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Tan KWS, Park ASY, Cheung BWS, Wong GHT, Thompson B. SPEctacle Correction for the TReatment of Amblyopia (SPECTRA): study protocol for a prospective non-randomised interventional trial in adults with anisometropic/mixed mechanism amblyopia. BMJ Open 2024; 14:e080151. [PMID: 38950991 PMCID: PMC11218016 DOI: 10.1136/bmjopen-2023-080151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
INTRODUCTION Amblyopia is a neurodevelopmental vision disorder typically affecting one eye, resulting in compromised binocular function. While evidence-based treatments exist for children, there are no widely accepted treatments for adults. This trial aims to assess the efficacy of appropriate optical treatment in improving vision and visual functions in adults with amblyopia. This is hypothesised to significantly improve visual acuity of the amblyopic eye and other visual functions. METHODS AND ANALYSIS SPEctacle Correction for the TReatment of Amblyopia is a prospective non-randomised interventional trial. The following criteria for amblyopia will be used: best corrected visual acuity (BCVA) in the amblyopic eye of 0.3 to 1.0 (inclusive) logMAR VA and in the fellow eye, 0.1 logMAR or better, with an interocular VA difference of ≥2 logMAR lines. Eligible participants aged 18-39 will receive full/near-full optical treatment requiring wear for at least half their waking hours for the trial duration. A difference of ≥1.00D spherical equivalent between a participant's current refractive correction and the study prescription is required for eligibility. Primary outcome is the change in amblyopic eye BCVA from baseline to 24-week postenrolment. Secondary outcomes include distance and near VA of both eyes, stereoacuity, contrast sensitivity, interocular suppression, angle of strabismus and fixation stability measured at monthly intervals. Visual evoked potentials will also be measured at baseline, week 12 and week 24. Treatment compliance and quality of life for all participants will be monitored.Analyses comparing baseline and week 24 will utilise pairwise comparisons. Linear mixed models will be fitted to the data for measures taken monthly. This allows estimates and inferences to be drawn from the coefficients of the model, while handling missing data. ETHICS AND DISSEMINATION Human ethics approval was obtained from the respective ethics board of the Hong Kong Polytechnic University (HSEARS20210915002) and the University of Waterloo (#44235). The study protocol will conform to the principles of the Declaration of Helsinki. Results will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER NCT05394987; clinicaltrials.org.
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Affiliation(s)
| | | | | | | | - Benjamin Thompson
- Centre for Eye and Vision Research Limited, Hong Kong
- Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Randhawa S, Griffiths N, O'Brien P, Panter C, Boparai K, Harrad R, Khuddus N, Webber A, Bouchet C, Felizzi F. Qualitative Exploration of the Visual Function Impairments and Health-Related Quality of Life Impacts of Amblyopia in Adult and Pediatric Populations. Ophthalmol Ther 2023; 12:2505-2528. [PMID: 37356087 PMCID: PMC10441976 DOI: 10.1007/s40123-023-00751-8] [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: 01/24/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION Amblyopia is a reduction in vision in one or both eyes due to impaired development of the visual pathway. This study explored the experience of amblyopia and treatment from the patient, caregiver, and clinician perspectives. METHODS A targeted literature review, including a review of social media listening (SML) studies, was conducted. Next, qualitative interviews were conducted with amblyopia patients, caregivers of children with amblyopia, and ophthalmologists with experience treating patients with amblyopia. The findings informed the development of a disease model. Amblyopia clinical experts provided input at key stages. RESULTS Twelve data sources were reviewed, including qualitative studies in the literature and SML studies. Overall, 133 patients/caregivers were interviewed (23 adults, 16 adolescents, 47 child-caregiver dyads), plus 10 ophthalmologists from the United States, France, and Germany. Reduced visual acuity, impaired depth perception, impaired peripheral vision, and double vision were the most frequently reported symptoms. Amblyopia impacted daily activities (reading, using digital devices), the ability to move around, school/work (productivity, seeing the board in class), emotional well-being (frustration, sadness), and social functioning (difficulty socializing). Treatments, including patching and corrective lens, also impacted daily activities (using digital devices, sports/leisure), mobility (bumping into things), and work/school (tasks taking longer) as well as emotional well-being (embarrassment), and social functioning (bullying/stigma). CONCLUSION The findings contribute valuable insights into the adult and pediatric experience of amblyopia from a multi-stakeholder perspective. The findings were used to critically assess existing clinical outcome assessments and supported the development of patient- and observer-reported outcome measures for use in amblyopia clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
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Kaur S, Sharda S, Aggarwal H, Dadeya S. Comprehensive review of amblyopia: Types and management. Indian J Ophthalmol 2023; 71:2677-2686. [PMID: 37417105 PMCID: PMC10491072 DOI: 10.4103/ijo.ijo_338_23] [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: 02/03/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
The optimal method of treatment for a child depends on the patient's age at the time of diagnosis, the onset and type of amblyopia, and the degree of compliance attainable. In deprivation amblyopia, the cause of visual impairment (e.g., cataract, ptosis) needs to be treated first, and then the disorder can be treated such as other types of amblyopia. Anisometropic amblyopia needs glasses first. In strabismic amblyopia, conventionally amblyopia should be treated first, and then strabismus corrected. Correction of strabismus will have little if any effect on the amblyopia, although the timing of surgery is controversial. Best outcomes are achieved if amblyopia is treated before the age of 7 years. The earlier the treatment, the more efficacious it is. In selected cases of bilateral amblyopia, the more defective eye must be given a competitive advantage over the comparatively good eye. Glasses alone can work when a refractive component is present, but occlusion might make the glasses work faster. The gold standard therapy for amblyopia remains occlusion of the better eye although penalization is also evidenced to achieve equal results. Pharmacotherapy has been shown to achieve suboptimal outcomes. Newer monocular and binocular therapies based on neural tasks and games are adjuncts to patching and can also be used in adults.
