Effectiveness of binocularity-stimulating treatment in children with residual amblyopia following occlusion

Advanced Visualization Engineering for Vision Disorders: A Clinically Focused Guide to Current Technology and Future Applications

Head-mounted visualization technology, often in the form of virtual, augmented, and mixed reality (VAMR), has revolutionized how visual disorders may be approached clinically. In this manuscript, we review the available literature on VAMR for visual disorders and provide a clinically oriented guide to how VAMR technology has been deployed for visual impairments. The chief areas of clinical investigation with VAMR are divided include (1) vision assessment, (2) vision simulation, and (3) vision rehabilitation. We discuss in-depth the current literature of these areas in VAMR and upcoming/future applications to combat the detrimental impact of visual impairment worldwide.

A Scoping Review of Assistance and Therapy with Head-Mounted Displays for People Who Are Visually Impaired

Given the inherent visual affordances of Head-Mounted Displays (HMDs) used for Virtual and Augmented Reality (VR/AR), they have been actively used over many years as assistive and therapeutic devices for the people who are visually impaired. In this paper, we report on a scoping review of literature describing the use of HMDs in these areas. Our high-level objectives included detailed reviews and quantitative analyses of the literature, and the development of insights related to emerging trends and future research directions.

Our review began with a pool of 1251 papers collected through a variety of mechanisms. Through a structured screening process, we identified 61 English research papers employing HMDs to enhance the visual sense of people with visual impairments for more detailed analyses. Our analyses reveal that there is an increasing amount of HMD-based research on visual assistance and therapy, and there are trends in the approaches associated with the research objectives. For example, AR is most often used for visual assistive purposes, whereas VR is used for therapeutic purposes. We report on eight existing survey papers, and present detailed analyses of the 61 research papers, looking at the mitigation objectives of the researchers (assistive versus therapeutic), the approaches used, the types of HMDs, the targeted visual conditions, and the inclusion of user studies. In addition to our detailed reviews and analyses of the various characteristics, we present observations related to apparent emerging trends and future research directions.

Amblyopia and Routine Eye Exam in Children: Parent's Perspective

Amblyopia is a reduced best-corrected visual acuity of one or both eyes that cannot be attributed to a structural abnormality; it is a functional reduction in the vision of an eye caused by disuse during a critical period of visual development. It is considered the leading cause of visual defects in children. With early diagnosis and treatment, children with amblyopia can significantly improve their vision. However, if it is neglected and not treated during childhood, unfortunately, it permanently decreases vision. Therefore, prevention, detection, and treatment largely depend on parents. This article explores parents' perspectives on amblyopia and routine examination of their children's eyes. A cross-sectional study used an electronic questionnaire consisting of five main sections to assess the level of awareness of amblyopia among parents. As a result, a total of 325 participants were included in our analysis. 209 (64.3%) were mothers, and 116 (35/7%) were fathers. The age groups were 35-50 years of age (61.5%), 20-34 years (23.4%), and older than 50 years (15%). Participants with a history of amblyopia numbered 23 (7.1%), and 39 had an amblyopic child (12%). A good awareness level of amblyopia among parents was found in only 10 (3%) participants, a fair awareness level in 202 (62%), and 113 (35%) participants were classified as having a poor awareness level of amblyopia. Only 13.8% of the parents took their children for yearly routine eye exams, while the majority (72%) took their children only if they had a complaint, and 14.2% took them for eye checkups only before school entry. In conclusion, parents' awareness of amblyopia in Tabuk City, KSA, was low. In addition, a limited proportion of parents reported consistently taking their children for routine eye exams. Therefore, raising awareness should be considered in public education regarding the disease.

Applications of Extended Reality in Ophthalmology: Systematic Review

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.

Outcomes of using Bangerter foils for the treatment of residual amblyopia following patching therapy

PURPOSE

To evaluate the effectiveness of additional treatment using Bangerter foil (BF) for children with residual amblyopia.

METHODS

Patients with residual amblyopia who were treated with BF between 2015 and 2020 were reviewed. Residual amblyopia was defined as no further improvement in vision following patching therapy for at least 6 months. BF that corresponds to the VA of the amblyopic eye was applied to the spectacle lens of the fellow eye. Patients were divided into two groups: group A, which included patients treated with BF alone, and group B, which included patients treated with BF and a head-mounted display. After at least 2 months of treatment, baseline and final VA and stereoacuity were compared.

