“She needs to see an eye doctor,” the pediatrician told the parents of a preschool child. I, a first-year medical student at the time, was shadowing a community pediatrician to learn more about medicine. During a physical exam, the pediatrician had noted that the child’s eyes were misaligned — one eye turned slightly inward toward her nose when she looked closely at a toy. Further tests confirmed the diagnosis and showed that the misaligned eye was not seeing properly.
I remembered learning about eye misalignment (called strabismus) in class. When the eyes are misaligned, the brain receives different visual input from each and begins to ignore the information from the poorly aligned eye. As a result, the visual pathways between this eye and the brain do not develop properly, leading to loss of vision, a condition called amblyopia.
Early diagnosis and treatment are essential for children with amblyopia because the key connections between the eyes and the brain need to be formed correctly during early childhood. For this patient, the pediatrician explained that the eye doctor would most likely offer a combination of treatments: eyeglasses, patching the better-seeing eye and possibly surgery.
Patching the better-seeing eye has long been a mainstay of amblyopia treatment. It forces the child to use the poorly aligned eye, and thus allows connections to develop between this eye and the brain. Many children resist using the patch, however, and it is often worn for fewer hours than prescribed. Furthermore, eye patching does not successfully treat amblyopia in all children, which has led to continued interest in developing new treatments.
One such treatment involves the use of a new iPad game and was recently published by Kelly et al. in JAMA Ophthalmology. In the study, the researchers designed special glasses for children with amblyopia that alter the visual contrast between eyes, allowing the children to experience binocular — or two-eyed — vision while playing an iPad game. Because amblyopia is caused by binocular discordance between eyes, the authors reasoned that this training technique could offer advantages compared to traditional monocular eye patching.
In a randomized controlled trial, 14 patients received the binocular game treatment, while 14 other patients received eye patching. After two weeks of treatment, the children were assessed for changes in visual acuity in the amblyopic eye. The researchers found that participants who were randomized to the game demonstrated significantly greater improvements in visual acuity — more than double the improvements observed in those who were randomized to patching.
Technologies like iPads have the potential not only to actively engage patients in the treatment of their illness, but also to provide more effective treatment options. Currently, further work is needed to assess the treatment of amblyopia using binocular gaming. For example, we need to examine its long-term effectiveness and optimize the timing and duration of treatment. Based on this and future research studies, the hope is that perhaps one day in the future, binocular gaming will be part of the optimal treatment plan for a child with amblyopia.
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