Dichoptic movie viewing treats childhood amblyopia

Abstract

Background Contrast-balanced dichoptic experience with perceptual-learning tasks or simple games has been shown to improve visual acuity significantly in amblyopia. However, these tasks are intensive and repetitive, and up to 40% of unsupervised patients are noncompliant. We investigated the efficacy of a potentially more engaging movie method to provide contrast-balanced binocular experience via complementary dichoptic stimulation. Methods Eight amblyopic children 4–10 years of age were enrolled in a prospective cohort study to watch 3 dichoptic movies per week for 2 weeks on a passive 3D display. Dichoptic versions of 18 popular animated feature films were created. A patterned image mask of irregularly shaped blobs was multiplied with the movie images seen by the amblyopic eye and an inverse mask was multiplied with the images seen by the fellow eye. Fellow-eye contrast was initially set at a reduced level that allowed binocular vision and was then incremented by 10% at each visit. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and 2 weeks. Results Mean amblyopic eye visual acuity (with standard error of the mean) improved from a logarithm of minimum angle of resolution of 0.72 ± 0.08 at baseline to 0.52 ± 0.09 (P = 0.003); that is, 2.0 lines of improvement at the 2-week outcome visit. No significant change in interocular suppression or stereoacuity was found. Conclusions Passive viewing of dichoptic feature films is feasible and could be a promising new treatment for childhood amblyopia. The maximum improvement that may be achieved by watching dichoptic movies remains to be determined. No known side effects are associated with this new treatment.

Binocular iPad Game vs Patching for Treatment of Amblyopia in Children

“…15−17 The magnitude of improvement was more similar to the 2 lines found with dichoptic movie treatment, 19 suggesting that a larger improvement may be owing to better compliance with our adventure game. Indeed, 85% (23 of 27) of children played at least 75% of prescribed treatment compared with 44% (20 of 45) in the Tetris game study.…”

Effect of a Binocular iPad Game vs Part-time Patching in Children Aged 5 to 12 Years With Amblyopia

“…Only 22% of our children achieved greater than 75% compliance, suggesting that compliance should be reviewed more frequently and games need to be more appealing such as more engrossing children’s games, binocular first person action games, 18 and binocular movie viewing. 19 …”

Assessing Suppression in Amblyopic Children With a Dichoptic Eye Chart

“…Most of the children in the present study who showed visual acuity improvement with treatment were participants in an ongoing study of a binocular amblyopia treatment based on the protocol originally described by Hess et al 2,13,15,33,41 Previous reports of amblyopic adults who participated in similar binocular treatment protocols reported correlated improvements in contrast ratio balance and amblyopic eye visual acuity. 2,12,33,38,42–45 However, prior studies of amblyopic children who participated in binocular treatment have consistently failed to show improvement in contrast ratio balance despite improvements in visual acuity. 13,14,16,46 These earlier studies in amblyopic children relied on the dichoptic global motion coherence task to quantify severity of suppression.…”