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Affiliation(s)
- Savleen Kaur
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shipra Sharda
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | | | - Subhash Dadeya
- Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
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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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Webber A, Randhawa S, Felizzi F, Soos M, Arbuckle R, O'Brien P, Harrad R, Khuddus N, Bouchet C, Panter C. The Amblyopia Quality of Life (AmbQoL): Development and Content Validation of a Novel Health-Related Quality of Life Instrument for Use in Adult and Pediatric Amblyopia Populations. Ophthalmol Ther 2023; 12:1281-1313. [PMID: 36828953 PMCID: PMC10011248 DOI: 10.1007/s40123-023-00668-2] [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: 12/06/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Amblyopia is a neurodevelopmental vision disorder, characterized by poor vision in one or both eyes. Given the lack of existing clinical outcome assessments (COA) considered fit-for-purpose for amblyopia clinical trials, this study developed new COAs to assess amblyopia symptoms and health-related quality of life (HRQoL) impacts in adult and pediatric amblyopia populations that conform with best practice standards and regulatory guidelines. METHODS Findings from a targeted qualitative literature review informed the development of three versions of the new Amblyopia Quality of Life Questionnaire (AmbQoL): a patient-reported outcome measure (PRO) for individuals aged 13 years and older, a PRO for children aged 9-12 years, and an observer-reported outcome measure (ObsRO) for caregivers of children aged 4-8 years. Qualitative interviews were conducted with the target populations, and with ophthalmologists experienced in treating amblyopia patients to evaluate the content validity for further development of the AmbQoL. A translatability assessment was conducted to ensure cultural appropriateness and usability across multiple languages. Feedback from Food and Drug Administration (FDA) was also sought on the instruments, and clinical experts provided input at key stages. RESULTS Interviews were conducted with 112 patients/caregivers and ten ophthalmologists from the USA, France, and Germany. The instructions, items, and response options were well understood across all AmbQoL versions. Feedback from the patients, caregivers, ophthalmologists, the translatability assessment, the FDA, and the expert clinicians informed minor wording modifications to enhance clarity and translatability. Some items were removed due to low relevance. The study resulted in a 23-item adult/adolescent PRO, 24-item child PRO, and 12-item ObsRO, each employing a 7-day recall period. CONCLUSION Each AmbQoL version has documented support for its face and content validity for use in amblyopia populations aged ≥ 4 years. Further research is necessary to evaluate the psychometric measurement properties of the AmbQoL instruments to enable their use in amblyopia treatment trials.
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Affiliation(s)
- Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
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Mehringer W, Wirth M, Roth D, Michelson G, Eskofier BM. Stereopsis Only: Validation of a Monocular Depth Cues Reduced Gamified Virtual Reality with Reaction Time Measurement. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:2114-2124. [PMID: 35167462 DOI: 10.1109/tvcg.2022.3150486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The visual depth perception is composed of monocular and binocular depth cues. Studies show that in absence of binocular depth cues the performance of visuomotor tasks like pointing to or grasping objects is limited. Thus, binocular depth cues are of great importance for motor control required in everyday life. However, binocular depth cues like retinal disparity (basis for stereopsis) might be influenced due to developmental disorders of the visual system. For example, amblyopia in which one eye's visual input is not processed leads to loss of stereopsis. The primary amblyopia treatment is occlusion of the healthy eye to force the amblyopic eye to train. However, improvements in stereopsis are poor. Therefore, binocular treatments arose that equilibrate both eyes' visual input to enable binocular vision. However, most approaches rely on divided stimuli which do not account for loss of stereopsis. We created a Virtual Reality (VR) with reduced monocular depth cues in which a stereoscopic task is shown to both eyes simultaneously, consisting of two balls jumping towards the user. One ball appears closer to the user which must be identified. To evaluate the task performance the reaction time is measured. We validated our approach with 18 participants with stereopsis under three contrast settings including one leading to monocular vision. The number of correct responses reduces from 90% under binocular vision to 52% under monocular vision corresponding to random guessing. Our results indicate that it is possible to disable monocular depth cues and create a dynamic stereoscopic task inside a VR.
