasses. We included any type of binocular viewing intervention, on any device (e.g. computer monitors viewed with liquid-crystal display shutter glasses; hand-held screens, including mobile phones with lenticular prism overlay; or virtual reality displays). Control groups received standard amblyopia treatment, which could include patching or pharmacological blurring of the better-seeing eye. We included full-time (all waking hours) and part-time (between 1 and 12 hours a day) patching regimens. We excluded children who had received any treatment other than optical treatment; and studies with less than 8-week follow-up. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcome of the review was the change from baseline of distance BCVA in the amblyopic eye after 16 (± 2) weeks of treatment, measured in logMAR units on an age-appropriate acuity test. MAIN RESULTS We identified one eligible RCT of conventional patching treatment versus novel binocular treatment, and analysed a subset of 68 children who fulfilled the age criterion of this review. We obtained data for the mean change in amblyopic eye visual acuity, adverse events (diplopia), and adherence to prescribed treatment at 8- and 16-week follow-up intervals, though no data were available for change in BCVA after 52 weeks. Risk of bias for the included study was considered to be low. The certainty of evidence for the visual acuity outcomes at 8 and 16 weeks of treatment and adherence to the study intervention was rated moderate using the GRADE criteria, downgrading by one level due to imprecision. The certainty of evidence was downgraded by two levels and rated low for the proportion of participants reporting adverse events due to the sample size. Acuity improved in the amblyopic eye in both the binocular and patching groups following 16 weeks of treatment (improvement of -0.21 logMAR in the binocular group and -0.24 logMAR in the patching group, mean difference (MD) 0.03 logMAR (95% confidence interval (CI) -0.10 to 0.04; 63 children). This difference was non-significant and the improvements in both the binocular and patching groups are also considered clinically similar. Following 8 weeks of treatment, acuity improved in both the binocular and patching groups (improvement of -0.18 logMAR in the patching group compared to -0.16 logMAR improvement in the binocular-treatment group) (MD 0.02, 95% CI -0.04 to 0.08). Again this difference was statistically non-significant, and the differences observed between the patching and binocular groups are also clinically non-significant. No adverse event of permanent diplopia was reported. Adherence was higher in the patching group (47% of participants in the iPad group achieved over 75% compliance compared with 90% of the patching group). Data were not available for changes in stereopsis nor for contrast sensitivity following treatment. AUTHORS' CONCLUSIONS Currently, there is only one RCT that offers evidence of the safety and effectiveness of binocular treatment. The authors are moderately confident that after 16 weeks of treatment, the gain in amblyopic eye acuity with binocular treatment is likely comparable to that of conventional patching treatment. However, due to the limited sample size and lack of long term (52 week) follow-up data, it is not yet possible to draw robust conclusions regarding the overall safety and sustained effectiveness of binocular treatment. Further research, using acknowledged methods of visual acuity and stereoacuity assessment with known reproducibility, is required to inform decisions about the implementation of binocular treatments for amblyopia in clinical practice, and should incorporate longer term follow-up to establish the effectiveness of binocular treatment. Randomised controlled trials should also include outcomes reported by users, adherence to prescribed treatment, and recurrence of amblyopia after cessation of treatment.
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Affiliation(s)
- Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Experimental Psychology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Siobhan Ludden
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- HSE DNCC Grangegorman Eye Clinic, Dublin, Ireland
| | - Manuela Bossi
- Department of Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Annegret Dahlmann-Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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14
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Hsieh YC, Liao WL, Tsai YY, Lin HJ. Efficacy of vision therapy for unilateral refractive amblyopia in children aged 7-10 years. BMC Ophthalmol 2022; 22:44. [PMID: 35100972 PMCID: PMC8805323 DOI: 10.1186/s12886-022-02246-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background There is a critical period for visual development, conventionally considered to be the first 6 years of life. Children aged 7 years and older are significantly less responsive to amblyopia treatment. This study investigated the efficacy of binocular vision therapy in amblyopic children aged 7–10 years. Methods This retrospective study enrolled 36 children with unilateral amblyopia who were divided into a case group (receiving vision therapy, optical correction, and part-time patching of the weaker eye) and a control group (receiving optical correction and part-time patching of the weaker eye). Visual acuity (VA) was measured at baseline, at the 3-month, 6-month, and 9-month visits, and 3 months after cessation of treatment. Results There were 19 subjects in the case group and 17 subjects in the control group. Mean VA in the case group improved from 0.39 ± 0.24 logMAR at baseline to 0.10 ± 0.23 logMAR at the endpoint of treatment (p < 0.001, paired t-test). Mean VA in the control group improved from 0.64 ± 0.30 logMAR at baseline to 0.52 ± 0.27 logMAR at the endpoint of treatment (p = 0.015, paired t-test). The improvement was significantly greater in the case group than in the control group (p = 0.006, two-samples independent t-test). All subjects underwent follow-up examinations within 6 to 12 months. There was no regression of VA in the case group 3 months after cessation of vision therapy. The patients in the case group who received visual therapy were with better VA improvement then patients with only optic correction and patching. Conclusions Vision therapy combined with conventional treatment (optical correction and part-time patching) is more effective than conventional treatment alone in children aged 7–10 years with unilateral refractive amblyopia. The treatment results not only in greater vision gain, but also in shorter duration of treatment.
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Affiliation(s)
- Yi-Ching Hsieh
- Department of Ophthalmology, Eye Center, China Medical University Hospital, No. 2, Yude Road, Taichung, Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Personal Medical Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, Eye Center, China Medical University Hospital, No. 2, Yude Road, Taichung, Taiwan.,Department of Ophthalmology, China Medial University, Taichung, Taiwan
| | - Hui-Ju Lin
- Department of Ophthalmology, Eye Center, China Medical University Hospital, No. 2, Yude Road, Taichung, Taiwan. .,School of Chinese Medicine, China Medial University, Taichung, Taiwan.
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15
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Mirmohammadsadeghi A, Sadeghi M, Kasaee A, Akbari MR. Anaglyphic Three-Dimensional Movie: A Simple Binocular Method to Treat Anisometropic or Strabismic Amblyopia in Adults. J Curr Ophthalmol 2022; 34:124-127. [PMID: 35620363 PMCID: PMC9128432 DOI: 10.4103/joco.joco_101_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the efficacy of anaglyphic three-dimensional movies to treat adults with anisometropic or strabismic amblyopia. Methods This is an interventional case series. The seven cases were put on a trial frame containing subjective refraction, fogging plus lenses for the dominant eye, correcting prism, and anaglyphic red-cyan plastic spectacles. Patients participated in 20 sessions of 1.5 h of anaglyphic three-dimensional animated movie watching in the office. Significant visual acuity (VA) improvement was defined as improvement ≥0.2 in logMAR values. Change in octaves of stereopsis was defined as halving the arcsec or 0.3 change in log arcsec. Results The average age was 26.9 ± 10.0 (16-42) years. The mean VA in amblyopic eye improved significantly from 0.42 ± 0.19 (0.15-0.7) logMAR to 0.25 ± 0.15 (0.1-0.5) logMAR after completion of sessions (P = 0.02), and four cases showed significant VA improvement. The mean stereoacuity improved significantly from 2.6 ± 0.3 (2.1-2.9) log arcsec to 2.1 ± 0.5 (1.7-2.9) log arcsec (P = 0.04). Four cases showed ≥2 octaves improvements in stereopsis. Conclusion A simple and readily available method of amblyopia treatment can be effective in some adult cases.
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Affiliation(s)
| | - Motahhareh Sadeghi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Kasaee
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Akbari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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16
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Fu E, Wang T, Li J, Yu M, Yan X. Video game treatment of amblyopia. Surv Ophthalmol 2021; 67:830-841. [PMID: 34606819 DOI: 10.1016/j.survophthal.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
Amblyopia is visual impairment characterized by a structurally normal eye showing significantly lower visual acuity than the fellow eye. Traditional treatment of amblyopia includes patching the good eye to force the amblyopic eye to work during normal daily activities; however, this approach is are limited by low compliance. Recently, researchers proposed a new treatment for amblyopia: video game playing. In the current review, we discuss whether video game playing can treat amblyopia, whether video game playing could better treat amblyopia than traditional treatments, and how the video game treats amblyopia and its possible mechanism. Based on results from our literature review and meta-analysis, we suggest there is strong evidence for the effectiveness of video game treatments. Moreover, multiple factors within and outside of video games could influence the treatment effect.
