Assessing Suppression in Amblyopic Children With a Dichoptic Eye Chart

Birch, Eileen E.; Morale, Sarah E.; Jost, Reed M.; Cruz, Angie De La; Kelly, Krista R.; Wang, Yizhong; Bex, Peter J.

doi:10.1167/iovs.16-19986

Cited by 53 publications

(91 citation statements)

References 43 publications

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“…28,30–32 Small sample sizes or children’s difficulty with the psychophysical taskusedto measure suppression may underlie a lack of suppression changes in children with amblyopia in previous binocular treatment studies. 16,18,19 However, our data are consistent with reduced suppression in amblyopic adults after binocular game treatment.…”

Section: Discussionmentioning

confidence: 99%

“…16,18,19 However, our data are consistent with reduced suppression in amblyopic adults after binocular game treatment. 33,34 There has been a focus on interocular suppression in the etiology of amblyopia, 1,14,28 and alleviating suppression with binocular treatment may be the key to amblyopia treatment. We found no improvement in stereoacuity or in extent of the suppression scotoma (Worth 4-dot test) herein.…”

Section: Discussionmentioning

confidence: 99%

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Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Kelly

Jost

Dao³

et al. 2016

JAMA Ophthalmol

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174

209

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IMPORTANCE Fellow eye patching has long been the standard treatment for amblyopia, but it does not always restore 20/20 vision or teach the eyes to work together. Amblyopia can be treated with binocular games that rebalance contrast between the eyes so that a child may overcome suppression. However, it is unclear whether binocular treatment is comparable to patching in treating amblyopia.OBJECTIVES To assess the effectiveness of a binocular iPad (Apple Inc) adventure game as amblyopia treatment and compare this binocular treatment with patching, the current standard of care. DESIGN, SETTING, AND PARTICIPANTSThis investigation was a randomized clinical trial with a crossover design at a nonprofit eye research institute. Between February 20, 2015, and January 4, 2016, a total of 28 patients were enrolled in the study, with 14 randomized to binocular game treatment and 14 to patching treatment.INTERVENTIONS Binocular game and patching as amblyopia treatments. MAIN OUTCOMES AND MEASURESThe primary outcome was change in amblyopic eye best-corrected visual acuity (BCVA) at the 2-week visit. Secondary outcomes were change in stereoacuity and suppression at the 2-week visit and change in BCVA at the 4-week visit. RESULTS Among 28 children, the mean (SD) age at baseline was 6.7 (1.4) years (age range, 4.6-9.5 years), and 7 (25%) were female. At baseline, the mean (SD) amblyopic eye BCVA was 0.48 (0.14) logMAR (approximately 20/63; range, 0.3-0.8 logMAR [20/40 to 20/125]), with 14 children randomized to the binocular game and 14 to patching for 2 weeks. At the 2-week visit, improvement in amblyopic eye BCVA was greater with the binocular game compared with patching, with a mean (SD) improvement of 0.15 (0.08) logMAR (mean [SD], 1.5 [0.8] lines) vs 0.07 (0.08) logMAR (mean [SD], 0.7 [0.8] line; P = .02) after 2 weeks of treatment. These improvements from baseline were significant for the binocular game (mean [SD] improvement, 1.5 [0.8] lines; P < .001) and for patching (mean [SD] improvement, 0.7 [0.8] line; P = .006). Depth of suppression improved from baseline at the 2-week visit for the binocular game (mean [SD], 4.82 [2.82] vs 3.24 [2.87]; P = .03) and for patching (mean [SD], 4.77 [3.10] vs 2.57 [1.67]; P = .004). Patching children crossed over to binocular game treatment, and all 28 children played the game for another 2 weeks. At the 4-week visit, no group difference was found in BCVA change, with children who crossed over to the binocular games catching up with children treated with binocular games, for a mean (SD) improvement of 0.17 (0.10) logMAR (mean [SD], 1.7 [1.0] lines) for the binocular game vs a mean (SD) improvement of 0.16 (0.12) logMAR (mean [SD], 1.6 [1.2] lines) for the patching crossover (P = .73). CONCLUSIONS AND RELEVANCEA binocular iPad game was effective in treating childhood amblyopia and was more efficacious than patching at the 2-week visit. Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.TRIAL REGISTRATION clinicaltrials....

