Binocular Therapy for Childhood Amblyopia Improves Vision Without Breaking Interocular Suppression

Bossi, Manuela; Tailor, Vijay; Anderson, Elaine J.; Bex, Peter J.; Greenwood, John A.; Dahlmann‐Noor, Annegret; Dakin, Steven C.

doi:10.1167/iovs.16-20913

Cited by 78 publications

(94 citation statements)

References 81 publications

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“…Classical patching therapy might be counterproductive for the development of coordinated vergence eye movements because it forces the two eyes to work independently and does not favor the correct development of binocular oculomotor control. Dichoptic therapies that attempt to balance the input to the two eyes and favor conjugate eye movements might be better suited to ensure binocular cooperation [36,93,44,52,89,90,56,9]. Here, we have shown that the link between the oculomotor and hand motor system is unaffected by simulated visual impairment.…”

Section: Clinical Significance Of Our Findingsmentioning

confidence: 72%

Three-Dimensional Binocular Eye-Hand Coordination in Normal Vision and with Simulated Visual Impairment

Maiello

Kwon

Bex

2017

Preprint

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Sensorimotor coupling in healthy humans is demonstrated by the higher accuracy of visually tracking intrinsically-rather than extrinsicallygenerated hand movements in the fronto-parallel plane. It is unknown whether this coupling also facilitates vergence eye movements for tracking objects in depth, or can overcome symmetric or asymmetric binocular visual impairments. Human observers were therefore asked to track with their gaze a target moving horizontally or in depth. The movement of the target was either directly controlled by the observer's hand or followed hand movements executed by the observer in a previous trial. Visual impairments were simulated by blurring stimuli independently in each eye. Accuracy was higher for self-generated movements in all conditions, demonstrating that motor signals are employed by the oculomotor system to improve the accuracy of vergence as well as horizontal eye movements. Asymmetric monocular blur affected horizontal tracking less than symmetric binocular blur, but impaired tracking in depth

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Section: Clinical Significance Of Our Findingsmentioning

confidence: 72%

Three-Dimensional Binocular Eye-Hand Coordination in Normal Vision and with Simulated Visual Impairment

Maiello

Kwon

Bex

2017

Preprint

Self Cite

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“…In the level III study by Vedamurthy et al 16 that used a combination of perceptual learning and dichoptic therapy, stereoacuity improved by a mean of 0.18 log arc seconds (SD, 0.05 log arc seconds) in the active game group and 0.08 log arc seconds (SD, 0.04 log arc seconds) for the monocular movie-viewing group (P < 0.005). In the 2017 level III study of BBV reported by Bossi et al, 33 the number of children with measurable stereoacuity increased from 1 of 7 of the anisometropic amblyopes pretreatment to 6 of 7 posttreatment. In these 7 subjects, the median stereoacuity improved from 170 arc seconds (interquartile 230 arc seconds) to 85 arc seconds (interquartile 30 arc seconds) (P ¼ 0.0215).…”

Section: Binocularity and Sensory Outcomes Such As Stereopsismentioning

confidence: 91%

“…Bossi et al 33 reported another form of dichoptic therapy in 2017 that they described as balanced binocular viewing (BBV) treatment. This therapy uses a computer and shutter glasses to present dichoptic movies that are matched in visibility across the eyes.…”

Section: Amblyopic Eye Visual Acuitymentioning

confidence: 99%

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Binocular Treatment of Amblyopia

Pineles¹,

Aakalu

Hutchinson

et al. 2020

Ophthalmology

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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. Ophthalmology 2020;127:261-272 ª 2019 by the American Academy of OphthalmologyThe American Academy of Ophthalmology prepares Ophthalmic Technology Assessments to evaluate new and existing procedures, drugs, and diagnostic and screening tests. The goal of an Ophthalmic Technology Assessment is to systematically review the available research for clinical efficacy, effectiveness, and safety. After review by members of the Ophthalmic Technology Assessment Committee, other assessments by Academy committees, relevant subspecialty societies, and legal counsel are submitted to the Academy's Board of Trustees for consideration as official Academy statements. The purpose of this assessment by the Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel was to review the publis...

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“…The clinical relevance of the dominant eye is now well-accepted, as several studies have since verified the existence of physiological, sensory and motor bases for ocular dominance in patients with normal binocularity and equal refractive errors [10][11][12][13][14][15][16][17][18]. For example, Hofeldt concluded that placing a moderate neutral density filter over the dominant eye diminished motion task performance more than placing the filter over the non-dominant or both eyes [12].…”

Section: Introductionmentioning

confidence: 99%

The Dominant Eye: Dominant for Parvo- But Not for Magno-Biased Stimuli?

Foutch

Bassi

2020

Vision

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Eye dominance is often defined as a preference for the visual input of one eye to the other. Implicit in this definition is the dominant eye has better visual function. Several studies have investigated the effect of visual direction or defocus on ocular dominance, but there is less evidence connecting ocular dominance and monocular visual thresholds. We used the classic “hole in card” method to determine the dominant eye for 28 adult observers (11 males and 17 females). We then compared contrast thresholds between the dominant and non-dominant eyes using grating stimuli biased to be processed more strongly either by the magnocellular (MC) or parvocellular (PC) pathway. Using non-parametric mean rank tests, the dominant eye was more sensitive overall than the non-dominant eye to both stimuli (z = −2.54, p = 0.01). The dominant eye was also more sensitive to the PC-biased stimulus (z = −2.22, p = 0.03) but not the MC-biased stimulus (z = −1.16, p = 0.25). We discuss the clinical relevance of these results as well as the implications for parallel visual pathways.

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Binocular Therapy for Childhood Amblyopia Improves Vision Without Breaking Interocular Suppression

Abstract: BBV is a binocular treatment for amblyopia that can be self-administered at home (with remote monitoring), producing rapid and substantial benefits that cannot be solely mediated by a reduction in interocular suppression.

Cited by 78 publications

References 81 publications

Three-Dimensional Binocular Eye-Hand Coordination in Normal Vision and with Simulated Visual Impairment

Three-Dimensional Binocular Eye-Hand Coordination in Normal Vision and with Simulated Visual Impairment

Binocular Treatment of Amblyopia

The Dominant Eye: Dominant for Parvo- But Not for Magno-Biased Stimuli?

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