RESULTS

Seventy-four patients with a mean age of 8.0 ± 1.6 years at the time of BF treatment were included. The mean duration of the BF treatment was 10.4 ± 5.6 months. After a mean follow-up period of 24.9 ± 11.9 months after BF treatment, the median (IQR) VA of the amblyopic eye changed from 0.20 (0.15-0.40) LogMAR to 0.10 (0.04-0.20) LogMAR (P = 0.001). The median (IQR) stereoacuity changed from 3.19 (2.53-3.75) log arcsec to 2.60 (2.15-3.48) log arcsec (P = 0.001). The number of patients improved vision by 0.2 LogMAR or more lines was 18 patients (30%) for group A and 3 patients (23%) for group B. The VA of the amblyopic eye before BF treatment was significantly associated with vision improvement.

CONCLUSION

BF can be considered an alternative treatment plan to provide further benefit for children with residual amblyopia.

Immersive virtual reality health games: a narrative review of game design

BACKGROUND

High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games.

METHODS

We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design.

FINDINGS

We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies.

CONCLUSION

HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Occlusion for stimulus deprivation amblyopia

BACKGROUND

Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation of a clear image on the retina. SDA can be resistant to treatment, leading to poor visual prognosis. SDA probably constitutes less than 3% of all amblyopia cases, although precise estimates of prevalence are unknown. In high-income countries, most people present under the age of one year; in low- to middle-income countries, people are likely to be older at the time of presentation. The mainstay of treatment is correction of the obstruction (e.g., removal of the cataract) and then occlusion of the better-seeing eye, but regimens vary, can be difficult to execute, and traditionally are believed to lead to disappointing results.

OBJECTIVES

To evaluate the effectiveness of occlusion therapy for SDA in an attempt to establish realistic treatment outcomes and to examine evidence of any dose-response effect and assess the effect of the duration, severity, and causative factor on the size and direction of the treatment effect.

SEARCH METHODS

We searched CENTRAL (2018, Issue 12), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; and five other databases. We used no date or language restrictions in the electronic searches. We last searched the databases on 12 December 2018.

SELECTION CRITERIA

We planned to include randomized controlled trials (RCTs) and controlled clinical trials of participants with unilateral SDA with visual acuity worse than 0.2 LogMAR or equivalent. We specified no restrictions for inclusion based upon age, gender, ethnicity, comorbidities, medication use, or the number of participants.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology.

MAIN RESULTS

We identified no trials that met the inclusion criteria specified in the protocol for this review.

AUTHORS' CONCLUSIONS

We found no evidence from RCTs or quasi-randomized trials on the effectiveness of any treatment for SDA. RCTs are needed in order to evaluate the safety and effectiveness of occlusion, duration of treatment, level of vision that can be realistically achieved, effects of age at onset and magnitude of visual defect, optimum occlusion regimen, and factors associated with satisfactory and unsatisfactory outcomes with the use of various interventions for SDA.

The awareness of amblyopia among parents in Saudi Arabia

Purpose

Amblyopia is the most common cause of unilateral visual impairment. This study investigated parents' awareness of amblyopia in different regions of Saudi Arabia.

Methods

This was a cross-sectional population study. The survey consisted of two main sections; the first section contained 13 general background questions, and the second section (10 questions) focused on awareness of amblyopia, routine vision checks and how to raise awareness of amblyopia in the community. The survey was distributed to respondents using email and social media.

Results

The responses of 1649 families were received. Respondents' age range was from 22-62 years (mean ± standard deviation = 33.6 ± 8.7 years). Most respondents had no previous knowledge of amblyopia (1155 participants, 70%), and 313 participants (19%) had no idea if their children had amblyopia. In total, 990 participants (60%) did not visit the eye clinic with their children for a routine eye exam. A total of 495 parents (30%), who were aware of amblyopia, knew of it mainly from eye clinic visits and from Internet websites. A total of 140 respondents reported that their children had amblyopia; 58.3% of those children underwent routine eye examinations once a year, and the rest underwent routine eye examinations twice a year.

Conclusion

The results clearly showed a lack of amblyopia awareness among the Saudi community. This lack of awareness can lead to visual impairment among children. More efficient efforts are urgently needed from health professionals, education centres, the media and social organizations to promote awareness of amblyopia.