Barriers to successful dichoptic treatment for amblyopia in young children.
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ABSTRACT: Purpose
In an ongoing randomised clinical trial comparing dichoptic VR video games with patching for amblyopia, we evaluated any potential barriers to successful use of this novel amblyopia treatment method.Methods
From December 2017, all newly diagnosed amblyopic children were recruited. Excluded were children under age 4 and patients with strabismus exceeding 30PD. The video game was played for 1 h per week at the outpatient clinic under direct supervision. Records were kept of difficulties encountered during treatment and categorised into domains. Factors influencing the successful completion of this treatment were identified and related to patient characteristics.Results
Ninety-one children were recruited for the trial, 20 parents refused participation before randomisation, because of the logistical challenges the outpatient dichoptic treatment would cause them. Of the 17 children who commenced dichoptic treatment (median age 6.2 years; IQR 4.9-8.4 years), 10 did not complete treatment. Children under age 5.5 years were unable to comprehend the game settings or the game itself. Older children (N = 7; 41%) were less willing to comply with the video game. Loss of interest in the game (N = 8; 47%) was found to be a limiting factor at all ages.Conclusion
Half of the children failed to complete VR dichoptic treatment, mainly due to young age. In countries with nationwide screening where amblyopia is detected before age 6, the applicability of such dichoptic treatment is limited.
SUBMITTER: Kadhum A
PROVIDER: S-EPMC8478762 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe effect of contrast-balanced dichoptic video game training on distance visual acuity (DVA) and stereo acuity has been investigated in severe-to-moderate amblyopia, but its effect on mild amblyopia and fixation stability has not been assessed. This pilot study aimed to evaluate the effect of home-based dichoptic video game on amblyopic eye DVA, stereo acuity and fixation stability in adults with mild amblyopia.MethodsA randomized single-masked design was adopted. The active 6-week home-based treatment was an anaglyphic, contrast-balanced dichoptic video game, and the placebo was an identical non-dichoptic game. Participants (n = 23) had mild amblyopia (amblyopic DVA ≤ 0.28 log Minimum Angle of Resolution (logMAR)). The primary outcome was change in amblyopic DVA at 6 weeks postrandomization. Near visual acuity, stereo acuity and fixation stability (bivariate contour eclipse area) were also measured. Follow-up occurred at 12 and 24 weeks postrandomization.ResultsMean amblyopic eye DVA was 0.21 ± 0.06 and 0.18 ± 0.06 logMAR for the active (n = 12) and placebo (n = 11) group, respectively. Amblyopic DVA improved significantly more in the active group (0.09 ± 0.05) than in the placebo group (0.03 ± 0.04 logMAR; p < 0.05). The difference between groups remained at 12 weeks postrandomization (p = 0.04) but not at 24 weeks (p = 0.43). Titmus stereo acuities improved significantly more in the active group (0.40 log arcsec) than in the placebo group (0.09 log arcsec) after 6 weeks of gameplay. The between-group difference was still present at 24 weeks postrandomization (p = 0.05). There were no differences between groups on any other secondary outcomes.ConclusionHome-based dichoptic video gameplay may be an effective method to improve amblyopic DVA and stereo acuity in mild amblyopia.
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Project description:PurposeWe aimed to study the effect of stimulus contrast on the orientation selectivity of interocular interaction in amblyopia using a dichoptic masking paradigm.MethodsEight adults with anisometropic or mixed amblyopia and 10 control adults participated in our study. The contrast threshold in discriminating a target Gabor in the tested eye was measured with mean luminance in the untested eye, as well as with a bandpass oriented filtered noise in the other eye at low spatial frequency (0.25 c/d). Threshold elevation, which represents interocular suppression, was assessed using a the dichoptic masking paradigm (i.e. the contrast threshold difference between the target only and masked conditions), for each eye. Orientation selectivity of the interocular suppression as reflected by dichoptic masking was quantified by the difference between the parallel and orthogonal masking configurations. Two levels of mask's contrast (3 times or 10 times that of an individual's contrast threshold) were tested in this study.ResultsThe strength of dichoptic masking suppression was stronger at high, rather than low mask contrast in both amblyopic and control subjects. Normal controls showed orientation-dependent dichoptic masking suppression both under high and low contrast levels. However, amblyopes showed orientation-tuned dichoptic masking suppression only under the high contrast level, but untuned under the low contrast level.ConclusionsWe demonstrate that interocular suppression assessed by dichoptic masking is contrast-dependent in amblyopia, being orientation-tuned only at high suprathreshold contrast levels of the mask.
