Binocular iPad treatment for amblyopia in preschool children

Abstract

Background: Recent experimental evidence supports a role for binocular visual experience in the treatment of amblyopia. The purpose of this study was to determine whether repeated binocular visual experience with dichoptic iPad games could effectively treat amblyopia in preschool children.

Methods: A total of 50 consecutive amblyopic preschool children 3-6.9 years of age were assigned to play sham iPad games (first 5 children) or binocular iPad games (n = 45) for at least 4 hours per week for 4 weeks. Thirty (67%) children in the binocular iPad group and 4 (80%) in the sham iPad group were also treated with patching at a different time of day. Visual acuity and stereoacuity were assessed at baseline, at 4 weeks, and at 3 months after the cessation of game play.

Results: The sham iPad group had no significant improvement in visual acuity (t4 = 0.34, P = 0.75). In the binocular iPad group, mean visual acuity (plus or minus standard error) improved from 0.43 ± 0.03 at baseline to 0.34 ± 0.03 logMAR at 4 weeks (n = 45; paired t44 = 4.93; P < 0.0001). Stereoacuity did not significantly improve (t44 = 1.35, P = 0.18). Children who played the binocular iPad games for ≥8 hours (≥50% compliance) had significantly more visual acuity improvement than children who played 0-4 hours (t43 = 4.21, P = 0.0001).

Conclusions: Repeated binocular experience, provided by dichoptic iPad game play, was more effective than sham iPad game play as a treatment for amblyopia in preschool children.

FIG 1

Left, Mean (±SE) change in logMAR visual acuity (baseline minus 4-week outcome) with binocular iPad and sham iPad game play. Middle, Mean change in logMAR visual acuity for children who reported playing the binocular iPad games ≥8 hours (≥50% compliance) and children who reported 0–4 hours (≤25% compliance). Right, Mean change in logMAR visual acuity for children who played the binocular iPad games ≥8 hours and patched for 2 hours per day at a different time of day (game+patch), children who played the binocular iPad games ≥8 hours (game only) and did not patch, children who did not play the binocular iPad games but patched (Patch only), and children who did not play the binocular iPad games or patch (None). Positive values indicate that visual acuity improved. Vertical lines on each bar show standard errors. Numbers above the bars indicate the sample size in each group.

FIG 2

Visual acuity at baseline and at the 4-week outcome visit. Horizontal lines show baseline visual acuity. Filled bars show children who had visual acuity improvement. Open bars show children with no improvement or visual acuity deterioration. Left, Children who reported playing the binocular iPad games ≥8 hours (≥50% compliance), ordered by their baseline best-corrected visual acuity. Middle, Children who reported 0–4 hours (≤25% compliance) of binocular iPad game play, ordered by their baseline best-corrected visual acuity. Right, Children in the sham iPad group, sorted by baseline best-corrected visual acuity.