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Affiliation(s)
- En Fu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China; School of Optometry, Shenzhen University, Shenzhen, China
| | - Ting Wang
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China; School of Optometry, Shenzhen University, Shenzhen, China
| | - Jin Li
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China; School of Optometry, Shenzhen University, Shenzhen, China
| | - Mingyu Yu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China; School of Optometry, Shenzhen University, Shenzhen, China
| | - Xiaohe Yan
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China; School of Optometry, Shenzhen University, Shenzhen, China.
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17
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Ong CW, Tan MCJ, Lam M, Koh VTC. Applications of Extended Reality in Ophthalmology: Systematic Review. J Med Internet Res 2021; 23:e24152. [PMID: 34420929 PMCID: PMC8414293 DOI: 10.2196/24152] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/19/2020] [Accepted: 04/06/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Virtual reality, augmented reality, and mixed reality make use of a variety of different software and hardware, but they share three main characteristics: immersion, presence, and interaction. The umbrella term for technologies with these characteristics is extended reality. The ability of extended reality to create environments that are otherwise impossible in the real world has practical implications in the medical discipline. In ophthalmology, virtual reality simulators have become increasingly popular as tools for surgical education. Recent developments have also explored diagnostic and therapeutic uses in ophthalmology. OBJECTIVE This systematic review aims to identify and investigate the utility of extended reality in ophthalmic education, diagnostics, and therapeutics. METHODS A literature search was conducted using PubMed, Embase, and Cochrane Register of Controlled Trials. Publications from January 1, 1956 to April 15, 2020 were included. Inclusion criteria were studies evaluating the use of extended reality in ophthalmic education, diagnostics, and therapeutics. Eligible studies were evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Relevant studies were also evaluated using a validity framework. Findings and relevant data from the studies were extracted, evaluated, and compared to determine the utility of extended reality in ophthalmology. RESULTS We identified 12,490 unique records in our literature search; 87 met final eligibility criteria, comprising studies that evaluated the use of extended reality in education (n=54), diagnostics (n=5), and therapeutics (n=28). Of these, 79 studies (91%) achieved evidence levels in the range 2b to 4, indicating poor quality. Only 2 (9%) out of 22 relevant studies addressed all 5 sources of validity evidence. In education, we found that ophthalmic surgical simulators demonstrated efficacy and validity in improving surgical performance and reducing complication rates. Ophthalmoscopy simulators demonstrated efficacy and validity evidence in improving ophthalmoscopy skills in the clinical setting. In diagnostics, studies demonstrated proof-of-concept in presenting ocular imaging data on extended reality platforms and validity in assessing the function of patients with ophthalmic diseases. In therapeutics, heads-up surgical systems had similar complication rates, procedural success rates, and outcomes in comparison with conventional ophthalmic surgery. CONCLUSIONS Extended reality has promising areas of application in ophthalmology, but additional high-quality comparative studies are needed to assess their roles among incumbent methods of ophthalmic education, diagnostics, and therapeutics.
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Affiliation(s)
- Chee Wui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcus Chun Jin Tan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Michael Lam
- Department of Ophthalmology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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18
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Portable rotating grating stimulation for anisometropic amblyopia with 6 months training. Sci Rep 2021; 11:11430. [PMID: 34075118 PMCID: PMC8169940 DOI: 10.1038/s41598-021-90936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Treatment of grating stimulation has been used in amblyopia for decades, but high dropout rate and inconvenience for daily practice occur in previous studies. We developed a home-based portable system with rotating grating stimulation on a tablet. Thirty anisometropic amblyopic children were randomly allocated into the control or Grating group. They drew contour of the picture under patch of a better eye for 6 months. Best-corrected visual acuity (BCVA), grating acuity (GA), and contrast sensitivity (CS) were assessed at the baseline, 1st, 2nd, 3rd, and 6th months of training. All participants completed the 6-month training. Patched eyes of both groups exhibited no difference. Trained eyes of the control group had significantly slight improvement in BCVA and GA. In particular, the Grating group exhibited significantly higher BCVA, GA, and CS compared with those of the control group at the 3rd and 6th months of training. Moreover, percentage of the Grating group with great improvement (BCVA ≥ 0.3 or CS ≥ 0.3) was significantly larger than those of the control group at the 3rd or 6th months of training. The portable grating stimulation system demonstrates its trainability by no dropout and effectiveness by significant improvements in all assessments through a well experimental design. Trial Registration: ClinicalTrials.gov NCT04213066, registered 30/12/2019, https://clinicaltrials.gov/ct2/show/NCT04213066.
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19
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Suttle CM. Active treatments for amblyopia: a review of the methods and evidence base. Clin Exp Optom 2021; 93:287-99. [DOI: 10.1111/j.1444-0938.2010.00486.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Catherine M Suttle
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
E‐mail
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20
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Abstract
Traditional therapies to treat amblyopia, such as optical correction or occlusion/penalization of the non-amblyopic eye, are efficacious but are not without limitations such as poor adherence and decreased success with increasing age. Recently, there has been an interest in new amblyopia therapies, some using binocular techniques, through a variety of platforms including video games, movies, and virtual reality. Overall, available efficacy results for these treatments are highly variable.
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Affiliation(s)
- Michelle M Falcone
- Department of Ophthalmology, Boston Children's Hospital, Boston, United States.,Department of Ophthalmology, Harvard Medical School, Boston, United States
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Boston, United States.,Department of Ophthalmology, Harvard Medical School, Boston, United States
| | - Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital, Boston, United States.,Department of Ophthalmology, Harvard Medical School, Boston, United States.,Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, United States
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21
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Murali K, Ramesh A, Murthy S, Goyal A. Binocular therapy as primary intervention in adults with anisometropic amblyopia. Taiwan J Ophthalmol 2021; 12:317-324. [PMID: 36248080 PMCID: PMC9558481 DOI: 10.4103/tjo.tjo_37_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE: Refractive correction and patching is the timetested mainstay of treatment for anisometropic amblyopia within the critical period of visual development. Binocular therapies using dichoptic training which overcome suppression by balancing the contrast between two eyes has been increasingly gaining ground. We evaluated the efficacy of dichoptic training in the adult population with anisometropic amblyopia. This study aims to evaluate the effectiveness of dichopticbased active vision therapy, using “VisuoPrime” software as primary intervention, in adults with anisometropic amblyopes. MATERIALS AND METHODS: A prospective interventional study in adults (18–40 years) with anisometropic amblyopia was conducted from August 2019 to March 2020. METHODS: Twentynine subjects with anisometropic amblyopia played binocular games through “VisuoPrime” software 30 min daily for 6 weeks. Bestcorrected visual acuity (BCVA) and binocularity was assessed at 1 and 3 months. Student's paired ttest, Wilcoxon signedrank sum test and MannWhitney tests were used. Statistical package of SPSS version 20.0 was used for analysis, considering P < 0.05 as statistically significant. RESULTS: BCVA of the amblyopic eye improved from 0.60 ± 0.40 logMAR to 0.45 ± 0.29 logMAR and 0.38 ± 0.23 logMAR at 1 and 3 months, respectively (P = 0.0001). Near acuity improved from 0.21 ± 0.14 to 0.14 ± 0.08 logMAR and 0.1 ± 0.04 logMAR at 1 and 3 months respectively (P < 0.0001). Improvement in stereopsis was observed in 24% of subjects which maintained at 3 month followup. CONCLUSION: Dichopticbased active vision therapy using “VisuoPrime” software was effective as a primary modality in adults with anisometropic amblyopia.
