A binocular iPad treatment for amblyopic children

Abstract

Purpose: Monocular amblyopia treatment (patching or penalization) does not always result in 6/6 vision and amblyopia often recurs. As amblyopia arises from abnormal binocular visual experience, we evaluated the effectiveness of a novel home-based binocular amblyopia treatment.

Methods: Children (4-12 y) wore anaglyphic glasses to play binocular games on an iPad platform for 4 h/w for 4 weeks. The first 25 children were assigned to sham games and then 50 children to binocular games. Children in the binocular group had the option of participating for an additional 4 weeks. Compliance was monitored with calendars and tracking fellow eye contrast settings. About half of the children in each group were also treated with patching at a different time of day. Best-corrected visual acuity, suppression, and stereoacuity were measured at baseline, at the 4- and 8-week outcome visits, and 3 months after cessation of treatment.

Results: Mean (±SE) visual acuity improved in the binocular group from 0.47±0.03 logMAR at baseline to 0.39±0.03 logMAR at 4 weeks (P<0.001); there was no significant change for the sham group. The effect of binocular games on visual acuity did not differ for children who were patched vs those who were not. The median stereoacuity remained unchanged in both groups. An additional 4 weeks of treatment did not yield additional visual acuity improvement. Visual acuity improvements were maintained for 3 months after the cessation of treatment.

Conclusions: Binocular iPad treatment rapidly improved visual acuity, and visual acuity was stable for at least 3 months following the cessation of treatment.

Figure 1

BCVA of the amblyopic eye at the baseline visit and the 4-week primary outcome visit. Children were assigned to either binocular games or sham games. As an additonal amblyopia treatment, about half of the children in each group also patched the fellow eye at a different time of day than iPad game play. Data points below the diagonal line represent improvement in BCVA.

Figure 2

Change in the BCVA of the amblyopic eye after 4 weeks of game play (baseline BCVA−outcome BCVA). Left: Change in BCVA for binocular games group and sham games group. Right: As an additonal amblyopia treatment, about half of the children in both the binocular games and sham game groups also patched the fellow eye at a different time of day than iPad game play. Change in BCVA for the four subgroups is shown: binocular games+patching, binocular games only, sham games+patching, and sham games only.

Figure 3

BCVA of the amblyopic eye at the baseline visit and the 4-week primary outcome visit for children who were compliant or non-compliant with iPad game play. Data points below the diagnonal line represent improvement in BCVA.

Figure 4

BCVA of the amblyopic eye at baseline, at the 4-week primary outcome visit, and after an additional 4 weeks on binocular game play (8-week outcome). Data are shown for the 23 compliant children who participated in a second 4-week period of binocular iPad game play for a total of 8 weeks.