Leveling Up: Can Video Games Be Used to Treat Amblyopia?

Amblyopia is classically taught as a monocular problem resulting from a disruption in binocularity. Traditional eye patching has long been used for treating this condition, and a plethora of randomized controlled trials have shown that it results in improved vision for over 80% of children.

So why do we need a new approach? Despite its efficacy for some, 40% do not achieve 20/20 visual acuity (VA), and approximately 25% to 40% experience a recurrence following successful patching. Amblyopia occurs when there is habitual ocular suppression that turns a structurally intact binocular system into a functionally monocular system, said Eileen Birch, PhD, speaking during a symposium on Sunday at AAO 2016.

“In other words, amblyopia is a binocular disorder,” said Dr. Birch. “It is not a monocular disorder.” With this in mind, Dr. Birch developed an iPad-based app designed to be used with dichoptic glasses to allow for contrast-rebalanced visual experiences.

Falling blocks. Her first prototype involved a Tetris-type game that 106 amblyopic children were asked to play 4 hours weekly for 1 month. The amblyopic eye was allowed to see high-contrast red blocks, while the fellow eye was fixed on low-contrast green blocks. Despite the fact that only 44% of the children had ≥75% compliance, she found a significant 0.09 logMAR improvement in VA (p < .0001) compared with just 0.03 logMAR improvement in those playing sham games. This improvement was maintained for 12 months.

Gold rush. Despite the success, the low compliance rate pushed Dr. Birch and her team to develop games that were more engaging and more action oriented. She employed the same dichoptic contrast-rebalanced approach, but this time, children had to guide moles through mazes and puzzles to collect gold and return it to their cart through 42 levels of play. Compliance improved to 86%, and VA improved by 0.15 logMAR compared with 0.07 logMAR for those who were randomized to patching. Additionally, patched subjects were allowed to cross over to the game group after 2 weeks, and they managed to catch up to their peers. At 4 weeks, both groups showed approximately 0.2 logMAR of improvement.  

Dr. Birch is now in the process of developing a contrast-rebalanced movie, and she believes that videos and games will be a fun, inexpensive, and effective approach for treating amblyopia in the near future. —Keng Jin Lee

Financial disclosure. Dr. Birch: National Eye Institute: S.

Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.