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22
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Zlatkute G, de la Bastida VCS, Vishwanath D. Unimpaired perception of relative depth from perspective cues in strabismus. ROYAL SOCIETY OPEN SCIENCE 2020; 7:200955. [PMID: 33489262 PMCID: PMC7813253 DOI: 10.1098/rsos.200955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Strabismus is a relatively common ophthalmological condition where the coordination of eye muscles to binocularly fixate a single point in space is impaired. This leads to deficits in vision and particularly in three-dimensional (3D) space perception. The exact nature of the deficits in 3D perception is poorly understood as much of understanding has relied on anecdotal reports or conjecture. Here, we investigated, for the first time, the perception of relative depth comparing strabismic and typically developed binocular observers. Specifically, we assessed the susceptibility to the depth cue of perspective convergence as well as the capacity to use this cue to make accurate judgements of relative depth. Susceptibility was measured by examining a 3D bias in making two-dimensional (2D) interval equidistance judgements and accuracy was measured by examining 3D interval equidistance judgements. We tested both monocular and binocular viewing of images of perspective scenes under two different psychophysical methods: two-alternative forced-choice (2AFC) and the method of adjustment. The biasing effect of perspective information on the 2D judgements (3D cue susceptibility) was highly significant and comparable for both subject groups in both the psychophysical tasks (all ps < 0.001) with no statistically significant difference found between the two groups. Both groups showed an underestimation in the 3D task with no significant difference between the group's judgements in the 2AFC task, but a small statistically significant difference (ratio difference of approx. 10%, p = 0.016) in the method of adjustment task. A small but significant effect of viewing condition (monocular versus binocular) was revealed only in the non-strabismic group (ratio difference of approx. 6%, p = 0.002). Our results show that both the automatic susceptibility to, and accuracy in the use of, the perspective convergence cue in strabismus is largely comparable to that found in typically developed binocular vision, and have implications on the nature of the encoding of depth in the human visual system.
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Affiliation(s)
- Giedre Zlatkute
- School of Psychology and Neuroscience, University of St Andrews, St Mary's Quad, St Andrews, Fife KY16 9JP, UK
| | | | - Dhanraj Vishwanath
- School of Psychology and Neuroscience, University of St Andrews, St Mary's Quad, St Andrews, Fife KY16 9JP, UK
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23
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Gopal SKS, Kelkar J, Kelkar A, Pandit A. Simplified updates on the pathophysiology and recent developments in the treatment of amblyopia: A review. Indian J Ophthalmol 2020; 67:1392-1399. [PMID: 31436180 PMCID: PMC6727694 DOI: 10.4103/ijo.ijo_11_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment affecting 2-5% of the general population. Amblyopia is a developmental cortical disorder of the visual pathway essentially due to abnormal visual stimulus, reaching the binocular cortical cells, which may be multivariate. Ganglion cells are of two types: parvocellular (P cells) and magnocellular (M cells); they are the first step where the light energy is converted in to neural impulse. P cells are involved in fine visual acuity, fine stereopsis, and color vision and M cells are involved in gross stereopsis and movement recognition. Strabismus, refractive error, cataract, and ptosis, occurring during critical period are highly amblyogenic. The critical period extends from birth to 7--8 years. The earlier the clinically significant refractive error and strabismus are detected and treated, the greater the likelihood of preventing amblyopia. Treatment for amblyopia in children includes: optical correction of significant refractive errors, patching, pharmacological treatment, and alternative therapies which include: vision therapy, binocular therapy, and liquid crystal display eyeglasses are newer treatment modalities for amblyopia. Age of starting the treatment is not predictive of outcome, instituting treatment on detection and early detection plays a role in achieving better outcomes. This review aims to give a simplified update on amblyopia, which will be of use to a clinician, in understanding the pathophysiology of the complex condition. We also share the cortical aspects of amblyopia and give recent developments in the treatment of amblyopia.
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Affiliation(s)
- Santhan K S Gopal
- Kamala Nethralaya Eye Clinic and Surgical Centre, Bengaluru, Karnataka, India
| | - Jai Kelkar
- National Institute of Ophthalmology, Maharashtra, India
| | - Aditya Kelkar
- National Institute of Ophthalmology, Maharashtra, India
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24
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Coco-Martin MB, Piñero DP, Leal-Vega L, Hernández-Rodríguez CJ, Adiego J, Molina-Martín A, de Fez D, Arenillas JF. The Potential of Virtual Reality for Inducing Neuroplasticity in Children with Amblyopia. J Ophthalmol 2020; 2020:7067846. [PMID: 32676202 PMCID: PMC7341422 DOI: 10.1155/2020/7067846] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, virtual reality (VR) has emerged as a new safe and effective tool for neurorehabilitation of different childhood and adulthood conditions. VR-based therapies can induce cortical reorganization and promote the activation of different neuronal connections over a wide range of ages, leading to contrasted improvements in motor and functional skills. The use of VR for the visual rehabilitation in amblyopia has been investigated in the last years, with the potential of using serious games combining perceptual learning and dichoptic stimulation. This combination of technologies allows the clinician to measure, treat, and control changes in interocular suppression, which is one of the factors leading to cortical alterations in amblyopia. Several clinical researches on this issue have been conducted, showing the potential of promoting visual acuity, contrast sensitivity, and stereopsis improvement. Indeed, several systems have been evaluated for amblyopia treatment including the use of different commercially available types of head mounted displays (HMDs). These HMDs are mostly well tolerated by patients during short exposures and do not cause significant long-term side effects, although their use has been occasionally associated with some visual discomfort and other complications in certain types of subjects. More studies are needed to confirm these promising therapies in controlled randomized clinical trials, with special emphasis on the definition of the most adequate planning for obtaining an effective recovery of the visual and binocular function.
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Affiliation(s)
- María B. Coco-Martin
- 1Group of Applied Clinical Neurosciences and Advanced Data Analysis, Neurology Department, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - David P. Piñero
- 2Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- 3Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - Luis Leal-Vega
- 1Group of Applied Clinical Neurosciences and Advanced Data Analysis, Neurology Department, Faculty of Medicine, University of Valladolid, Valladolid, Spain
| | - Carlos J. Hernández-Rodríguez
- 2Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- 3Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - Joaquin Adiego
- 4Group of Applied Clinical Neurosciences and Advanced Data Analysis, Computer Science Department, School of Computing, University of Valladolid, Valladolid, Spain
| | - Ainhoa Molina-Martín
- 2Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Dolores de Fez
- 2Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Juan F. Arenillas
- 1Group of Applied Clinical Neurosciences and Advanced Data Analysis, Neurology Department, Faculty of Medicine, University of Valladolid, Valladolid, Spain
- 5Department of Neurology, Stroke Unit and Stroke Program, University Hospital, University of Valladolid, Valladolid, Spain
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25
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Pineles SL, Aakalu VK, Hutchinson AK, Galvin JA, Heidary G, Binenbaum G, VanderVeen DK, Lambert SR. Binocular Treatment of Amblyopia: A Report by the American Academy of Ophthalmology. Ophthalmology 2019; 127:261-272. [PMID: 31619356 DOI: 10.1016/j.ophtha.2019.08.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments. METHODS Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology. RESULTS Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance. CONCLUSIONS There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.