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Kelly

Jost

Dao³

et al. 2016

JAMA Ophthalmol

Self Cite

174

209

View full text Add to dashboard Cite

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“…20 The increase in saccades during reading in our study may be due to a suppression scotoma associated with anisometropic amblyopia. 21 Central scotomas have been shown to reduce the visual span, and they may cause inaccurate, more frequent saccades during reading. 22 …”

Section: Discussionmentioning

confidence: 99%

Slow reading in children with anisometropic amblyopia is associated with fixation instability and increased saccades

Kelly

Jost

Cruz

et al. 2017

Journal of American Association for Pediatric Ophthalmology and

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Background Previous studies show slow reading in strabismic amblyopia. We recently identified amblyopia, not strabismus, as the key factor in slow reading in children. No studies have focused on reading in amblyopic children without strabismus. We examined reading in anisometropic children and evaluated whether slow reading was associated with ocular motor dysfunction in children with amblyopia. Methods Anisometropic children (7–12 years) with or without amblyopia were compared to age-similar normal controls. Children silently read a grade-appropriate paragraph during binocular viewing. Reading rate (words/min), number of forward and regressive saccades (per 100 words) and fixation duration were recorded with the ReadAlyzer. Binocular fixation instability was also evaluated (EyeLink 1000). Results Amblyopic anisometropic children read more slowly (n = 25; mean with standard deviation, 149 ± 42 words/min) than nonamblyopic anisometropic children (n = 15; 196 ± 80 words/min; P = 0.024) and controls (n = 25; 191 ± 65 words/min; P = 0.020). Nonamblyopic anisometropic children read at a comparable rate to controls (P = 0.81). Slow reading in amblyopic anisometropic children was correlated with increased forward saccades (r = −0.84, P < 0.001), increased regressive saccades (r = −0.85, P < 0.001), and fellow eye instability during binocular viewing (r = −0.52, P = 0.019). Conclusions Slow reading in school-age children with anisometropic amblyopia is related to increased frequency of saccades and fixation instability of the fellow eye. Further research should consider the effects of slower reading on academic performance.

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“…Contrast balance index (CBI) provides a quantitative measure of depth of suppression. The test determines the contrast ratio between dichoptically presented letters at which the likelihood that the observer will correctly report the left or right eye letter is equal . Sloan letters chosen from the EDTRS letter set were presented on a dichoptic display (five letters per line) equivalent to 1.2 logMAR at 90 cm viewing distance.…”

Section: Methodsmentioning

confidence: 99%

From suppression to stereoacuity: a composite binocular function score for clinical research

Webber

Wood

Thompson

et al. 2019

Ophthalmic Physiologic Optic

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Purpose: This study aimed to validate a binocular function score that is based on common clinical measures of visual function, providing a more complete analysis of binocular outcomes, against laboratory-based dichoptic tests of threshold stereoacuity and depth of suppression. Methods: Scores on a composite binocular function (BF) score derived from clinical stereoacuity measures (Randot Preschool Stereoacuity Test and Randot Butterfly) and the Worth 4 Dot test were determined in adults (n = 20; age 24.8 ± 7.2 years) and children (N = 77; age 8.3 ± 1.7 years) with abnormal binocular vision from strabismus or amblyopia. Adults had threshold stereoacuity measured with a novel, computerised dichoptic psychophysical test of stereopsis. Depth of suppression (dichoptic eye chart inter-ocular contrast balance test) was determined in both adults and children. Results: Clinical Randot stereoacuity was measurable in 50% of adult and 61% of child participants. Threshold stereoacuity was measurable in 65% of the adult participants. The presence of suppression or simultaneous perception (flat fusion or diplopia) was measurable in all participants, enabling assignment of a BF score to all participants in both groups. In adults, the BF score was highly correlated with the psychophysical threshold stereoacuity measure (ρ = 0.71; p < 0.001). In both adults and children, there was also a high correlation between the BF score and inter-ocular contrast balance (adult ρ = 0.90; child ρ = 0.86; p < 0.001). Conclusions: The composite BF score is a convenient and valid scale of binocularity that can be used to extend the stereoacuity measure in cohorts where nil stereoacuity is common and thus could be considered as an outcome measure in clinical trials.

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Assessing Suppression in Amblyopic Children With a Dichoptic Eye Chart

Cited by 53 publications

References 43 publications

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

Slow reading in children with anisometropic amblyopia is associated with fixation instability and increased saccades

From suppression to stereoacuity: a composite binocular function score for clinical research

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