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Pang PCK, Lam CSY, Hess RF, Thompson B. Effect of dichoptic video game treatment on mild amblyopia - a pilot study. Acta Ophthalmol 2021; 99:e423-e432. [PMID: 32996689 PMCID: PMC8246520 DOI: 10.1111/aos.14595] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/15/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
Purpose The effect of contrast‐balanced dichoptic video game training on distance visual acuity (DVA) and stereo acuity has been investigated in severe‐to‐moderate amblyopia, but its effect on mild amblyopia and fixation stability has not been assessed. This pilot study aimed to evaluate the effect of home‐based dichoptic video game on amblyopic eye DVA, stereo acuity and fixation stability in adults with mild amblyopia. Methods A randomized single‐masked design was adopted. The active 6‐week home‐based treatment was an anaglyphic, contrast‐balanced dichoptic video game, and the placebo was an identical non‐dichoptic game. Participants (n = 23) had mild amblyopia (amblyopic DVA ≤ 0.28 log Minimum Angle of Resolution (logMAR)). The primary outcome was change in amblyopic DVA at 6 weeks postrandomization. Near visual acuity, stereo acuity and fixation stability (bivariate contour eclipse area) were also measured. Follow‐up occurred at 12 and 24 weeks postrandomization. Results Mean amblyopic eye DVA was 0.21 ± 0.06 and 0.18 ± 0.06 logMAR for the active (n = 12) and placebo (n = 11) group, respectively. Amblyopic DVA improved significantly more in the active group (0.09 ± 0.05) than in the placebo group (0.03 ± 0.04 logMAR; p < 0.05). The difference between groups remained at 12 weeks postrandomization (p = 0.04) but not at 24 weeks (p = 0.43). Titmus stereo acuities improved significantly more in the active group (0.40 log arcsec) than in the placebo group (0.09 log arcsec) after 6 weeks of gameplay. The between‐group difference was still present at 24 weeks postrandomization (p = 0.05). There were no differences between groups on any other secondary outcomes. Conclusion Home‐based dichoptic video gameplay may be an effective method to improve amblyopic DVA and stereo acuity in mild amblyopia.
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Affiliation(s)
- Peter C. K. Pang
- School of Optometry The Hong Kong Polytechnic University Kowloon Hong Kong
| | - Carly S. Y. Lam
- School of Optometry The Hong Kong Polytechnic University Kowloon Hong Kong
- Centre for Eye and Vision Research (CEVR) Hong Kong
| | - Robert F. Hess
- Department of Ophthalmology and Visual Sciences McGill University Montreal Quebec Canada
| | - Benjamin Thompson
- School of Optometry and Vision Science University of Waterloo Waterloo Ontario Canada
- Centre for Eye and Vision Research (CEVR) Hong Kong
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Rajavi Z, Soltani A, Vakili A, Sabbaghi H, Behradfar N, Kheiri B, Reza M. Virtual Reality Game Playing in Amblyopia Therapy: A Randomized Clinical Trial. J Pediatr Ophthalmol Strabismus 2021; 58:154-160. [PMID: 34039154 DOI: 10.3928/01913913-20210108-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the visual outcome of occlusion therapy with virtual reality game playing as a new therapy for children with amblyopia. METHODS This randomized clinical trial was performed on 50 children between 4 and 10 years old who had unilateral amblyopia. They were randomly divided into virtual reality and patching groups (n = 25 in each). The virtual reality group was trained binocularly using the virtual reality games through a head set for 1 hour per day 5 days a week for 4 weeks. Patients in the patching group occluded their non-amblyopic eyes 2, 4, and 6 hours for mild (best corrected visual acuity [BCVA] 0.2 to 0.3 logarithm of the minimum angle of resolution [logMAR]), moderate (0.3 to 0.6 logMAR), and severe (worse than 0.6 logMAR) amblyopia, respectively. RESULTS The mean BCVA based on logMAR units improved significantly in both groups (P < .0001), but the difference between the two groups was not significant (P = .59). BCVA based on the responded letters improved in both groups (virtual reality: P = .0001, patching: P = .001), and change in BCVA in the virtual reality group was higher than in the patching group (P = .002). CONCLUSIONS Virtual reality game playing was equal or superior to patching in an analysis of linear and letter BCVA, respectively. Therefore, applying this new amblyopia therapy is recommended. [J Pediatr Ophthalmol Strabismus. 2021;58(3):154-160.].