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Affiliation(s)
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Amy K Hutchinson
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer A Galvin
- Eye Physicians and Surgeons PC, Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gil Binenbaum
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Brown R, Blanchfield P, Fakis A, McGraw P, Foss AJE. Clinical investigation plan for the use of interactive binocular treatment (I-BiT) for the management of anisometropic, strabismic and mixed amblyopia in children aged 3.5-12 years: a randomised controlled trial. Trials 2019; 20:437. [PMID: 31311577 PMCID: PMC6636162 DOI: 10.1186/s13063-019-3523-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/13/2019] [Indexed: 12/03/2022] Open
Abstract
Background Amblyopia (lazy eye) affects the vision of approximately 2% of all children. Traditional treatment consists of wearing a patch over their ‘good’ eye for a number of hours daily, over several months. This treatment is unpopular and compliance is often low. Therefore, results can be poor. I-BiT is a system, based on stereo technology using shutter glasses, designed to treat amblyopia using dichoptic stimulation. This trial uses a redesigned system for home use and includes eye-tracking capability. Methods/design This is a randomised controlled trial involving three groups of 40 patients each, aged between 3.5 and 12 years, with a diagnosis of (1) anisometropic amblyopia, (2) mixed or strabismic amblyopia prior to strabismic surgery and (3) mixed or strabismic amblyopia who have just undergone strabismus surgery. They will be randomised in a 1:1 ratio between I-BiT and control and will receive treatment, at home over a 6-week period. Their visual acuity will be assessed independently at baseline, mid-treatment (week 3), at the end of treatment (week 6) and, for those receiving the active I-BiT treatment, 4 weeks after completing treatment (week 10). The primary endpoint will be the change in visual acuity from baseline to the end of treatment. Secondary endpoints will be additional visual acuity measures, patient acceptability, compliance and the incidence of adverse events. Discussion This is a randomised controlled trial using the redesigned I-BiT™ system to determine if this is a feasible treatment strategy for the management of anisometropic, strabismic and mixed amblyopia. Trial registration ISRCTN Number/Clinical trials.gov, ID: NCT02810847. Registered on 23 June 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3523-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Brown
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Peter Blanchfield
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Apostolos Fakis
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Paul McGraw
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Alexander J E Foss
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
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The treatment of amblyopia: current practice and emerging trends. Graefes Arch Clin Exp Ophthalmol 2019; 257:1061-1078. [DOI: 10.1007/s00417-019-04254-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 02/04/2023] Open
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Kraus CL, Culican SM. New advances in amblyopia therapy I: binocular therapies and pharmacologic augmentation. Br J Ophthalmol 2018; 102:1492-1496. [PMID: 29777043 PMCID: PMC6241622 DOI: 10.1136/bjophthalmol-2018-312172] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 12/20/2022]
Abstract
Amblyopia therapy options have traditionally been limited to penalisation of the non-amblyopic eye with either patching or pharmaceutical penalisation. Solid evidence, mostly from the Pediatric Eye Disease Investigator Group, has validated both number of hours a day of patching and days per week of atropine use. The use of glasses alone has also been established as a good first-line therapy for both anisometropic and strabismic amblyopia. Unfortunately, visual acuity equalisation or even improvement is not always attainable with these methods. Additionally, non-compliance with prescribed therapies contributes to treatment failures, with data supporting difficulty adhering to full treatment sessions. Interest in alternative therapies for amblyopia treatment has long been a topic of interest among researchers and clinicians alike. Incorporating new technology with an understanding of the biological basis of amblyopia has led to enthusiasm for binocular treatment of amblyopia. Early work on perceptual learning as well as more recent enthusiasm for iPad-based dichoptic training have each generated interesting and promising data for vision improvement in amblyopes. Use of pharmaceutical augmentation of traditional therapies has also been investigated. Several different drugs with unique mechanisms of action are thought to be able to neurosensitise the brain and enhance responsiveness to amblyopia therapy. No new treatment has emerged from currently available evidence as superior to the traditional therapies in common practice today. But ongoing investigation into the use of both new technology and the understanding of the neural basis of amblyopia promises alternate or perhaps better cures in the future.
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Affiliation(s)
- Courtney L Kraus
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Deshpande PG, Bhalchandra PC, Nalgirkar AR, Tathe SR. Improvement of visual acuity in residual meridional amblyopia by astigmatic axis video games. Indian J Ophthalmol 2018; 66:1156-1160. [PMID: 30038164 PMCID: PMC6080462 DOI: 10.4103/ijo.ijo_1096_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study was carried out to evaluate the efficacy of developed “astigmatic axis video games” in children and adolescents having meridional amblyopia, with the aim to improve the visual acuity (VA). Till date, no studies are available on the treatment of amblyopic meridian. Meridional amblyopia (MA) results when astigmatism remains untreated for a long period. The aim of the study was to assess the effectiveness of a set of novel video games, the astigmatism axis video games (AAVGs), in improving the visual acuity (VA) in MA. Methods: We included 50 eyes with residual myopic MA (cylinder ≥2.0 and ≤4.0 D) whose VA did not improve beyond 0.3 LogMAR equivalent, despite patching for 2 h/day for the preceding 3 months. Patients were subjected to AAVG in conjunction with best-corrected glasses and patching of the better eye for 2 h/day for 3 months. Results: Out of 50 eyes, 32 eyes were from children between 8 and 12 years and 18 were >12 years. Full improvement of LogMAR VA up to 0.0 was seen in 36/50 (72.0%) oblique astigmatism eyes. Partial improvement of LogMAR VA at least 0.3 LogMAR or more was observed in another 7 eyes (14%) eyes. The mean VA improved from 0.43 ± 0.1 LogMAR at baseline to 0.077 ± 0.08 at 3 months (P < 0.001). Good number of eyes (n = 16, 32%) showed speedy visual improvement between 2 and 4 weeks after initiation of AAVG. No adverse effects were observed. Conclusion: Satisfactory improvement in VA in eyes with residual MA provides preliminary data into the effectiveness of stimulation of the precise amblyopic axis by AAVG in conjunction with spectacles and “minimal patching” regimen of 2 h/day. Further comparative study is warranted.
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Affiliation(s)
- Pradeep G Deshpande
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
| | - Poonam C Bhalchandra
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
| | - Aniruddha R Nalgirkar
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
| | - Sandeep R Tathe
- Global Medical Foundation and Dr. Nayana Research Centre, Aurangabad, Maharashtra, India
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An action video game for the treatment of amblyopia in children: A feasibility study. Vision Res 2018; 148:1-14. [PMID: 29709618 DOI: 10.1016/j.visres.2018.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/29/2018] [Accepted: 04/01/2018] [Indexed: 11/22/2022]
Abstract
The gold-standard treatment for childhood amblyopia remains patching or penalizing the fellow eye, resulting in an average of about a one line (0.1 logMAR) improvement in visual acuity following ≈120 h of patching in children 3-8 years old. However, compliance with patching and other treatment options is often poor. In contrast, fast-paced action video games can be highly engaging, and have been shown to yield broad-based improvements in vision and attention in adult amblyopia. Here, we pilot-tested a custom-made action video game to treat children with amblyopia. Twenty-one (n = 21) children (mean age 9.95 ± 3.14 [se]) with unilateral amblyopia (n = 12 anisometropic and n = 9 strabismic) completed 20 h of game play either monocularly, with the fellow eye patched (n = 11), or dichoptically, with reduced contrast to the fellow eye (n = 10). Participants were assessed for visual acuity (VA), stereo acuity and reading speed at baseline, and following 10 and 20 h of play. Additional exploratory analyses examined improvements after 6-10 weeks of completion of training (follow-up). Following 20 h of training, VA improved, on average, by 0.14 logMAR (≈38%) for the dichoptic group and by 0.06 logMAR (≈15%) for the monocular group. Similarly, stereoacuity improved by 0.07 log arcsec (≈17%) following dichoptic training, and by 0.06 log arcsec (≈15%) following monocular training. Across both treatment groups, 7 of the 12 individuals with anisometropic amblyopia showed improvement in stereoacuity, whereas only 1 of the 9 strabismic individuals improved. Most improvements were largely retained at follow-up. Our feasibility study therefore suggests that the action video game approach may be used as an effective adjunct treatment for amblyopia in children, achieving results similar to those of the gold-standard treatment in shorter duration.
