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Invited Commentary
February 2018

Lessons From Recent Randomized Clinical Trials of Binocular Treatment for Amblyopia

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
JAMA Ophthalmol. 2018;136(2):181-183. doi:10.1001/jamaophthalmol.2017.5938

In this issue of JAMA Ophthalmology, Gao et al1 report the results of the Binocular Treatment of Amblyopia using Videogames (BRAVO) study. Those of us who see and treat children and adults with amblyopia were initially enthused by the findings of previous case series2 suggesting that a binocular approach to treating amblyopia was effective, targeting suppression without patching or atropine sulfate. Our enthusiasm was only slightly tempered by the results of the randomized clinical trial completed by the Pediatric Eye Disease Investigator Group (PEDIG),3 which failed to find binocular treatment, with a falling-blocks game, noninferior to part-time patching. After a post hoc analysis,3 it was concluded that visual acuity improvement with binocular iPad treatment was not as good as with 2 hours of prescribed daily patching. That study3 also reported poor adherence with the binocular falling-blocks game: only 39 of the 176 participants (22%) randomized to the binocular game performed more than 75% of the prescribed treatment.3 Rather than dismiss binocular treatment based on the findings of the PEDIG randomized clinical trial, the authors3 speculated that better adherence with binocular treatment would lead to more encouraging results.