• Binocular iPad Game vs. Part-Time Patching for Amblyopia in Children

    By Lynda Seminara and selected by Neil M. Bressler, MD

    Journal Highlights

    JAMA Ophthalmology, December 2016

    Download PDF


    There is a need for more effective, child-friendly options to treat amblyopia. Traditional therapies are disliked by patients and are associated with inade­quate adherence. Holmes et al. com­pared visual acuity results for children treated with either part-time patching or a binocular iPad game and found that binocular treatment was less effec­tive than patching.

    This multicenter randomized non­inferiority trial included 385 children (aged 5-12 years) whose amblyopia re­sulted from strabismus, anisometropia, or both. Patients in the binocular group (n = 190) were instructed to play the iPad game for 1 hour a day; those in the patching group (n = 195) were to wear a patch over their unaffected eye for 2 hours daily. Follow-up visits occurred at 4-week intervals through week 16.

    By 16 weeks, the mean visual acuity of the amblyopic eye had improved 1.05 lines (2-sided 95% CI, 0.85-1.24 lines) in the binocular group and 1.35 lines in the patching group (2-sided 95% CI, 1.17-1.54 lines), with an adjusted treatment group difference of 0.31 lines favoring patching (upper lim­it of 1-sided 95% CI, 0.53 lines). This upper limit exceeded the prespecified noninferiority limit of 0.5 lines.

    Only 39 (22%) of the 176 partici­pants in the binocular group with log file data available performed more than 75% of their assigned treatment (median, 46%). Many lost interest in the game after several days or weeks. Among younger participants (from age 5 to 7 years) with no previous ambly­opia treatment, visual acuity of the amblyopic eye improved by a mean of 2.5 lines in the binocular group and 2.8 lines in the patching group.

    Although the primary noninferi­ority analysis was indeterminate, a post hoc analysis indicated that the improvement in visual acuity attained with this particular binocular game was not as good as that achieved by patching. In conclusion, the low rate of adherence to binocular treatment suggests that greater emphasis be given to adherence and to developing binoc­ular apps that are more appealing to children, such as movies and first-person action games.

    The original article can be found here.