Can binocular gaming improve amblyopia?

Can binocular gaming improve amblyopia?

What if playing a game for an hour a day over the course of several weeks could help adults and children with amblyopia restore binocular vision?

"... Under the right conditions, patients with amblyopia can indeed restore binocular vision."

That's the question at the heart of research focused on binocular treatment. It focuses on "training" both eyes simultaneously by altering such factors as contrast for each eye, notes Yi Pang, M.D., O.D., Ph.D., assistant dean for research at the Illinois College of Optometry and a practitioner and researcher with experience in amblyopia.

For example, in a study published in July 2014 in Eye, researchers treated 50 children using a binocular iPad game and 25 using a "sham" game, in some cases in conjunction with patching. According to results, mean visual acuity improved in the binocular group, but there was no significant change for the sham group.

This was but one among nine small-scale studies focused on binocular treatments, both in adults and children. The approach—and the technology behind it—has been championed by Robert F. Hess, D.Sc., of McGill University's Department of Ophthalmology at the University of Montreal, Quebec.

"We have done experiments that show that, under the right conditions, patients with amblyopia can indeed restore binocular vision," Dr. Hess says.

Based on the small-scale studies' results, a randomized clinical trial is in recruitment, to be administered by the Pediatric Eye Disease Investigatory Group (PEDIG). Dr. Pang, a PEDIG researcher, points out that such a trial is critical to establishing the efficacy of binocular gaming for treatment. The work so far has shown enough promise to warrant further research.

"Now, we need a large, randomized clinical trial to show whether it will work effectively for many patients—especially in comparison with patching," Dr. Pang says.

How treatments would work
In Dr. Hess' most recent research, the results were positive in terms of outcomes and patient compliance.

The screens used in such treatment incorporate a lenticular layover, which separates the field of vision for each eye. A patient plays a game that requires each eye to function to complete the game successfully. For example, in the familiar puzzle game Tetris, the game is fine-tuned in terms of contrast and other factors. The amblyopic eye sees game blocks as they fall from the top of the screen, while the healthy eye sees the blocks that are fixed in place at the bottom of the screen.

"The basic idea is you have different information for each eye," Dr. Hess notes. "Initially, that information is quite off-balance to counteract the patient's degree of suppression. Over time, as they complete the game successfully, the game slowly adjusts back to a more similar level of contrast. Eventually, you can get to a similar situation for both eyes."

Of the 14 cases included in the study, 13 patients showed significant improvements in visual acuity and stereopsis.

But would patients follow through on a doctor's orders to use this program for a half hour to an hour a day for four to six weeks?

The answer was yes. Dr. Hess notes that the devices record and report whether a patient logged daily use, and for how long. An OD or other eye care professional's oversight is critical to the process.
"What is absolutely essential from my perspective is that this is not a downloadable app anyone can access," he notes. "This has to be prescribed and managed. That's the way we can ensure it has the best chance of working for patients."

January 6, 2015

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