Randomised controlled trial of video clips and interactive games to improve vision in children with amblyopia using the I-BiT system

Nicola Herbison, Daisy MacKeith, Anthony Vivian, Jon Purdy, Apostolos Fakis, Isabel M Ash, Sue V Cobb, Richard M Eastgate, Stephen M Haworth, Richard M Gregson, Alexander Je Foss, Nicola Herbison, Daisy MacKeith, Anthony Vivian, Jon Purdy, Apostolos Fakis, Isabel M Ash, Sue V Cobb, Richard M Eastgate, Stephen M Haworth, Richard M Gregson, Alexander Je Foss

Abstract

Background: Traditional treatment of amblyopia involves either wearing a patch or atropine penalisation of the better eye. A new treatment is being developed on the basis of virtual reality technology allowing either DVD footage or computer games which present a common background to both eyes and the foreground, containing the imagery of interest, only to the amblyopic eye.

Methods: A randomised control trial was performed on patients with amblyopia aged 4-8 years with three arms. All three arms had dichoptic stimulation using shutter glass technology. One arm had DVD footage shown to the amblyopic eye and common background to both, the second used a modified shooter game, Nux, with sprite and targets presented to the amblyopic eye (and background to both) while the third arm had both background and foreground presented to both eyes (non-interactive binocular treatment (non-I-BiT) games).

Results: Seventy-five patients were randomised; 67 were residual amblyopes and 70 had an associated strabismus. The visual acuity improved in all three arms by approximately 0.07 logMAR in the amblyopic eye at 6 weeks. There was no difference between I-BiT DVD and non-I-BiT games compared with I-BiT games (stated primary outcome) in terms of gain in vision.

Conclusions: There was a modest vision improvement in all three arms. Treatment was well tolerated and safe. There was no difference between the three treatments in terms of primary stated outcomes but treatment duration was short and the high proportion of previously treated amblyopia and strabismic amblyopia disadvantaged dichoptic stimulation treatment.

Trial registration number: NCT01702727, results.

Keywords: Child health (paediatrics); Treatment other; Vision.

Conflict of interest statement

Competing interests: AJEF reports that Nottingham University Hospitals Trust and Nottingham University own the rights to an European patent EP 1 509 121 B1. My coauthors include IMA, SVC, RME, RMG and SMH who are included in the list of inventors.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
The Consolidated Standards of Reporting Trials (CONSORT) flow diagram for the trial.

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