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Boon MY, Asper LJ, Chik P, Alagiah P, Ryan M. Treatment and compliance with virtual reality and anaglyph‐based training programs for convergence insufficiency. Clin Exp Optom 2021; 103:870-876. [DOI: 10.1111/cxo.13057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mei Ying Boon
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Lisa J Asper
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Peiting Chik
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Piranaa Alagiah
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia,
| | - Malcolm Ryan
- Department of Computing, Macquarie University, Sydney, Australia,
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Hamm LM, Chen Z, Li J, Dai S, Black J, Yuan J, Yu M, Thompson B. Contrast‐balanced binocular treatment in children with deprivation amblyopia. Clin Exp Optom 2021; 101:541-552. [DOI: 10.1111/cxo.12630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/25/2017] [Accepted: 09/07/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Zidong Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Shuan Dai
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand,
| | - Joanna Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand,
| | - Junpeng Yuan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat‐Sen University, Guangzhou, Guangdong, China,
| | - 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, Ontario, Canada,
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Gao TY, Black JM, Babu RJ, Bobier WR, Chakraborty A, Dai S, Guo CX, Hess RF, Jenkins M, Jiang Y, Kearns LS, Kowal L, Lam CSY, Pang PCK, Parag V, Pieri R, Nallour Raveendren R, South J, Staffieri SE, Wadham A, Walker N, Thompson B. Adherence to home-based videogame treatment for amblyopia in children and adults. Clin Exp Optom 2021; 104:773-779. [PMID: 33689654 DOI: 10.1080/08164622.2021.1878834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: Home-based videogame treatments are increasingly popular for amblyopia treatment. However, at-home treatments tend to be done in short sessions and with frequent disruptions, which may reduce the effectiveness of binocular visual stimulation. These treatment adherence patterns need to be accounted for when considering dose-response relationships and treatment effectiveness.Background: Home-based videogame treatments are increasingly being used for various sensory conditions, including amblyopia ('lazy eye'), but treatment adherence continues to limit success. To examine detailed behavioural patterns associated with home-based videogame treatment, we analysed in detail the videogame adherence data from the Binocular tReatment of Amblyopia with VideOgames (BRAVO) clinical trial (ACTRN12613001004752).Methods: Children (7-12 years), teenagers (13-17 years) and adults (≥ 18 years) with unilateral amblyopia were loaned iPod Touch devices with either an active treatment or placebo videogame and instructed to play for a total of 1-2 hours/day for six weeks at home. Objectively-recorded adherence data from device software were used to analyse adherence patterns such as session length, daily distribution of gameplay, use of the pause function, and differences between age groups. Objectively-recorded adherence was also compared to subjectively-reported adherence from paper-based diaries.Results: One hundred and five of the 115 randomised participants completed six weeks of videogame training. Average adherence was 65% (SD 37%) of the minimum hours prescribed. Game training was generally performed in short sessions (mean 21.5, SD 11.2 minutes), mostly in the evening, with frequent pauses (median every 4.1 minutes, IQR 6.1). Children played in significantly shorter sessions and paused more frequently than older age groups (p < 0.0001). Participants tended to over-report adherence in subjective diaries compared to objectively-recorded gameplay time.Conclusion: Adherence to home-based videogame treatment was characterised by short sessions interspersed with frequent pauses, suggesting regular disengagement. This complicates dose-response calculations and may interfere with the effectiveness of treatments like binocular treatments for amblyopia, which require sustained visual stimulation.
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Affiliation(s)
- Tina Y Gao
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Joanna M Black
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Raiju J Babu
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - William R Bobier
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Arijit Chakraborty
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.,Chicago College of Optometry, Midwestern University, Midwestern, IL, USA
| | - Shuan Dai
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Australia
| | - Cindy X Guo
- School of Optometry and Vision Science, 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, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Lisa S Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lionel Kowal
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Carly S Y Lam
- School of Optometry, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Peter C K Pang
- School of Optometry, Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Roberto Pieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Jayshree South
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | - Angela Wadham
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.,School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.,Department of Ophthalmology, McGill Vision Research, McGill University, Montreal, QC, Canada.,School of Optometry, Hong Kong Polytechnic University, Hong Kong, SAR, China
