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Original Investigation
Clinical Trial
December 2016

Binocular iPad Game vs Patching for Treatment of Amblyopia in ChildrenA Randomized Clinical Trial

Author Affiliations
  • 1Retina Foundation of the Southwest, Dallas, Texas
  • 2ABC Eyes Pediatric Ophthalmology, PA, Dallas, Texas
  • 3Children’s Eye Care of North Texas, PA, Plano
  • 4Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas
JAMA Ophthalmol. 2016;134(12):1402-1408. doi:10.1001/jamaophthalmol.2016.4224
Key Points

Questions  Will a binocular iPad (Apple Inc) game be effective in treating childhood amblyopia, and how does the visual acuity improvement compare with that obtained with 2 hours of daily patching?

Findings  In this randomized clinical trial with a crossover design at the 2-week visit, binocular treatment with an iPad game improved amblyopic eye visual acuity by 1.5 lines compared with 0.7 line with patching.

Meaning  Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia; however, whether long-term binocular treatment is as effective in remediating amblyopia as patching remains to be investigated.

Abstract

Importance  Fellow eye patching has long been the standard treatment for amblyopia, but it does not always restore 20/20 vision or teach the eyes to work together. Amblyopia can be treated with binocular games that rebalance contrast between the eyes so that a child may overcome suppression. However, it is unclear whether binocular treatment is comparable to patching in treating amblyopia.

Objectives  To assess the effectiveness of a binocular iPad (Apple Inc) adventure game as amblyopia treatment and compare this binocular treatment with patching, the current standard of care.

Design, Setting, and Participants  This investigation was a randomized clinical trial with a crossover design at a nonprofit eye research institute. Between February 20, 2015, and January 4, 2016, a total of 28 patients were enrolled in the study, with 14 randomized to binocular game treatment and 14 to patching treatment.

Interventions  Binocular game and patching as amblyopia treatments.

Main Outcomes and Measures  The primary outcome was change in amblyopic eye best-corrected visual acuity (BCVA) at the 2-week visit. Secondary outcomes were change in stereoacuity and suppression at the 2-week visit and change in BCVA at the 4-week visit.

Results  Among 28 children, the mean (SD) age at baseline was 6.7 (1.4) years (age range, 4.6-9.5 years), and 7 (25%) were female. At baseline, the mean (SD) amblyopic eye BCVA was 0.48 (0.14) logMAR (approximately 20/63; range, 0.3-0.8 logMAR [20/40 to 20/125]), with 14 children randomized to the binocular game and 14 to patching for 2 weeks. At the 2-week visit, improvement in amblyopic eye BCVA was greater with the binocular game compared with patching, with a mean (SD) improvement of 0.15 (0.08) logMAR (mean [SD], 1.5 [0.8] lines) vs 0.07 (0.08) logMAR (mean [SD], 0.7 [0.8] line; P = .02) after 2 weeks of treatment. These improvements from baseline were significant for the binocular game (mean [SD] improvement, 1.5 [0.8] lines; P < .001) and for patching (mean [SD] improvement, 0.7 [0.8] line; P = .006). Depth of suppression improved from baseline at the 2-week visit for the binocular game (mean [SD], 4.82 [2.82] vs 3.24 [2.87]; P = .03) and for patching (mean [SD], 4.77 [3.10] vs 2.57 [1.67]; P = .004). Patching children crossed over to binocular game treatment, and all 28 children played the game for another 2 weeks. At the 4-week visit, no group difference was found in BCVA change, with children who crossed over to the binocular games catching up with children treated with binocular games, for a mean (SD) improvement of 0.17 (0.10) logMAR (mean [SD], 1.7 [1.0] lines) for the binocular game vs a mean (SD) improvement of 0.16 (0.12) logMAR (mean [SD], 1.6 [1.2] lines) for the patching crossover (P = .73).

Conclusions and Relevance  A binocular iPad game was effective in treating childhood amblyopia and was more efficacious than patching at the 2-week visit. Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.

Trial Registration  clinicaltrials.gov Identifier: NCT02365090.

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