Virtual Reality Game Playing in Amblyopia Therapy: A Randomized Clinical Trial

Rajavi, Zhale; Soltani, Ariana; Vakili, Amirmohammad; Sabbaghi, Hamideh; Behradfar, Narges; Kheiri, Bahareh; Reza, Mohammad

doi:10.3928/01913913-20210108-02

Cited by 20 publications

(14 citation statements)

References 17 publications

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“… 46 , 47 , 56 , 58 , 71 As reported by Waddingham et al, 84 Cleary et al, 86 Herbison et al, 87 Herbison et al, 88 Vedamurthy et al, 45 Hurd et al, 53 Halička et al, 55 Jhangian et al, 58 Tan et al, 60 and Xiao et al, 89 VA outcomes have shown comparable improvements through training using VR applications. Likewise, Rajavi et al, 49 Žiak et al, 16 Elhusseiny et al, 69 and Rajavi et al 50 have also made VA improvements, which reflected a promising application value for further research on this topic. Research regarding VR and observed changes in accommodative status and ocular structures have been reported by Turnbull & Phillips, 82 Elias et al, 13 Munsamy et al, 66 Yoon et al, 67 and Panfili et al 65 According to Turnbull & Phillips, 82 after a brief duration of VR usage, there was a considerable change in choroidal thickness.…”

Section: Resultsmentioning

confidence: 97%

Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality

et al. 2023

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Background Virtual reality is a relatively new intervention that has the potential to be used in the treatment of eye and vision problems. This article reviews the use of virtual reality-related interventions in amblyopia, strabismus, and myopia research. Methods Sources covered in the review included 48 peer-reviewed research published between January 2000 and January 2023 from five electronic databases (ACM Digital Library, IEEE Xplore, PubMed, ScienceDirect and Web of Science). To prevent any missing relevant articles, the keywords, and terms used in the search included “VR”, “virtual reality”, “amblyopia”, “strabismus,” and “myopia”. Quality assessment and data extraction were performed independently by two authors to form a narrative synthesis to summarize findings from the included research. Results Total number of 48 references were reviewed. There were 31 studies published on amblyopia, 18 on strabismus, and 6 on myopia, with 7 studies overlapping amblyopia and strabismus. In terms of technology, smartphone-based virtual reality headset viewers were utilized more often in amblyopia research, but commercial standalone virtual reality headsets were used more frequently in myopia and strabismus-related research. The software and virtual environment were mostly developed based on vision therapy and dichoptic training paradigms. Conclusion It has been suggested that virtual reality technology offers a potentially effective tool for amblyopia, strabismus, and myopia studies. Nonetheless, a variety of factors, especially the virtual environment and systems employed in the data presented, must be explored before determining whether virtual reality can be effectively applied in clinical settings. This review is significant as the technology in virtual reality software and application design features have been investigated and considered for future reference.

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Section: Resultsmentioning

confidence: 97%

Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality

et al. 2023

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“…This is the first study to measure and compare the efficacy and efficiency of supervised outpatient dichoptic action video gaming using VR goggles to objectively monitored occlusion therapy in 4–12‐year‐old children with newly diagnosed amblyopia. While several published studies (Barollo et al, 2017; Gambacorta et al, 2018; Gao et al, 2018; Herbison et al, 2016; Holmes et al, 2016; Huang et al, 2022; Li et al, 2015b; Manh et al, 2018; Mezad‐Koursh et al, 2018; Portela‐Camino et al, 2018; Rajavi et al, 2021) included subjects with a history of occlusion for amblyopia, it is unclear whether previous treatment could be a hindrance or an aid to acuity improvements subsequently gained through dichoptic therapy. Although we started with 96 recruited children, only 33 could be randomized: after 16 weeks of glasses adaptation, a third of the originally recruited children no longer had an interocular VA difference ≥0.20 logMAR and no longer qualified as amblyopic.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies comparing gaming with occlusion therapy in children have not monitored compliance electronically (Holmes et al, 2016; Jost et al, 2022; Kelly et al, 2016; Manh et al, 2018; Rajavi et al, 2021). Some studies have investigated only the effectiveness of gaming or dichoptic movie watching and did not compare with occlusion therapy (Barollo et al, 2017; Birch et al, 2015; Bossi et al, 2017; Gambacorta et al, 2018; Gao et al, 2018; Herbison et al, 2016; Huang et al, 2022; Kelly et al, 2018; Li et al, 2015a; Mansouri et al, 2014; Mezad‐Koursh et al, 2018; Portela‐Camino et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Other studies compared a combination of treatments, making it difficult to identify the contribution of gaming therapy (Birch et al, 2020; Dadeya & Dangda, 2016; Rajavi et al, 2016; Singh et al, 2017) (Hsieh et al, 2022; Pediatric Eye Disease Investigator G et al, 2019; Xiao et al, 2022). Furthermore, many of these studies included children who were previously occluded, whereby treatment was either incomplete or ineffective (Barollo et al, 2017; Gambacorta et al, 2018; Gao et al, 2018; Herbison et al, 2016; Holmes et al, 2016; Huang et al, 2022; Li et al, 2015a; Manh et al, 2018; Mansouri et al, 2014; Mezad‐Koursh et al, 2018; Portela‐Camino et al, 2018; Rajavi et al, 2021). It is unclear whether previous occlusion therapy acts as a barrier to improvements from subsequent dichoptic gaming therapy or actually makes it more likely to be successful.…”