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Abstract
AIM To investigate the role of television video games in childhood amblyopia treatment. METHOD This prospective, randomized, interventional study included 40 patients between 4-7 years of age, with unilateral amblyopia (visual acuity in amblyopic eye between 1-0.6 LogMAR equivalents) attending the squint clinic at a tertiary eye hospital. All patients were prescribed optimal spectacle correction and occlusion therapy, i.e. full time patching according to patient's age, was initiated after six weeks.; full-time patching according to patient's age was initiated after 6 weeks. Subjects were randomly divided into two groups of 20 each. Patients in the first group, Group A (control), were prescribed patching alone. Patients in the second group, Group B (study), were made to play action video games, with the help of a commercial television set, along with patching. They attended 12 half-hour sessions each, at weekly intervals. Follow-up assessments included best corrected visual acuity (BCVA) (both distance and near) and stereoacuity measurements at 3, 6, 9, and 12 weeks. RESULTS The mean age of patients was 6.03 ± 1.14 years. The distance BCVA in the amblyopic eye showed a significant improvement at final follow-up (12 weeks) in both groups: from 0.84 ± 0.19 to 0.55 ± 0.21 LogMAReq in Group A and 0.89 ± 0.16 to 0.46 ± 0.22 LogMAReq in Group B. However, improvement in BCVA was significantly better in group B at all visits (P=0.002, 12 weeks). The study group also had a significantly better outcome in terms near visual acuity improvement (P = 0.006, 12 weeks). There was also greater stereoacuity improvement in group B, with 7 patients improving to 100 secs of arc or better. CONCLUSION Video games supplemental to occlusion may be considered favorable for visual development in amblyopic children, and the study encourages further research on this subject.
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Affiliation(s)
- Subhash Dadeya
- a Guru Nanak Eye Centre & Maulana Azad Medical College , New Delhi , India
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Altered Balance of Receptive Field Excitation and Suppression in Visual Cortex of Amblyopic Macaque Monkeys. J Neurosci 2017; 37:8216-8226. [PMID: 28743725 DOI: 10.1523/jneurosci.0449-17.2017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/21/2017] [Accepted: 07/14/2017] [Indexed: 11/21/2022] Open
Abstract
In amblyopia, a visual disorder caused by abnormal visual experience during development, the amblyopic eye (AE) loses visual sensitivity whereas the fellow eye (FE) is largely unaffected. Binocular vision in amblyopes is often disrupted by interocular suppression. We used 96-electrode arrays to record neurons and neuronal groups in areas V1 and V2 of six female macaque monkeys (Macaca nemestrina) made amblyopic by artificial strabismus or anisometropia in early life, as well as two visually normal female controls. To measure suppressive binocular interactions directly, we recorded neuronal responses to dichoptic stimulation. We stimulated both eyes simultaneously with large sinusoidal gratings, controlling their contrast independently with raised-cosine modulators of different orientations and spatial frequencies. We modeled each eye's receptive field at each cortical site using a difference of Gaussian envelopes and derived estimates of the strength of central excitation and surround suppression. We used these estimates to calculate ocular dominance separately for excitation and suppression. Excitatory drive from the FE dominated amblyopic visual cortex, especially in more severe amblyopes, but suppression from both the FE and AEs was prevalent in all animals. This imbalance created strong interocular suppression in deep amblyopes: increasing contrast in the AE decreased responses at binocular cortical sites. These response patterns reveal mechanisms that likely contribute to the interocular suppression that disrupts vision in amblyopes.SIGNIFICANCE STATEMENT Amblyopia is a developmental visual disorder that alters both monocular vision and binocular interaction. Using microelectrode arrays, we examined binocular interaction in primary visual cortex and V2 of six amblyopic macaque monkeys (Macaca nemestrina) and two visually normal controls. By stimulating the eyes dichoptically, we showed that, in amblyopic cortex, the binocular combination of signals is altered. The excitatory influence of the two eyes is imbalanced to a degree that can be predicted from the severity of amblyopia, whereas suppression from both eyes is prevalent in all animals. This altered balance of excitation and suppression reflects mechanisms that may contribute to the interocular perceptual suppression that disrupts vision in amblyopes.
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Bodduluri L, Boon MY, Ryan M, Dain SJ. Impact of Gamification of Vision Tests on the User Experience. Games Health J 2017; 6:229-236. [PMID: 28691854 DOI: 10.1089/g4h.2016.0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Gamification has been incorporated into vision tests and vision therapies in the expectation that it may increase the user experience and engagement with the task. The current study aimed to understand how gamification affects the user experience, specifically during the undertaking of psychophysical tasks designed to estimate vision thresholds (chromatic and achromatic contrast sensitivity). METHODS Three tablet computer-based games were developed with three levels of gaming elements. Game 1 was designed to be a simple clinical test (no gaming elements), game 2 was similar to game 1 but with added gaming elements (i.e., feedback, scores, and sounds), and game 3 was a complete game. Participants (N = 144, age: 9.9-42 years) played three games in random order. The user experience for each game was assessed using a Short Feedback Questionnaire. RESULTS The median (interquartile range) fun level for the three games was 2.5 (1.6), 3.9 (1.7), and 2.5 (2.8), respectively. Overall, participants reported greater fun level and higher preparedness to play the game again for game 2 than games 1 and 3 (P < 0.05). There were significant positive correlations observed between fun level and preparedness to play the game again for all the games (p < 0.05). Engagement (assessed as completion rates) did not differ between the games. CONCLUSION Gamified version (game 2) was preferred to the other two versions. Over the short term, the careful application of gaming elements to vision tests was found to increase the fun level of users, without affecting engagement with the vision test.
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Affiliation(s)
- Lakshmi Bodduluri
- 1 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
| | - Mei Ying Boon
- 1 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
| | - Malcolm Ryan
- 2 Department of Computing, Macquarie University , Sydney, Australia
| | - Stephen J Dain
- 1 School of Optometry and Vision Science, University of New South Wales , Sydney, Australia
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Abstract
PURPOSE OF REVIEW To review the literature up to recent for the use of videos, videogames and dichoptic stimulation as a treatment for amblyopia. RECENT FINDINGS There have been three strategies explored. The first is to use videos and videogames monocularly with the normal eye covered. The second is dichoptic stimulation with a common background presented to both eyes and an enriched foreground to the amblyopic eye. The third are games specifically designed to generate stereopsis. Most work has focused on the second of these approaches but both of the first two approaches seem to give a similar improvement of 0.1-0.2 logMAR. One large randomized control trial (RCT) has published showing that dichoptic stimulation is not inferior to patching but no evidence that it was superior. It also showed that video games have their own compliance problems and a second smaller RCT did suggest that videogames, with a game designed by a gaming company, was superior. Most of the work done has had methodological issues and should be considered exploratory rather than definitive. SUMMARY Dichoptic stimulation is a viable treatment option for the treatment of amblyopia. The first trial results have shown results that are not superior to patching but they are not without methodological issues. There is sufficient encouragement to justify further research in this area.
