Ruth E Manny, Jonathan M Holmes1, Raymond T Kraker2, Zhuokai Li2, Amy L Waters3, Krista R Kelly4, Lingkun Kong5, Earl R Crouch6, Ingryd J Lorenzana7, Maan S Alkharashi8, Jennifer A Galvin9, Melissa L Rice10, B Michele Melia2, Susan A Cotter11. 1. Department of Ophthalmology and Vision Science, University of Arizona-Tucson, Tucson, Arizona. 2. Jaeb Center for Health Research, Tampa, Florida. 3. Children's Mercy Hospitals and Clinics, Kansas City, Missouri. 4. Retina Foundation of the Southwest, Dallas, Texas. 5. Texas Tech University Health Science Center, Lubbock, Texas. 6. Virginia Pediatric Eye Center, Virginia Beach, Virginia. 7. Advanced Vision Center, Schaumburg, Illinois. 8. Boston Children's Hospital, Boston, Massachusetts. 9. Eye Physicians & Surgeons, PC, Milford, Connecticut. 10. Cincinnati Children's Hospital, Cincinnati, Ohio. 11. Southern California College of Optometry at Marshall B Ketchum University, Fullerton, California.
Abstract
SIGNIFICANCE: Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. PURPOSE: This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. METHODS: Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. RESULTS: A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. CONCLUSIONS: In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.
SIGNIFICANCE: Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. PURPOSE: This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. METHODS: Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. RESULTS: A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. CONCLUSIONS: In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.
Authors: Susan A Cotter; Allison R Edwards; David K Wallace; Roy W Beck; Robert W Arnold; William F Astle; Carmen N Barnhardt; Eileen E Birch; Sean P Donahue; Donald F Everett; Joost Felius; Jonathan M Holmes; Raymond T Kraker; Michele Melia; Michael X Repka; Nicholas A Sala; David I Silbert; Katherine K Weise Journal: Ophthalmology Date: 2006-06 Impact factor: 12.079
Authors: Mitchell M Scheiman; Richard W Hertle; Roy W Beck; Allison R Edwards; Eileen Birch; Susan A Cotter; Earl R Crouch; Oscar A Cruz; Bradley V Davitt; Sean Donahue; Jonathan M Holmes; Don W Lyon; Michael X Repka; Nicholas A Sala; David I Silbert; Donny W Suh; Susanna M Tamkins Journal: Arch Ophthalmol Date: 2005-04
Authors: Reed M Jost; Krista R Kelly; Jeffrey S Hunter; David R Stager; Becky Luu; Joel N Leffler; Lori Dao; Cynthia L Beauchamp; Eileen E Birch Journal: J AAPOS Date: 2020-10-09 Impact factor: 1.220
Authors: Aveen Kadhum; Emily T C Tan; Dennis M Levi; Linda Colpa; Maria Fronius; Huibert J Simonsz; Sjoukje E Loudon Journal: Graefes Arch Clin Exp Ophthalmol Date: 2021-05-31 Impact factor: 3.117