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Project description:ObjectiveTo identify factors associated with visual acuity regression following successful treatment of anisometropic amblyopia.Design and methodThis was a retrospective cohort study. Database records for 100 and 61 children with anisometropic amblyopia who met at least one criterion for successful treatment proposed by the Pediatric Eye Disease Investigator Group (PEDIG) and had at least 1 year of follow-up data available after the criterion was met were analyzed. The study sample was split into two groups, those who regressed within 1 year of successful treatment (no longer met any of the PEDIG criteria for successful treatment) and those who did not. A two-step analysis involving a least absolute shrinkage and selection operator (LASSO) regression and a logistic regression were used to identify predictor variables for increased risk of regression. A broad range of clinical, perceptual, and demographic variables were included in the analyses.ResultsSixty-eight (42.5%) children regressed within 1 year of successful treatment. Among the 27 predictor variables considered within the statistical modeling process, the three most important for predicting treatment regression were the extent of amblyopic eye visual acuity improvement, age at first hospital visit and sex. Specifically, lower risk of regression was associated with larger amblyopic eye visual acuity improvement with treatment, younger age at initiation of treatment and female sex.ConclusionPatients who received treatment at a younger age and responded well to treatment had a lower risk of treatment regression. This pattern of results suggests that early detection of amblyopia and strategies that enhance treatment adherence may reduce the risk of treatment regression. The higher risk of regression in boys than girls that we observed may reflect known sex differences in brain development and /or sex differences in environment within our sample of children from South China.
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Project description:PurposeTo evaluate the monocular oral reading rate, accuracy, fluency, and comprehension in 10-year-old children previously treated for amblyopia.DesignProspective, observational case series.MethodsSeventy-nine children (mean age, 10.3 years) previously treated in a multicenter randomized trial comparing patching and atropine were tested at seven sites using a modification of the Gray Oral Reading Test, Fourth Edition (GORT-4).ResultsThe mean visual acuities (VA) in the amblyopic and fellow eyes at the time of the reading assessment were 0.17 logarithm of the minimum angle of resolution (logMAR) units (approximately 20/32) and -0.03 logMAR units (approximately 20/20), respectively. Compared with the sound eye, amblyopic eye performance was worse when reading orally with respect to rate (P < .001), accuracy (P = .03), and fluency (P < .001). Reading comprehension scores were similar with the amblyopic and fellow eyes (P = .45). Similar results were found with respect to original treatment group assignment (atropine or patching). There was a modest correlation between interocular difference (IOD) of VA at age 10 years and IOD in reading rate (r = 0.37; 95% confidence interval [CI], 0.18 to 0.56) and fluency (r = 0.28; 95% CI, 0.08 to 0.49). There was no correlation between the IOD in VA and IOD in accuracy (r = 0.08; 95% CI, -0.14 to 0.30) or comprehension (r = 0.16; 95% CI, -0.05 to 0.37).ConclusionsThe monocular oral reading ability when measured with the GORT-4 was slightly worse when reading with previously treated amblyopic eyes compared with fellow eyes in terms of rate, accuracy, and fluency, but reading comprehension testing was similar.
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Project description:To determine whether age at initiation of treatment for amblyopia influences the response among children 3 to less than 13 years of age with unilateral amblyopia who have 20/40 to 20/400 amblyopic eye visual acuity.A meta-analysis of individual subject data from 4 recently completed randomized amblyopia treatment trials was performed to evaluate the relationship between age and improvement in logMAR amblyopic eye visual acuity. Analyses were adjusted for baseline amblyopic eye visual acuity, spherical equivalent refractive error in the amblyopic eye, type of amblyopia, prior amblyopia treatment, study treatment, and protocol. Age was categorized (3 to <5 years, 5 to <7 years, and 7 to <13 years) because there was a nonlinear relationship between age and improvement in amblyopic eye visual acuity.Children from 7 to less than 13 years of age were significantly less responsive to treatment than were younger age groups (children from 3 to <5 years of age or children from 5 to <7 years of age) for moderate and severe amblyopia (P < .04 for all 4 comparisons). There was no difference in treatment response between children 3 to less than 5 years of age and children 5 to less than 7 years of age for moderate amblyopia (P = .67), but there was a suggestion of greater responsiveness in children 3 to less than 5 years of age compared with children 5 to less than 7 years of age for severe amblyopia (P = .09).Amblyopia is more responsive to treatment among children younger than 7 years of age. Although the average treatment response is smaller in children 7 to less than 13 years of age, some children show a marked response to treatment.
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