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Guo CX, Babu RJ, Black JM, Bobier WR, Lam CSY, Dai S, Gao TY, Hess RF, Jenkins M, Jiang Y, Kowal L, Parag V, South J, Staffieri SE, Walker N, Wadham A, Thompson B. Binocular treatment of amblyopia using videogames (BRAVO): study protocol for a randomised controlled trial. Trials 2016; 17:504. [PMID: 27756405 PMCID: PMC5069878 DOI: 10.1186/s13063-016-1635-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Amblyopia is a common neurodevelopmental disorder of vision that is characterised by visual impairment in one eye and compromised binocular visual function. Existing evidence-based treatments for children include patching the nonamblyopic eye to encourage use of the amblyopic eye. Currently there are no widely accepted treatments available for adults with amblyopia. The aim of this trial is to assess the efficacy of a new binocular, videogame-based treatment for amblyopia in older children and adults. We hypothesise that binocular treatment will significantly improve amblyopic eye visual acuity relative to placebo treatment. Methods/design The BRAVO study is a double-blind, randomised, placebo-controlled multicentre trial to assess the effectiveness of a novel videogame-based binocular treatment for amblyopia. One hundred and eight participants aged 7 years or older with anisometropic and/or strabismic amblyopia (defined as ≥0.2 LogMAR interocular visual acuity difference, ≥0.3 LogMAR amblyopic eye visual acuity and no ocular disease) will be recruited via ophthalmologists, optometrists, clinical record searches and public advertisements at five sites in New Zealand, Canada, Hong Kong and Australia. Eligible participants will be randomised by computer in a 1:1 ratio, with stratification by age group: 7–12, 13–17 and 18 years and older. Participants will be randomised to receive 6 weeks of active or placebo home-based binocular treatment. Treatment will be in the form of a modified interactive falling-blocks game, implemented on a 5th generation iPod touch device viewed through red/green anaglyphic glasses. Participants and those assessing outcomes will be blinded to group assignment. The primary outcome is the change in best-corrected distance visual acuity in the amblyopic eye from baseline to 6 weeks post randomisation. Secondary outcomes include distance and near visual acuity, stereopsis, interocular suppression, angle of strabismus (where applicable) measured at baseline, 3, 6, 12 and 24 weeks post randomisation. Treatment compliance and acceptability will also be assessed along with quality of life for adult participants. Discussion The BRAVO study is the first randomised controlled trial of a home-based videogame treatment for older children and adults with amblyopia. The results will indicate whether a binocular approach to amblyopia treatment conducted at home is effective for patients aged 7 years or older. Trial registration This trial was registered in Australia and New Zealand Clinical Trials Registry (ACTRN12613001004752) on 10 September 2013.
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Affiliation(s)
- Cindy X Guo
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Raiju J Babu
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - William R Bobier
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Carly S Y Lam
- School of Optometry, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Shuan Dai
- Department of Ophthalmology, Starship Children's Hospital, Auckland, New Zealand
| | - Tina Y Gao
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Robert F Hess
- Department of Ophthalmology, McGill Vision Research, McGill University, Montreal, QC, Canada
| | - Michelle Jenkins
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Lionel Kowal
- Department of Surgery, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Jayshree South
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Sandra Elfride Staffieri
- Department of Surgery, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Angela Wadham
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand. .,School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.
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Herbison N, MacKeith D, Vivian A, Purdy J, Fakis A, Ash IM, Cobb SV, Eastgate RM, Haworth SM, Gregson RM, Foss AJ. Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system. Br J Ophthalmol 2016; 100:1511-1516. [PMID: 26951772 PMCID: PMC5136691 DOI: 10.1136/bjophthalmol-2015-307798] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/05/2015] [Accepted: 01/25/2016] [Indexed: 11/21/2022]
Abstract
Background Traditional treatment of amblyopia involves either wearing a patch or atropine penalisation of the better eye. A new treatment is being developed on the basis of virtual reality technology allowing either DVD footage or computer games which present a common background to both eyes and the foreground, containing the imagery of interest, only to the amblyopic eye. Methods A randomised control trial was performed on patients with amblyopia aged 4–8 years with three arms. All three arms had dichoptic stimulation using shutter glass technology. One arm had DVD footage shown to the amblyopic eye and common background to both, the second used a modified shooter game, Nux, with sprite and targets presented to the amblyopic eye (and background to both) while the third arm had both background and foreground presented to both eyes (non-interactive binocular treatment (non-I-BiT) games). Results Seventy-five patients were randomised; 67 were residual amblyopes and 70 had an associated strabismus. The visual acuity improved in all three arms by approximately 0.07 logMAR in the amblyopic eye at 6 weeks. There was no difference between I-BiT DVD and non-I-BiT games compared with I-BiT games (stated primary outcome) in terms of gain in vision. Conclusions There was a modest vision improvement in all three arms. Treatment was well tolerated and safe. There was no difference between the three treatments in terms of primary stated outcomes but treatment duration was short and the high proportion of previously treated amblyopia and strabismic amblyopia disadvantaged dichoptic stimulation treatment. Trial registration number NCT01702727, results.
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Affiliation(s)
- Nicola Herbison
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Daisy MacKeith
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| | - Anthony Vivian
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| | - Jon Purdy
- Department of Computer Science, University of Hull, Hull, UK
| | - Apostolos Fakis
- Derby Clinical Trials Unit, College of Health and Social Care, University of Derby, Derby, UK
| | - Isabel M Ash
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Sue V Cobb
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham, Nottingham, UK
| | - Richard M Eastgate
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham, Nottingham, UK
| | - Stephen M Haworth
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Richard M Gregson
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
| | - Alexander Je Foss
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, UK
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Maconachie GDE, Gottlob I. The challenges of amblyopia treatment. Biomed J 2016; 38:510-6. [PMID: 27013450 PMCID: PMC6138377 DOI: 10.1016/j.bj.2015.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
The treatment of amblyopia, particularly anisometropic (difference in refractive correction) and/or strabismic (turn of one eye) amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 1998. Since this review, a number of publications have revealed new findings in the treatment of amblyopia. This includes the finding that less intensive occlusion treatments can be successful in treating amblyopia. A relationship between adherence to treatment and visual acuity has also been established and has been shown to be influenced by the use of intervention material. In addition, there is growing evidence of that a period of glasses wearing only can significantly improve visual acuity alone without any other modes of treatment. This review article reports findings since the Snowdon's report.
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Affiliation(s)
- Gail D E Maconachie
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKSCB, Leicester Royal Infirmary, Leicester LE2 7LX, UK
| | - Irene Gottlob
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKSCB, Leicester Royal Infirmary, Leicester LE2 7LX, UK.
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Levi DM, Knill DC, Bavelier D. Stereopsis and amblyopia: A mini-review. Vision Res 2015; 114:17-30. [PMID: 25637854 PMCID: PMC4519435 DOI: 10.1016/j.visres.2015.01.002] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/26/2014] [Accepted: 01/09/2015] [Indexed: 12/28/2022]
Abstract
Amblyopia is a neuro-developmental disorder of the visual cortex that arises from abnormal visual experience early in life. Amblyopia is clinically important because it is a major cause of vision loss in infants and young children. Amblyopia is also of basic interest because it reflects the neural impairment that occurs when normal visual development is disrupted. Amblyopia provides an ideal model for understanding when and how brain plasticity may be harnessed for recovery of function. Over the past two decades there has been a rekindling of interest in developing more effective methods for treating amblyopia, and for extending the treatment beyond the critical period, as exemplified by new clinical trials and new basic research studies. The focus of this review is on stereopsis and its potential for recovery. Impaired stereoscopic depth perception is the most common deficit associated with amblyopia under ordinary (binocular) viewing conditions (Webber & Wood, 2005). Our review of the extant literature suggests that this impairment may have a substantial impact on visuomotor tasks, difficulties in playing sports in children and locomoting safely in older adults. Furthermore, impaired stereopsis may also limit career options for amblyopes. Finally, stereopsis is more impacted in strabismic than in anisometropic amblyopia. Our review of the various approaches to treating amblyopia (patching, perceptual learning, videogames) suggests that there are several promising new approaches to recovering stereopsis in both anisometropic and strabismic amblyopes. However, recovery of stereoacuity may require more active treatment in strabismic than in anisometropic amblyopia. Individuals with strabismic amblyopia have a very low probability of improvement with monocular training; however they fare better with dichoptic training than with monocular training, and even better with direct stereo training.
