A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years
Pediatric Eye Disease Investigator Group, Jonathan M Holmes, Ruth E Manny, Elizabeth L Lazar, Eileen E Birch, Krista R Kelly, Allison I Summers, Stacy R Martinson, Aparna Raghuram, Jeffrey D Colburn, Christine Law, Justin D Marsh, Derek P Bitner, Raymond T Kraker, David K Wallace, Pediatric Eye Disease Investigator Group, Jonathan M Holmes, Ruth E Manny, Elizabeth L Lazar, Eileen E Birch, Krista R Kelly, Allison I Summers, Stacy R Martinson, Aparna Raghuram, Jeffrey D Colburn, Christine Law, Justin D Marsh, Derek P Bitner, Raymond T Kraker, David K Wallace
Abstract
Purpose: To compare visual acuity (VA) improvement in children aged 7 to 12 years with amblyopia treated with a binocular iPad game plus continued spectacle correction vs. continued spectacle correction alone.
Design: Multicenter randomized clinical trial.
Participants: One hundred thirty-eight participants aged 7 to 12 years with amblyopia (33-72 letters, i.e., approximately 20/200 to 20/40) resulting from strabismus, anisometropia, or both. Participants were required to have at least 16 weeks of optical treatment in spectacles if needed or demonstrate no improvement in amblyopic-eye visual acuity (VA) for at least 8 weeks prior to enrollment.
Methods: Eligible participants (mean age 9.6 years, mean baseline VA of 59.6 letters, history of prior amblyopia treatment other than spectacles in 96%) were randomly assigned to treatment for 8 weeks with the dichoptic binocular Dig Rush iPad game (prescribed for 1 hour per day 5 days per week) plus spectacle wear if needed (n = 69) or continued spectacle correction alone if needed (n = 69).
Main outcome measures: Change in amblyopic-eye VA from baseline to 4 weeks, assessed by a masked examiner.
Results: At 4 weeks, mean amblyopic-eye VA letter score improved from baseline by 1.3 (2-sided 95% confidence interval [CI]: 0.1-2.6; 0.026 logMAR) with binocular treatment and by 1.7 (2-sided 95% CI: 0.4-3.0; 0.034 logMAR) with continued spectacle correction alone. After adjusment for baseline VA, the letter score difference between groups (binocular minus control) was -0.3 (95% CI: -2.2 to 1.5, P = 0.71, difference of -0.006 logMAR). No difference in letter scores was observed between groups when the analysis was repeated after 8 weeks of treatment (adjusted mean: -0.1, 98.3% CI: -2.4 to 2.1). For the binocular group, adherence data from the iPad indicated that slightly more than half of the participants (58% and 56%) completed >75% of prescribed treatment by the 4- and 8-week visits, respectively.
Conclusions: In children aged 7 to 12 years who have received previous treatment for amblyopia other than spectacles, there was no benefit to VA or stereoacuity from 4 or 8 weeks of treatment with the dichoptic binocular Dig Rush iPad game.
Trial registration: ClinicalTrials.gov NCT02983552.
Conflict of interest statement
Conflict of Interest: No conflicting relationships exist for any of the authors.
Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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Source: PubMed