Does the gamification aspect of an online focal ambient visual acuity stimulation therapeutic game for treating amblyopia in children improve adherence? (Preprint)

Abstract

BACKGROUND The golden standard treatment for amblyopia is patching the better eye. Visual acuity improvement of the amblyopic eye is significantly impacted by adherence of the patching therapy. It is known that the overall adherence is rather low. OBJECTIVE This retrospective study evaluated whether an updated version of attention binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in an improved patient adherence in 4- to 16-year-old patients with amblyopia. METHODS We analyzed pseudonymised electronically recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older (2015) and the other group the newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the amount of minutes using the therapeutic games as monitored in the automatized logbook versus prescribed minutes of using the games. RESULTS Children in Group 2015 (n=138) spent on average 2009.3±1372.1 (36 to 5472) minutes using FAVAS; children in Group 2020 (n=129) spent on average 2695.5±1526.8 (37.5 to 5672) minutes using the improved therapy. Group 2020 spent on average 686.2 more minutes on FAVAS than Group 2015 (t=3.87, P<.001). Although patient adherence was very variable, compared to the 57%±34% in Group 2015, it significantly improved up to 78%±46% in Group 2020 (t=4.3, P<.001). CONCLUSIONS FAVAS 2020 with an improved gamification aspect as well as tablet computer functionality increased adherence significantly compared to the earlier version FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. CLINICALTRIAL DRKS00017633