No playing around: iPads over patching?

November 30, 2016
New amblyopia treatment could leave tried-and-true patching in the 20th Century.

Play a video game once daily, and see your doctor in two weeks—it's the prescription of a child's wildest dreams that may come to redefine amblyopia treatment.

Published online in November's JAMA Ophthalmology, a new study suggests that specialized video gameplay on an iPad is more effective at treating amblyopic children than the standard patching treatment. Such findings hold promise in encouraging treatment compliance through simple play, and might help alleviate children's perceived stigmas from patching regimens.

Amblyopia, or lazy eye, affects nearly 3% of American children. It's a condition that, if left untreated through childhood, will persist as the most common cause of monocular visual impairment in young to middle-aged adults.  

Traditionally, patching or atropine drops are administered in the dominant eye, forcing the weaker eye to compensate; however, this method doesn't always restore 20/20 vision or teach the eyes to work together. This is where a binocular treatment in the form of a video game could help.  

Researchers randomly assigned 28 amblyopic children, each about 7 years old, either to an action-oriented iPad game or the standard patching treatment. Kids in the game treatment wore special glasses that separated game elements seen in each eye by contrast, and then the kids were asked to play the game for one hour, 5 days a week, spanning two weeks.

According to the study, best-corrected visual acuity in the amblyopic eye at a two-week follow up was about twice the improvement found with patching, and with less than 50% treatment time required by patching.  

"We show that in just two weeks, visual acuity gain with binocular treatment was half that found with 6 months of patching, suggesting that binocular treatment may yield faster gains than patching," study authors noted in a JAMA news release. "Whether long-term binocular treatment is as effective in remediating amblyopia as patching remains to be investigated."  

Video games as instruments of eye care?  

Although vision therapy's traditional tools of the trade—those Wolff wands, Marsden balls, lenses and prisms—still offer tried-and-tested options, increasingly it's innovative, interactive technology that is becoming de rigueur therapy.  

The Pew Research Center notes half of all Americans already play some form of video games, so it's little wonder that this new therapy resembles a device with which many are already familiar and comfortable.  

"Video games really are the future in helping drive home that vision therapy works," said Miki Lyn D'Angelo, O.D., owner of a vision therapy practice in New York, in an interview with AOA Focus. "There's so much news about this technology right now that it's really taking off. It's the way of the future."  

Dr. D'Angelo's in-office vision therapy system incorporates a 60-inch flat-screen TV, liquid crystal glasses and an Xbox gaming controller that allows patients to work on vergence, saccades, visual memory, accommodative problems and more. Another system uses a Nintendo Wii balance board to work on vestibular and visual-motor systems. It's technology that works for both her youngest and oldest patients.  

"Usually there's surprise and when patients see the system they ask, 'what do you mean this is helping my eyes?' Because it really is just a game to them," she said.  

Read more about the intersection of vision therapy and video games on page 18 of the April 2016 edition of AOA Focus.

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