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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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Gao TY, Guo CX, Babu RJ, Black JM, Bobier WR, Chakraborty A, Dai S, Hess RF, Jenkins M, Jiang Y, Kearns LS, Kowal L, Lam CSY, Pang PCK, Parag V, Pieri R, Raveendren RN, South J, Staffieri SE, Wadham A, Walker N, Thompson B. Effectiveness of a Binocular Video Game vs Placebo Video Game for Improving Visual Functions in Older Children, Teenagers, and Adults With Amblyopia: A Randomized Clinical Trial. JAMA Ophthalmol 2019; 136:172-181. [PMID: 29302694 DOI: 10.1001/jamaophthalmol.2017.6090] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Binocular amblyopia treatment using contrast-rebalanced stimuli showed promise in laboratory studies and requires clinical trial investigation in a home-based setting. Objective To compare the effectiveness of a binocular video game with a placebo video game for improving visual functions in older children and adults. Design, Setting, and Participants The Binocular Treatment of Amblyopia Using Videogames clinical trial was a multicenter, double-masked, randomized clinical trial. Between March 2014 and June 2016, 115 participants 7 years and older with unilateral amblyopia (amblyopic eye visual acuity, 0.30-1.00 logMAR; Snellen equivalent, 20/40-20/200) due to anisometropia, strabismus, or both were recruited. Eligible participants were allocated with equal chance to receive either the active or the placebo video game, with minimization stratified by age group (child, age 7 to 12 years; teenager, age 13 to 17 years; and adult, 18 years and older). Interventions Falling-blocks video games played at home on an iPod Touch for 1 hour per day for 6 weeks. The active video game had game elements split between eyes with a dichoptic contrast offset (mean [SD] initial fellow eye contrast, 0.23 [0.14]). The placebo video game presented identical images to both eyes. Main Outcomes and Measures Change in amblyopic eye visual acuity at 6 weeks. Secondary outcomes included compliance, stereoacuity, and interocular suppression. Participants and clinicians who measured outcomes were masked to treatment allocation. Results Of the 115 included participants, 65 (56.5%) were male and 83 (72.2%) were white, and the mean (SD) age at randomization was 21.5 (13.6) years. There were 89 participants (77.4%) who had prior occlusion. The mean (SD) amblyopic eye visual acuity improved 0.06 (0.12) logMAR from baseline in the active group (n = 56) and 0.07 (0.10) logMAR in the placebo group (n = 59). The mean treatment difference between groups, adjusted for baseline visual acuity and age group, was -0.02 logMAR (95% CI, -0.06 to 0.02; P = .25). Compliance with more than 25% of prescribed game play was achieved by 36 participants (64%) in the active group and by 49 (83%) in the placebo group. At 6 weeks, 36 participants (64%) in the active group achieved fellow eye contrast greater than 0.9 in the binocular video game. No group differences were observed for any secondary outcomes. Adverse effects included 3 reports of transient asthenopia. Conclusions and Relevance The specific home-based binocular falling-blocks video game used in this clinical trial did not improve visual outcomes more than the placebo video game despite increases in fellow eye contrast during game play. More engaging video games with considerations for compliance may improve effectiveness. Trial Registration anzctr.org.au Identifier: ACTRN12613001004752.
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Affiliation(s)
- Tina Y Gao
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - 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, Ontario, 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, Ontario, Canada
| | - Arijit Chakraborty
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Shuan Dai
- Department of Ophthalmology, Starship Children's Hospital, Auckland, New Zealand
| | - Robert F Hess
- Department of Ophthalmology, McGill Vision Research, McGill University, Montreal, Quebec, 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
| | - Lisa S Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, University of Melbourne Department of Surgery, Melbourne, Victoria, Australia
| | - Lionel Kowal
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, University of Melbourne Department of Surgery, Melbourne, Victoria, Australia
| | - Carly S Y Lam
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Peter C K Pang
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Roberto Pieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, University of Melbourne Department of Surgery, Melbourne, Victoria, Australia
| | | | - Jayshree South
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Sandra Elfride Staffieri
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, University of Melbourne Department of Surgery, Melbourne, Victoria, Australia
| | - Angela Wadham
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Natalie Walker
- 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, Ontario, Canada.,Department of Ophthalmology, McGill Vision Research, McGill University, Montreal, Quebec, Canada
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14
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Birch EE, Jost RM, De La Cruz A, Kelly KR, Beauchamp CL, Dao L, Stager D, Leffler JN. Binocular amblyopia treatment with contrast-rebalanced movies. J AAPOS 2019; 23:160.e1-160.e5. [PMID: 31103562 PMCID: PMC6698207 DOI: 10.1016/j.jaapos.2019.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Binocular amblyopia treatments promote visual acuity recovery and binocularity by rebalancing the signal strength of dichoptic images. Most require active participation by the amblyopic child to play a game or perform a repetitive visual task. The purpose of this study was to investigate a passive form of binocular treatment with contrast-rebalanced dichoptic movies. METHODS A total of 27 amblyopic children, 4-10 years of age, wore polarized glasses to watch 6 contrast-rebalanced dichoptic movies on a passive 3D display during a 2-week period. Amblyopic eye contrast was 100%; fellow eye contrast was initially set to a lower level (20%-60%), which allowed the child to overcome suppression and use binocular vision. Fellow eye contrast was incremented by 10% for each subsequent movie. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and at 2 weeks. RESULTS Amblyopic eye best-corrected visual acuity improved from 0.57 ± 0.22 at baseline to 0.42 ± 0.23 logMAR (t26 = 8.09; P < 0.0001; 95% CI for improvement, 0.11-0.19 logMAR). Children aged 3-6 years had more improvement (0.21 ± 0.11 logMAR) than children aged 7-10 years (0.11 ± 0.06 logMAR; t25 = 3.05; P = 0.005). Children with severe amblyopia (≥0.7 logMAR) at baseline experienced greater improvement (0.24 ± 0.12 logMAR) than children with moderate amblyopia at baseline (0.12 ± 0.06 logMAR; t25 = 3.49; P = 0.002). CONCLUSIONS In this cohort, passive viewing of contrast-rebalanced dichoptic movies effectively improved visual acuity in amblyopic subjects. The degree of improvement observed was similar to that previously reported for 2 weeks of binocular games treatment and with 3-4 months of occlusion therapy.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas.
| | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | | | | | | | - David Stager
- Pediatric Ophthalmology & Adult Strabismus, Plano, Texas
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15
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Raveendran RN, Bobier WR, Thompson B. Binocular vision and fixational eye movements. J Vis 2019; 19:9. [PMID: 30943531 DOI: 10.1167/19.4.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to assess the relationship between binocular vision and fixation stability (FS). Across three experiments, we investigated (a) whether fixation was more stable during binocular versus monocular viewing across a range of stimulus contrasts in normal observers (n = 11), (b) whether binocular rivalry affected FS in normal observers (n = 14), and (c) whether FS was affected by interocular contrast differences in normal observers (n = 8) and patients with anisometropic amblyopia (n = 5). FS was quantified using global bivariate contour ellipse area, and microsaccades were detected using an unsupervised cluster-detection method. In normal observers, binocular viewing showed more stable fixation at all stimulus contrasts, and binocular rivalry did not affect FS. When interocular contrast was manipulated under dichoptic viewing conditions, normal observers exhibited less stable fixation for an eye that viewed 0% contrast (no fixation target). In anisometropic amblyopia, fixation was less stable in both eyes when the fellow eye viewed at 0% contrast. No effects were observed at other interocular contrast differences. Overall, binocular FS was impaired in both eyes in anisometropic amblyopia compared to normal observers. We conclude that binocular vision influences FS in normal observers but in an all-or-nothing fashion, whereby the presence or absence of a binocular target is important rather than the relative contrast of the targets in each eye. In anisometropic amblyopia, the fellow eye appears to control FS of both eyes under dichoptic viewing conditions.
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Affiliation(s)
- Rajkumar Nallour Raveendran
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada.,Present address: Envision Research Institute, Wichita, KS, USA
| | - William R Bobier
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
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16
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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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17
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Hamm LM, Anstice NS, Black JM, Dakin SC. Recognition acuity in children measured using The Auckland Optotypes. Ophthalmic Physiol Opt 2018; 38:596-608. [PMID: 30575072 DOI: 10.1111/opo.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Sloan letters displayed by the Electronic Visual Acuity (EVA) system are the gold standard for recognition acuity measurement in research settings. However, letters are not always appropriate for children. The Auckland Optotypes (TAO) are a new, open-access set of 10 pictograms available in regular and vanishing formats. We sought to assess feasibility of using both formats of TAO for measuring visual acuity (VA) in children using a Bayesian adaptive staircase, in a community setting. METHODS We tested 121 children (5-12 years old) with both formats of TAO, a handheld flipchart vision screener (Parr vision test), as well as the gold standard EVA. We measured feasibility of the three comparison tests in three ways. First, using limits of agreement (LoA) with EVA, second, calculating area under the receiver operating characteristic curve (AUC), and finally, investigating trial-by-trial responses. RESULTS Agreement between tests was within test-retest reliability of EVA measures (LoATAO regular = ±0.14, LoATAO vanishing = ±0.15, LoAP arr = ±0.16 logMAR). TAO tests were highly effective at identifying children with vision impairment (AUCTAO regular = 0.96, AUCTAO vanishing = 0.95), whereas Parr was less effective (AUCP arr = 0.82). In 5-6 year old children there was an enhanced advantage of TAO (AUCTAO regular = 0.97, AUCTAO vanishing = 0.98) over Parr (AUCP arr = 0.75). Although each child completed 16 trials, approximately 10 trials were sufficient to achieve excellent LoA, and six trials sufficient for accurate screening. CONCLUSION Threshold VA assessment and vision screening are feasible using both vanishing and regular formats of TAO.
