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A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years.

Publication ,  Journal Article
Manny, RE; Holmes, JM; Kraker, RT; Li, Z; Waters, AL; Kelly, KR; Kong, L; Crouch, ER; Lorenzana, IJ; Alkharashi, MS; Galvin, JA; Rice, ML ...
Published in: Optom Vis Sci
March 1, 2022

SIGNIFICANCE: Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. PURPOSE: This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. METHODS: Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. RESULTS: A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. CONCLUSIONS: In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.

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Published In

Optom Vis Sci

DOI

EISSN

1538-9235

Publication Date

March 1, 2022

Volume

99

Issue

3

Start / End Page

213 / 227

Location

United States

Related Subject Headings

  • Vision, Binocular
  • Treatment Outcome
  • Sensory Deprivation
  • Ophthalmology & Optometry
  • Humans
  • Follow-Up Studies
  • Eyeglasses
  • Child, Preschool
  • Child
  • Amblyopia
 

Citation

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Manny, R. E., Holmes, J. M., Kraker, R. T., Li, Z., Waters, A. L., Kelly, K. R., … Pediatric Eye Disease Investigator Group, . (2022). A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years. Optom Vis Sci, 99(3), 213–227. https://doi.org/10.1097/OPX.0000000000001867
Manny, Ruth E., Jonathan M. Holmes, Raymond T. Kraker, Zhuokai Li, Amy L. Waters, Krista R. Kelly, Lingkun Kong, et al. “A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years.Optom Vis Sci 99, no. 3 (March 1, 2022): 213–27. https://doi.org/10.1097/OPX.0000000000001867.
Manny RE, Holmes JM, Kraker RT, Li Z, Waters AL, Kelly KR, et al. A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years. Optom Vis Sci. 2022 Mar 1;99(3):213–27.
Manny, Ruth E., et al. “A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years.Optom Vis Sci, vol. 99, no. 3, Mar. 2022, pp. 213–27. Pubmed, doi:10.1097/OPX.0000000000001867.
Manny RE, Holmes JM, Kraker RT, Li Z, Waters AL, Kelly KR, Kong L, Crouch ER, Lorenzana IJ, Alkharashi MS, Galvin JA, Rice ML, Melia BM, Cotter SA, Pediatric Eye Disease Investigator Group. A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years. Optom Vis Sci. 2022 Mar 1;99(3):213–227.

Published In

Optom Vis Sci

DOI

EISSN

1538-9235

Publication Date

March 1, 2022

Volume

99

Issue

3

Start / End Page

213 / 227

Location

United States

Related Subject Headings

  • Vision, Binocular
  • Treatment Outcome
  • Sensory Deprivation
  • Ophthalmology & Optometry
  • Humans
  • Follow-Up Studies
  • Eyeglasses
  • Child, Preschool
  • Child
  • Amblyopia