What if children with lazy eye, or amblyopia, could improve their vision while watching their favorite TV shows? A new treatment called binocular digital therapy may offer a fun alternative to traditional therapies for a common form of childhood vision loss.
Several companies have tested virtual reality-style treatments for lazy eye in clinical trials. Luminopia One is the first to receive FDA-approval for prescription use. It’s expected to come on the market in 2022.
Here’s what we know about binocular digital therapy so far, and what we still need to learn.
Why Eye Patching and Atropine Drops Aren't Enough
Amblyopia results from abnormal visual development during childhood. It can cause permanent vision loss if left untreated. For decades, patching and/or blurring (atropine) drops have been the go-to remedies for lazy eye. These treatments are often prescribed alongside corrective glasses. They work by limiting use of the stronger eye, forcing children to use and strengthen their weaker eye.
But it's difficult to convince young children to wear a patch for the required amount of time — typically several hours per day. Some patients find the patches stigmatizing and uncomfortable. As a result, some ophthalmologists say fewer than 50% of children comply with the therapy. Family education and strong support from care teams may help boost adherence closer to 90%.
Atropine drops are an alternative treatment for amblyopia, but not without their own issues. Rare side effects such as flushing, dry mouth and rapid heartbeat are possible, which may limit use in some children.
Despite these proven treatment options, children are sometimes left with a significant remaining vision impairment even after completing treatment. Technology-based treatments may offer a solution that's more palatable to both children and parents.
Binocular Digital Therapy for Lazy Eye
While monocular therapies like patching limit the child’s ability to use their preferred eye, binocular treatment encourages use of the weaker eye while also prodding patients’ brains to combine input from both eyes.
Luminopia provides patients with a VR headset that adds therapeutic modifications to streaming content. Kids use the headset for one hour a day, six days a week. For each treatment, they can choose from 700+ hours of content from popular providers such as Dreamworks, Sesame Street and Nickelodeon. The headset presents a blurrier picture to the stronger eye and a clearer picture to the weaker eye. Additionally, the therapy makes certain parts of the video invisible to each eye alone, encouraging the use of both eyes together.
“Think of it like a puzzle where the entire picture is not visible without use of the input from both eyes. Each eye has pieces of the puzzle that the brain puts together,” said Aaron Miller, MD, a pediatric ophthalmologist at Houston Eye Associates.
Is VR Good for Lazy Eye?
A small clinical trial of children aged 4 and older found that those treated with both Luminopia and corrective glasses for 12 weeks gained more improvements in vision than children who only wore corrective glasses. Almost 90% of the children continued using Luminopia throughout the study, suggesting they enjoyed it enough to stick with it.
But it's not clear whether the virtual reality treatment is any better than eye patching or atropine drops. Studies haven't looked into that, though they have compared patching with other tech-based therapies such as binocular video games.
Who Can Use Luminopia?
Amblyopia is usually caused by one of three things: an uncorrected refractive error, strabismus (eye misalignment) or an obstruction in the visual field (caused by a cataract, for example).
Binocular digital therapy is best equipped to address the first issue: uncorrected refractive error. It can also be used to treat some people with strabismus, depending on the severity. But it won't help correct obstructions to the visual field.
So far, the therapy has only been used successfully in children ages 4 to 7. Patients who have been previously treated with other methods can still benefit from using the device.
Luminopia's Cost and Availability
Luminopia has not announced pricing yet, but ophthalmologists expect the treatment to be two to five times more expensive than patching. Patching costs $30 to $50 per month. Insurers are not likely to cover digital binocular therapy until more evidence supports its use. Ophthalmologists may be less willing to prescribe a treatment that leaves parents without the need or ability to pay for it.
“Existing treatments for amblyopia are very effective when compliance is high, but the problem is that it often isn’t," Dr. Miller says. "The real potential of technology-based binocular treatment is to improve compliance by offering a solution that kids aren’t destined to hate. Whether these therapies succeed in clinical practice ultimately will depend a lot on their cost and accessibility."