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Affiliation(s)
- Lisa M Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand
| | - Nicola S Anstice
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand.,School of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Joanna M Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand
| | - Steven C Dakin
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.,New Zealand National Eye Centre, Auckland, New Zealand.,UCL Institute of Ophthalmology, University College London, London, UK
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18
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Reduced amblyopic eye fixation stability cannot be simulated using retinal-defocus-induced reductions in visual acuity. Vision Res 2018; 154:14-20. [PMID: 30389388 DOI: 10.1016/j.visres.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/05/2018] [Accepted: 10/23/2018] [Indexed: 11/23/2022]
Abstract
Amblyopia is associated with impaired visual acuity (VA) and reduced fixation stability (FS). To assess whether impaired VA may cause reduced FS, the effects of retinal-defocus-induced visual acuity reductions on FS were measured in observers with amblyopia and controls. Fixational eye movements were measured in 8 patients with amblyopia and 12 controls. Monocular near VA of a subset of controls (n = 5) was then varied from 20/20 to 20/100 using convex lenses. The amblyopia group completed three monocular conditions; 1) amblyopic eye fixating, 2) fellow eye fixating and 3) fellow eye fixating with VA reduced to match the amblyopic eye. Fixational eye movements were quantified using bivariate contour ellipse area (BCEA) and microsaccadic amplitude. Amblyopic eye BCEA was significantly larger with increased microsaccadic amplitude compared to the fellow eye and control eyes. BCEA and VA were positively correlated for amblyopic eyes. VA impairments induced by retinal defocus did not reduce FS in controls or the fellow eye of observers with amblyopia, even when fellow eye VA was matched to that of the amblyopic eye. This suggests that reduced FS in amblyopic eyes cannot be simulated by acute VA reductions. Therefore, reduced amblyopic eye FS may not be a direct consequence of the VA loss alone. As in previous studies, a correlation between BCEA and VA for amblyopic eyes was observed. This relationship could be due to a third, mediating variable or an effect of fixational eye movements on VA.
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19
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20
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Laplant J, Vagge A, Nelson LB. Practice Patterns in the Management of Amblyopia: A Survey Study. J Pediatr Ophthalmol Strabismus 2018; 55:100-106. [PMID: 29131912 DOI: 10.3928/01913913-20170718-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/14/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize current practice preferences of pediatric ophthalmologists in the management of amblyopia and whether these are influenced by demographic variables. METHODS A 10-question survey was distributed to all pediatric ophthalmologists and fellows attending the Annual Joseph H. Calhoun Pediatric Ophthalmology Forum at Wills Eye Hospital in 2016. The questionnaire consisted of demographic information and clinical management of amblyopia using clinical scenarios commonly encountered in pediatric ophthalmology practice. RESULTS Of the 133 pediatric ophthalmologists who attended, 74 completed the survey, all of which were included in the data analysis. Seventy-six percent of respondents prescribed refractive correction to a 3 year old with untreated anisometropic amblyopia prior to initiating occlusion therapy. For a child with coexisting exotropia, 57% recommended refractive and occlusion therapy until significant visual improvement, then surgery; however, 30% would perform surgery earlier. Fifty-seven percent stopped occlusion therapy at 10 years of age or older. Sixty-four percent estimated a patient patching compliance rate of 50% to 75%. There was no significant relationship (P < .05) between any of the demographic variables, indicating that no group was more or less likely to respond to the question in any way. CONCLUSIONS This study highlights the lack of a unified approach to certain aspects of amblyopia management. Physician-related demographic variables did not significantly affect clinical decision-making; however, variation did exist among respondents, a finding that warrants further investigation. [J Pediatr Ophthalmol Strabismus. 2018;55(2):100-106.].
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21
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Gao TY, Anstice N, Babu RJ, Black JM, Bobier WR, Dai S, Guo CX, Hess RF, Jenkins M, Jiang Y, Kearns L, Kowal L, Lam CSY, Pang PCK, Parag V, South J, Staffieri SE, Wadham A, Walker N, Thompson B. Optical treatment of amblyopia in older children and adults is essential prior to enrolment in a clinical trial. Ophthalmic Physiol Opt 2018; 38:129-143. [PMID: 29356022 DOI: 10.1111/opo.12437] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Optical treatment alone can improve visual acuity (VA) in children with amblyopia, thus clinical trials investigating additional amblyopia therapies (such as patching or videogames) for children require a preceding optical treatment phase. Emerging therapies for adult patients are entering clinical trials. It is unknown whether optical treatment is effective for adults with amblyopia and whether an optical correction phase is required for trials involving adults. METHODS We examined participants who underwent optical treatment in the Binocular Treatment for Amblyopia using Videogames (BRAVO) clinical trial (ANZCTR ID: ACTRN12613001004752). Participants were recruited in three age groups (7 to 12, 13 to 17, or ≥18 years), and had unilateral amblyopia due to anisometropia and/or strabismus, with amblyopic eye VA of 0.30-1.00 logMAR (6/12 to 6/60, 20/40 to 20/200). Corrective lenses were prescribed based on cycloplegic refraction to fully correct any anisometropia. VA was assessed using the electronic visual acuity testing algorithm (e-ETDRS) test and near stereoacuity was assessed using the Randot Preschool Test. Participants were assessed every four weeks up to 16 weeks, until either VA was stable or until amblyopic eye VA improved to better than 0.30 logMAR, rendering the participant ineligible for the trial. RESULTS Eighty participants (mean age 24.6 years, range 7.6-55.5 years) completed four to 16 weeks of optical treatment. A small but statistically significant mean improvement in amblyopic eye VA of 0.05 logMAR was observed (S.D. 0.08 logMAR; paired t-test p < 0.0001). Twenty-five participants (31%) improved by ≥1 logMAR line and of these, seven (9%) improved by ≥2 logMAR lines. Stereoacuity improved in 15 participants (19%). Visual improvements were not associated with age, presence of strabismus, or prior occlusion treatment. Two adult participants withdrew due to intolerance to anisometropic correction. Sixteen out of 80 participants (20%) achieved better than 0.30 logMAR VA in the amblyopic eye after optical treatment. Nine of these participants attended additional follow-up and four (44%) showed further VA improvements. CONCLUSIONS Improvements from optical treatment resulted in one-fifth of participants becoming ineligible for the main clinical trial. Studies investigating additional amblyopia therapies must include an appropriate optical treatment only phase and/or parallel treatment group regardless of patient age. Optical treatment of amblyopia in adult patients warrants further investigation.