Section: Introductionmentioning

confidence: 99%

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Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency

Kadhum

Tan

Fronius

et al. 2023

Acta Ophthalmologica

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PurposeTo compare the effectiveness and efficiency of supervised dichoptic action‐videogame play to occlusion therapy in children with amblyopia.MethodsNewly diagnosed children with amblyopia aged 4–12 years were recruited, excluding strabismus >30PD. After 16 weeks of refractive adaptation children were randomized to gaming 1 h/week supervised by the researcher, or electronically monitored occlusion 2 h/day. The gaming group played a dichoptic action‐videogame using virtual reality goggles, which included the task of catching a snowflake presented intermittently to the amblyopic eye. Contrast for the fellow eye was self‐adjusted until 2 identical images were perceived. The primary outcome was visual acuity (VA) change from baseline to 24 weeks.ResultsWe recruited 96 children, 29 declined and 2 were excluded for language or legal issues. After refractive adaptation, 24 of the remaining 65 no longer met the inclusion criteria for amblyopia, and 8 dropped out. Of 16 children treated with gaming, 7 (6.7 years) completed treatment, whereas 9 younger children (5.3 years) did not. Of 17 treated with occlusion, 14 (5.1 years) completed treatment and 3 (4.5 years) did not. Of 5 children with small‐angle strabismus, 3 treated with occlusion completed treatment and 2 treated with gaming did not. Median VA improved by 0.30 logMAR (IQR 0.20–0.40) after gaming, 0.20 logMAR (0.00–0.30) after occlusion (p = 0.823). Treatment efficiency was 1.25 logMAR/100 h (range 0.42–2.08) with gaming, 0.08 (−0.19–0.68) with occlusion (p < 0.001).ConclusionDichoptic gaming seems a viable alternative for older children with refractive amblyopia after glasses adaptation. Treatment efficiency with gaming under continuous supervision was 15 times higher than with occlusion at home.

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“…According to this evidence, VR dichoptic and PL treatment appears to be a powerful tool for visual function restoration in these diseases. However, little evidence is available on whether dichoptic VR treatment could improve visual acuity in patients with amblyopia [23].…”

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confidence: 99%

Asynchronous Dichoptic Visual Perceptual Training for Patients with Primary Open-Angle Glaucoma: A Pilot Study

Huang

Zhang

et al. 2023

Preprint

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Purpose We aimed to observe changes in the visual function of patients with primary open-angle glaucoma (POAG) after undergoing binocular asynchronous visual training. Methods Seven patients with POAG with binocular visual field defects underwent binocular asynchronous dichoptic virtual reality (VR)-based visual perceptual training for 20 days (45 min/session/day, 5 sessions/week, for 4 weeks). Perimetry, contrast sensitivity (CS), and vision-related quality of life assessments were performed for all patients. Results Six months after completing training, nine of 14 eyes showed better performance in the perimetry (the mean deviation [MD] of perimetry was improved as compared to baseline), including six severe eyes and three mild POAG eyes. Moreover, the MD values of four of the nine eyes showed significant improvement (more than 1-dB increase as compared to baseline), including three severe eyes and one mild POAG eye. However, the MD values did not differ significantly between baseline and post-training. Contrast sensitivity tests, performed at three spatial frequencies (3, 6, and 18 cycles/degree) were significantly enhanced after asynchronous dichoptic training (p = 0.021, 0.026, and 0.020, respectively). Conclusion Patients with POAG, particularly those with severe POAG, performed significantly better in perimetry after training. All patients showed significantly improved performance on the CS tests. Improvements in visual function were sustained for at least 6 months. These results suggest that visual rehabilitation in patients with POAG can be achieved through asynchronous VR-based dichoptic visual perceptual training. A larger randomized clinical trial is required to confirm these effects. Trial registration: The trial registration number is #ChiCTR2100054625.

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Virtual Reality Game Playing in Amblyopia Therapy: A Randomized Clinical Trial

Cited by 20 publications

References 17 publications

Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality

Design and assessment of amblyopia, strabismus, and myopia treatment and vision training using virtual reality

Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency

Asynchronous Dichoptic Visual Perceptual Training for Patients with Primary Open-Angle Glaucoma: A Pilot Study

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