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Affiliation(s)
- Dennis M Levi
- School of Optometry, Graduate Group in Vision Science and Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720-2020, USA.
| | - David C Knill
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY 14627-0268, USA; Center for Visual Science, University of Rochester, Rochester, NY 14627-0268, USA
| | - Daphne Bavelier
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY 14627-0268, USA; Center for Visual Science, University of Rochester, Rochester, NY 14627-0268, USA; Psychology and Education Sciences (FPSE), University of Geneva, Geneva, Switzerland
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Tailor V, Bossi M, Bunce C, Greenwood JA, Dahlmann‐Noor A. Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years. Cochrane Database Syst Rev 2015; 2015:CD011347. [PMID: 26263202 PMCID: PMC6718221 DOI: 10.1002/14651858.cd011347.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current treatments for amblyopia in children, occlusion and pharmacological blurring, have had limited success, with less than two-thirds of children achieving good visual acuity of at least 0.20 logMAR in the amblyopic eye, limited improvement of stereopsis, and poor compliance. A new treatment approach, based on the dichoptic presentation of movies or computer games (images presented separately to each eye), may yield better results, as it aims to balance the input of visual information from each eye to the brain. Compliance may also improve with these more child-friendly treatment procedures. OBJECTIVES To determine whether binocular treatments in children aged three to eight years with unilateral amblyopia result in better visual outcomes than conventional occlusion or pharmacological blurring treatment. SEARCH METHODS We searched the Cochrane Eyes and Vision Group Trials Register (last date of searches: 14 April 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2015), EMBASE (January 1980 to April 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. SELECTION CRITERIA Two review authors independently screened the results of the search in order to identify studies that met the inclusion criteria of the review: randomised controlled trials (RCTs) that enrolled participants between the ages of three and eight years old with unilateral amblyopia, defined as best-corrected visual acuity (BCVA) worse than 0.200 logMAR in the amblyopic eye, and BCVA 0.200 logMAR or better in the fellow eye, in the presence of an amblyogenic risk factor such as anisometropia, strabismus, or both. Prior to enrolment, participants were to have undergone a cycloplegic refraction and comprehensive ophthalmic examination including fundal examination. In addition, participants had to have completed a period of optical treatment, if indicated, and BCVA in the amblyopic eye had to remain unchanged on two consecutive assessments despite reportedly good compliance with glasses wearing. Participants were not to have received any treatment other than optical treatment prior to enrolment. We planned to include any type of binocular viewing intervention; these could be delivered on different devices including computer monitors viewed with LCD shutter glasses or hand-held screens including mobile phone screens with lenticular prism overlay. Control groups were to have received standard amblyopia treatment; this could include occlusion or pharmacological blurring of the better-seeing eye. We planned to include full-time (all waking hours) and part-time (between 1 and 12 hours a day) occlusion regimens. DATA COLLECTION AND ANALYSIS We planned to use standard methodological procedures expected by The Cochrane Collaboration. We had planned to meta-analyse the primary outcome, that is mean distance BCVA in the amblyopic eye at 12 months after the cessation of treatment. MAIN RESULTS We could identify no RCTs in this subject area. AUTHORS' CONCLUSIONS Further research is required to allow decisions about implementation of binocular treatments for amblyopia in clinical practice. Currently there are no clinical trials offering standardised evidence of the safety and effectiveness of binocular treatments, but results from non-controlled cohort studies are encouraging. Future research should be conducted in the form of RCTs, using acknowledged methods of visual acuity and stereoacuity assessment with known reproducibility. Other important outcome measures include outcomes reported by users, compliance with treatment, and recurrence of amblyopia after cessation of treatment.
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Affiliation(s)
- Vijay Tailor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Manuela Bossi
- UCL Institute of OphthalmologyDepartment of Visual NeurosciencesLondonUK
| | - Catey Bunce
- Moorfields Eye Hospital NHS Foundation TrustResearch and Development DepartmentCity RoadLondonUKEC1V 2PD
| | - John A Greenwood
- University College LondonExperimental Psychology26 Bedford WayLondonUKWC1H 0AP
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
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Amblyopia and the binocular approach to its therapy. Vision Res 2015; 114:4-16. [PMID: 25906685 DOI: 10.1016/j.visres.2015.02.009] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/09/2015] [Accepted: 02/15/2015] [Indexed: 01/29/2023]
Abstract
There is growing evidence that abnormal binocular interactions play a key role in amblyopia. In particular, stronger suppression of the amblyopic eye has been associated with poorer amblyopic eye visual acuity and a new therapy has been described that directly targets binocular function and has been found to improve both monocular and binocular vision in adults and children with amblyopia. Furthermore, non-invasive brain stimulation techniques that alter excitation and inhibition within the visual cortex have been shown to improve vision in the amblyopic eye. The aim of this review is to summarize this previous work and interpret the therapeutic effects of binocular therapy and non-invasive brain stimulation in the context of three potential neural mechanisms; active inhibition of signals from the amblyopic eye, attenuation of information from the amblyopic eye and metaplasticity of synaptic long term potentiation and long term depression.
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Esposito Veneruso P, Ziccardi L, Magli G, Falsini B, Magli A. Short-term effects of vision trainer rehabilitation in patients affected by anisometropic amblyopia: electrofunctional evaluation. Doc Ophthalmol 2014; 129:177-89. [PMID: 25294024 DOI: 10.1007/s10633-014-9462-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the short-term effects of the vision trainer rehabilitation technique on retinal and post-retinal function in young amblyopic patients outside the critical visual developmental period. METHODS Twenty-one patients (mean age 12.2 ± 2.7 years, ranging from 9.1 to 18 years) affected by unilateral anisometropic amblyopia were studied, providing 21 amblyopic eyes (AE) and 21 sound eyes (SE). Thirty eyes from 15 age-similar normal subjects served as controls. All subjects underwent extensive ophthalmologic characterization to exclude any disease not related to amblyopia. All AE were subjected to rehabilitation sessions performed by the Retimax vision trainer (VT) program. The protocol consisted of 2 sessions per week, each lasting 10 min, for 10 consecutive weeks. Before and after the rehabilitation, electrophysiological [pattern electroretinogram (PERG) and visual evoked potential (VEP)] and psychophysical [best corrected visual acuity (BCVA) and microperimetry] data were collected from AE and SE. RESULTS When comparing baseline data with those collected at the end of the study, PERG P50-N95 amplitude and BCVA values from AE had improved significantly by the end of the study (p < 0.05). Our electrophysiological findings also showed some abnormalities in SE when the data were compared to control eyes. We found a significant correlation (p < 0.05) between PERG amplitude and VEP implicit time in SE after visual rehabilitation. CONCLUSIONS Short-term visual rehabilitation performed by the VT program ameliorated the electrofunctional and psychophysical parameters of vision in children outside the critical developmental period, thus indicating that VT might be a potential adjuvant therapy of traditional patching treatment.
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Kassem IS, Miller MT, Archer SM. One Year of Pediatric Ophthalmology and Strabismus Research in Review. Asia Pac J Ophthalmol (Phila) 2013; 2:388-400. [PMID: 26107151 PMCID: PMC6839686 DOI: 10.1097/apo.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To highlight recent advances in amblyopia and strabismus. DESIGN Literature review. METHODS A literature search of articles published in the English language was performed in PubMed or MEDLINE between May 2012 and April 2013 using the terms amblyopia or strabismus. Articles deemed relevant were selected. RESULTS The review highlights articles that increase our understanding of strabismus and amblyopia as well as newer treatment strategies. CONCLUSIONS The review highlights some new information and possible future advances in amblyopia and strabismus.
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Affiliation(s)
- Iris S Kassem
- From the *University of Illinois at Chicago Eye and Ear Infirmary, Chicago, IL; and †Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI
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Interactive binocular treatment (I-BiT) for amblyopia: results of a pilot study of 3D shutter glasses system. Eye (Lond) 2013; 27:1077-83. [PMID: 23807383 DOI: 10.1038/eye.2013.113] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 05/01/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE A computer-based interactive binocular treatment system (I-BiT) for amblyopia has been developed, which utilises commercially available 3D 'shutter glasses'. The purpose of this pilot study was to report the effect of treatment on visual acuity (VA) in children with amblyopia. METHODS Thirty minutes of I-BiT treatment was given once weekly for 6 weeks. Treatment sessions consisted of playing a computer game and watching a DVD through the I-BiT system. VA was assessed at baseline, mid-treatment, at the end of treatment, and at 4 weeks post treatment. Standard summary statistics and an exploratory one-way analysis of variance (ANOVA) were performed. RESULTS Ten patients were enrolled with strabismic, anisometropic, or mixed amblyopia. The mean age was 5.4 years. Nine patients (90%) completed the full course of I-BiT treatment with a mean improvement of 0.18 (SD=0.143). Six out of nine patients (67%) who completed the treatment showed a clinically significant improvement of 0.125 LogMAR units or more at follow-up. The exploratory one-way ANOVA showed an overall effect over time (F=7.95, P=0.01). No adverse effects were reported. CONCLUSION This small, uncontrolled study has shown VA gains with 3 hours of I-BiT treatment. Although it is recognised that this pilot study had significant limitations-it was unblinded, uncontrolled, and too small to permit formal statistical analysis-these results suggest that further investigation of I-BiT treatment is worthwhile.
