Falling blocks video game ineffective for unilateral amblyopia

JAN 22, 2018

Pediatric Ophth/Strabismus

This study explored whether a home-based binocular video game is an effective strategy for improving visual acuity in older children and adults with unilateral amblyopia.

Study design

Researchers enrolled 115 children and adults, ranging in age from 7 to 55 years, in a multicenter, double-masked, randomized clinical trial. All participants had unilateral amblyopia (anisometropic or strabismic) with visual acuity between 20/40 and 20/200. The intervention consisted of a falling-blocks video games, which participants played at home on an iPod Touch for 1 hour per day for 6 weeks.

The treatment group worse special glasses that enabled a dichoptic contrast offset: The amblyopic eye saw a subset of game elements at 100% contrast, and the fellow eye saw the remaining game elements at a lower contrast. The placebo video game presented identical images to both eyes. Visual acuity was rechecked in 6 weeks.

Outcomes

The active video game did not improve visual outcomes more than the placebo, although the intervention group reported an increase in fellow eye contrast during game play.

Limitations

Mean compliance in the active group appeared worse than the placebo group partly due to the greater number of withdrawals in the active group during the 6-week treatment period. Some participants reported a declining interest in the falling-blocks video game during follow-up. More engaging content, along with greater game play variety, might help to maintain compliance and attentional engagement over longer treatment periods. The iPod-based Dichoptic Global Motion Test used in this trial was prone to image misalignment and the task was difficult for younger children.

Clinical significance

The specific binocular falling-blocks video game tested in this clinical trial did not produce greater visual improvements than placebo in this population of older, mostly treated patients with amblyopia. More engaging video games could improve attention and compliance before binocular treatments are rendered effective for amblyopia.

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