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Affiliation(s)
- Tina Y Gao
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Nicola Anstice
- 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, Ontario, 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, Ontario, Canada
| | - Shuan Dai
- Department of Ophthalmology, Auckland City Hospital and Starship Children's Hospital, Auckland, New Zealand
| | - Cindy X Guo
- 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, Quebec, 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
| | - Lisa Kearns
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Lionel Kowal
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Carly S Y Lam
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Peter C K Pang
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - 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
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Wadham
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Natalie Walker
- 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, Ontario, Canada
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22
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Paudel N. Smartphone Applications for Amblyopia Treatment: A Review of Current Apps and Professional Involvement. Telemed J E Health 2018; 24:797-802. [PMID: 29346038 DOI: 10.1089/tmj.2017.0220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to review games for amblyopia (lazy eye) that are commercially available in mobile applications (apps) stores and assess the involvement of eye care professionals in their development. MATERIALS AND METHODS The Google play store and the Apple iTunes store were searched in July 2017 and updated in September 2017 for amblyopia games using the terms amblyopia, lazy eye, amblyopia therapy, lazy eye therapy, lazy eye exercises, amblyopia exercises, lazy eye games, and amblyopia games. General ophthalmology or optometry apps and apps in languages other than English were excluded. RESULTS A total of 42 games were identified, 12 Android only (28%), 20 iOS only (48%), and 10 (24%) both Android and iOS. Most of the games were available under the medical category (60%). Most of the games were released in 2015. The price of the games ranged from $0.00 to $32.00 (USD). Nearly half of the games (45%) were to be played binocularly either using red-green goggles (38%) or a virtual reality set (7%). Only 7% of the games had explicitly documented the involvement of eye care professionals during game development. Only one game (app) was developed in collaboration with a research group and a children's hospital. CONCLUSIONS This study identified that most of the currently available games do not have eye care professional input. An establishment of the quality assurance by a body of qualified eye care professionals could enhance the confidence of patients and clinicians using the game.
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Affiliation(s)
- Nabin Paudel
- Visual Psychophysics and Pediatrics Unit, Drishti Eye Care Center , Kalanki, Kathmandu, Nepal
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23
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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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Gong Q, Wei H, Zhou X, Li Z, Liu L. Risk factors analysis of consecutive exotropia: Oblique muscle overaction may play an important role. Medicine (Baltimore) 2016; 95:e5644. [PMID: 27977611 PMCID: PMC5268057 DOI: 10.1097/md.0000000000005644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To evaluate clinical factors associated with the onset of consecutive exotropia (XT) following esotropia surgery.By a retrospective nested case-control design, we reviewed the medical records of 193 patients who had undergone initial esotropia surgery between 2008 and 2015, and had follow-up longer than 6 months. The probable risk factors were evaluated between groups 1 (consecutive XT) and 2 (non-consecutive exotropia). Pearson chi-square test and Mann-Whitney U test were used for univariate analysis, and conditional logistic regression model was applied for exploring the potential risk factors of consecutive XT.Consecutive exotropia occurred in 23 (11.9%) of 193 patients. Patients who had undergone large bilateral medial rectus recession (BMR) (P = 0.017) had a high risk of developing consecutive XT. Oblique dysfunction (P = 0.001), adduction limitation (P = 0.000) were associated with a high risk of consecutive XT, which was confirmed in the conditional logistic regression analysis. In addition, large amount of BMR (6 mm or more) was associated with higher incidence of adduction limitation (P = 0.045). The surgical methods and preoperative factors did not appear to influence the risk of developing consecutive XT (P > 0.05).The amount of surgery could be optimized to reduce the risk of consecutive XT. The presence of oblique overaction and postoperative adduction limitation may be associated with a high risk of consecutive XT, which may require close supervision, and/or even earlier operation intervention.
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Affiliation(s)
| | - Hong Wei
- Department of Ophthalmology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan
| | - Xu Zhou
- Evidence-based Medicine Center, School of Basic Medical Sciences, Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Ziyuan Li
- Department of Ophthalmology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan
| | - Longqian Liu
- Department of Optometry and Visual Science
- Department of Ophthalmology, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan
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