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Foss AJ, Gregson RM, MacKeith D, Herbison N, Ash IM, Cobb SV, Eastgate RM, Hepburn T, Vivian A, Moore D, Haworth SM. Evaluation and development of a novel binocular treatment (I-BiT™) system using video clips and interactive games to improve vision in children with amblyopia ('lazy eye'): study protocol for a randomised controlled trial. Trials 2013; 14:145. [PMID: 23688108 PMCID: PMC3663671 DOI: 10.1186/1745-6215-14-145] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background Amblyopia (lazy eye) affects the vision of approximately 2% of all children. Traditional treatment consists of wearing a patch over their ‘good’ eye for a number of hours daily, over several months. This treatment is unpopular and compliance is often low. Therefore results can be poor. A novel binocular treatment which uses 3D technology to present specially developed computer games and video footage (I-BiT™) has been studied in a small group of patients and has shown positive results over a short period of time. The system is therefore now being examined in a randomised clinical trial. Methods/design Seventy-five patients aged between 4 and 8 years with a diagnosis of amblyopia will be randomised to one of three treatments with a ratio of 1:1:1 - I-BiT™ game, non-I-BiT™ game, and I-BiT™ DVD. They will be treated for 30 minutes once weekly for 6 weeks. Their visual acuity will be assessed independently at baseline, mid-treatment (week 3), at the end of treatment (week 6) and 4 weeks after completing treatment (week 10). The primary endpoint will be the change in visual acuity from baseline to the end of treatment. Secondary endpoints will be additional visual acuity measures, patient acceptability, compliance and the incidence of adverse events. Discussion This is the first randomised controlled trial using the I-BiT™ system. The results will determine if the I-BiT™ system is effective in the treatment of amblyopia and will also determine the optimal treatment for future development. Trial registration ClinicalTrials.gov identifier: NCT01702727
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Affiliation(s)
- Alexander J Foss
- Human Factors Research Group, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
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Prentice award lecture 2011: removing the brakes on plasticity in the amblyopic brain. Optom Vis Sci 2012; 89:827-38. [PMID: 22581119 DOI: 10.1097/opx.0b013e318257a187] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Experience-dependent plasticity is closely linked with the development of sensory function. Beyond this sensitive period, developmental plasticity is actively limited; however, new studies provide growing evidence for plasticity in the adult visual system. The amblyopic visual system is an excellent model for examining the "brakes" that limit recovery of function beyond the critical period. While amblyopia can often be reversed when treated early, conventional treatment is generally not undertaken in older children and adults. However, new clinical and experimental studies in both animals and humans provide evidence for neural plasticity beyond the critical period. The results suggest that perceptual learning and video game play may be effective in improving a range of visual performance measures and importantly the improvements may transfer to better visual acuity and stereopsis. These findings, along with the results of new clinical trials, suggest that it might be time to reconsider our notions about neural plasticity in amblyopia.
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Abstract
PURPOSE Virtual reality (VR)-based treatment has been introduced as a potential option for amblyopia management, presumably without involving the problems of occlusion and penalization, including variable and unsatisfactory outcomes, long duration of treatment, poor compliance, psychological impact, and complications. However, VR-based treatment is costly and not accessible for most children. This paper introduces a method that encompasses the advantages of VR-based treatment at a lower cost. METHODS The presented system consists of a pair of glasses with two color filters and software for use on a personal computer. The software is designed such that some active graphic components can only be seen by the amblyopic eye and are filtered out for the other eye. Some components would be seen by both to encourage fusion. The result is that the patient must use both eyes, and specifically the amblyopic eye, to play the games. RESULTS A prototype of the system, the ABG InSight, was found capable of successfully filtering out elements of a certain color and therefore, could prove to be a viable alternative to VR-based treatment for amblyopia. CONCLUSION The anaglyphic system maintains most of the advantages of VR-based systems, but is less costly and highly accessible. It fulfills the means that VR-based systems are designed to achieve, and warrants further investigation.
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Affiliation(s)
- Ali Rastegarpour
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Evans BJW, Yu CS, Massa E, Mathews JE. Randomised controlled trial of intermittent photic stimulation for treating amblyopia in older children and adults. Ophthalmic Physiol Opt 2011; 31:56-68. [PMID: 21158885 DOI: 10.1111/j.1475-1313.2010.00801.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The treatment of amblyopia is reviewed and it is noted that in addition to conventional 'passive treatment' in children with occlusion, it has been argued that 'active treatment' may be effective in older children and adults. Intermittent photic stimulation (IPS) is one such active treatment. In Study 1, we report a clinical audit of 21 patients treated with IPS, which demonstrated that the maximum improvement is reached after 6 half hour sessions. Study 2 is a double-masked randomised controlled trial comparing IPS with a control treatment in 30 participants aged 10-57 years. Using a sensitive staircase measure of visual acuity (VA), the IPS group improved by about one line (p = 0.0053). The mean improvement was significantly greater (unpaired t-test, p = 0.022) in the IPS group (mean 0.096; S.E.M. 0.029) than in the control group (mean 0.019; S.E.M. 0.022). The improvement occurred in participants with strabismic amblyopia, but not in those with anisometropic amblyopia. Follow up data after about 1 year showed that VA had regressed to pre-treatment levels. The results are discussed within the context of another development in active amblyopia therapy, perceptual learning. The literature on this therapy reveals improvements in VA of about 2.5 lines in older children and adults with anisometropic amblyopia. It is concluded that perceptual learning is likely a better treatment option than IPS for anisometropic amblyopes, and probably also for strabismic amblyopes although a randomised controlled trial is required. It is noted that the existence of effective treatments for adults does not detract from the need to treat amblyopia in younger children.
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Affiliation(s)
- Bruce J W Evans
- Neville Chappell Research Clinic, Institute of Optometry, London, UK.
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To L, Thompson B, Blum JR, Maehara G, Hess RF, Cooperstock JR. A game platform for treatment of amblyopia. IEEE Trans Neural Syst Rehabil Eng 2011; 19:280-9. [PMID: 21335317 DOI: 10.1109/tnsre.2011.2115255] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have developed a prototype device for take-home use that can be used in the treatment of amblyopia. The therapeutic scenario we envision involves patients first visiting a clinic, where their vision parameters are assessed and suitable parameters are determined for therapy. Patients then proceed with the actual therapeutic treatment on their own, using our device, which consists of an Apple iPod Touch running a specially modified game application. Our rationale for choosing to develop the prototype around a game stems from multiple requirements that such an application satisfies. First, system operation must be sufficiently straightforward that ease-of-use is not an obstacle. Second, the application itself should be compelling and motivate use more so than a traditional therapeutic task if it is to be used regularly outside of the clinic. This is particularly relevant for children, as compliance is a major issue for current treatments of childhood amblyopia. However, despite the traditional opinion that treatment of amblyopia is only effective in children, our initial results add to the growing body of evidence that improvements in visual function can be achieved in adults with amblyopia.
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Affiliation(s)
- Long To
- Centre for Intelligent Machines, McGill University, Montreal, QC H3A2A7, Canada.
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Electronic monitoring of occlusion treatment for amblyopia in patients aged 7 to 16 years. Graefes Arch Clin Exp Ophthalmol 2009; 247:1401-8. [DOI: 10.1007/s00417-009-1090-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 04/07/2009] [Accepted: 04/10/2009] [Indexed: 10/20/2022] Open
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