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Comparing dichoptic action video game play to patching in adults with amblyopia.
Abstract
Adults with amblyopia, a condition characterized by reduced visual acuity (VA) and stereopsis, may benefit from playing action video games with the non-amblyopic eye patched (e.g. Li et al., 2011). However, it is unclear whether these patients can benefit merely from patching of the non-amblyopic eye (i.e. no game), the gold standard for amblyopia treatment in children. We addressed this question by directly contrasting the effects of playing action video games with those of patching. Thirty-two amblyopic adults were assigned to either play 40 hours of a dichoptic action game we developed (‘game group’, n=16; see Bayliss et al., 2013), or watch action movies with the non-amblyopic eye patched (‘patching group’, n=16). Following a two months no-contact period, game group participants crossed over to the patching-plus-movies treatment. VA was assessed at baseline and every 13 hours of game/movies treatment. We found that for the game group, VA improved by 26% on average (26%±3.2; p<.000001), regardless of clinical etiology (anisometropia or strabismus). Surprisingly, anisometropic amblyopes (n=7) in the patching group showed VA improvements comparable to those of the game group (n=7; 32%±4.4; p<.0005), and retained the benefits for at least two months after training. In contrast, strabismic amblyopes in the patching group showed no improvement (.01%±6.8). Game group participants maintained their gains throughout the cross-over period. However, no additional benefits from patching were noted during the cross-over period beyond those gained in the game period, for both anisometropic and strabismic amblyopes. We conclude that a dichoptic action game shows promise as viable treatment for amblyopia, as it improves VA for anisometropic and strabismic adult amblyopes, and the improvements are retained for at least two months following training. Supervised patching, however, is only effective for anisometropic amblyopes.
... Binocular fusion only occurs if the contrast of the image seen by the nonamblyopic eye is reduced sufficiently to address the interocular imbalance resulting from suppression. At first, such strategies involved an active participation of the subjects playing a dichoptic video game where success depended on using information simultaneously presented to each eye [27,28,31,35,38,[42][43][44][45][46]. There is also evidence that video game training in general can aid bilateral amblyopia [47]. ...
... Previously, a similar improvement was shown for an altered reality system in teenagers and adults [25]. One interest of dichoptic movie viewing is its potential to increase compliance in comparison to patching or to other forms of dichoptic training [25,31,35,41,45,69,70]. First of all, because dichoptic movie viewing is passive, it does not require any active participation of the subject, unlike perceptual learning or dichoptic video game play. ...
Dichoptic movie viewing has been shown to significantly improve visual acuity in amblyopia in children. Moreover, short-term occlusion of the amblyopic eye can transiently increase its contribution to binocular fusion in adults. In this study, we first asked whether dichoptic movie viewing could improve the visual function of amblyopic subjects beyond the critical period. Secondly, we tested if this effect could be enhanced by short-term monocular occlusion of the amblyopic eye. 17 subjects presenting stable functional amblyopia participated in this study. 10 subjects followed 6 sessions of 1.5 hour of dichoptic movie viewing (nonpatched group), and 7 subjects, prior to each of these sessions, had to wear an occluding patch over the amblyopic eye for two hours (patched group). Best-corrected visual acuity, monocular contrast sensitivity, interocular balance, and stereoacuity were measured before and after the training. For the nonpatched group, mean amblyopic eye visual acuity significantly improved from 0.54 to 0.46 logMAR (p
... Binocular viewing occurs when the amblyopic eye is the primary eye performing the visual task. [17][18][19] To achieve dichoptic contrast balance, the contrast level of the dominant eye is reduced to negate suppression to a level where the contrast level of the 2 eyes is rebalanced and made equal in pursuit of the given visual task. The potential benefit of dichoptic contrast balancing and binocular therapies is to minimize suppression of the amblyopic eye, thereby improving not only VA but also binocular function. ...
Purpose:
To review the published literature assessing the efficacy of binocular therapy for the treatment of amblyopia compared with standard treatments.
Methods:
Literature searches with no date restrictions and limited to the English language were conducted in January 2018 and updated in April 2019 in the PubMed database and the Cochrane Library database with no restrictions. The search yielded 286 citations, and the full text of 50 articles was reviewed. Twenty articles met the inclusion criteria for this assessment and were assigned a level of evidence rating by the panel methodologist. Six studies were rated level I, 1 study was rated level II, and 13 studies were rated level III because of the impact on the development and popularization of this technology.
Results:
Two of the level I and II studies reviewed described a significant improvement in visual acuity in the binocular group versus standard patching standard treatment (the total number of patients in these 2 studies was 147). However, the 5 studies that failed to show a visual improvement from binocular therapy compared with standard treatments were larger and more rigorously designed (the total number of patients in these 5 studies was 813). Level I and II studies also failed to show a significant improvement over baseline in sensory status, including depth of suppression and stereopsis of those treated with binocular therapy. Several smaller level III case series (total number of patients in these 13 studies was 163) revealed more promising results than the binocular treatments studied in the level I and II studies, especially using treatments that are more engaging and are associated with better compliance.
Conclusions:
There is no level I evidence to support the use of binocular treatment as a substitute for current therapies for amblyopia (including patching and optical treatment). Furthermore, 2 large randomized controlled trials showed inferior performance compared with standard patching treatment. On the basis of this review of the published literature, binocular therapy cannot be recommended as a replacement for standard amblyopia therapy. However, more research is needed to determine the potential benefits of proposed binocular treatments in the future.
... Hess y Thompson describen una serie de tratamientos que permiten la participación del ojo dominante en la terapia (41); es el caso de un tratamiento interactivo binocular (figura 2), también llamado iBit System (42)(43)(44). Otra propuesta es el protocolo de aprendizaje perceptual denominado Push-Pull (45) y un enfoque de juego de acción creado por Noah (46). Estas iniciativas convergen con el propósito de facilitar la recuperación de la función monocular bajo condiciones de visión binocular; sin embargo, no están diseñadas para reducir la supresión, reforzar la fusión y así reestablecer la visión binocular (41). ...
Las bacterias son los patógenos principales relacionados con infecciones que afectan las estruc¬turas del ojo de forma intra- o extraocular; el género Staphylococcus es el grupo más prevalente asociado con este tipo de infección. Para el control de las infecciones oculares se utilizan an¬tibióticos como oxacilina y meticilina, que en muchos casos llevan a la resistencia bacteriana. Además, el alto costo de los medicamentos, que en Colombia alcanzan cifras tres o cuatro veces mayores que en otros países, se constituyen en desventajas para su uso. Lo anterior ha llevado a estudiar la actividad antimicrobiana de las plantas frente a los microorganismos asociados a las infecciones oculares bacterianas. El propósito de este artículo de revisión es conocer los beneficios potenciales de las plantas o sus productos para el control de estas infecciones como una alternativa para su tratamiento.
There is growing evidence that abnormal binocular interactions play a key role in amblyopia. In particular, stronger suppression of the amblyopic eye has been associated with poorer amblyopic eye visual acuity and a new therapy has been described that directly targets binocular function and has been found to improve both monocular and binocular vision in adults and children with amblyopia. Furthermore, non-invasive brain stimulation techniques that alter excitation and inhibition within the visual cortex have been shown to improve vision in the amblyopic eye. The aim of this review is to summarize this previous work and interpret the therapeutic effects of binocular therapy and non-invasive brain stimulation in the context of three potential neural mechanisms; active inhibition of signals from the amblyopic eye, attenuation of information from the amblyopic eye and metaplasticity of synaptic long term potentiation and long term depression.
Copyright © 2015. Published by Elsevier Ltd.
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