PubMed:27832248 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PubMed/sourceid/27832248","sourcedb":"PubMed","sourceid":"27832248","text":"Binocular iPad Game vs Patching for Treatment of Amblyopia in Children: A Randomized Clinical Trial.\nImportance: Fellow eye patching has long been the standard treatment for amblyopia, but it does not always restore 20/20 vision or teach the eyes to work together. Amblyopia can be treated with binocular games that rebalance contrast between the eyes so that a child may overcome suppression. However, it is unclear whether binocular treatment is comparable to patching in treating amblyopia.\nObjectives: To assess the effectiveness of a binocular iPad (Apple Inc) adventure game as amblyopia treatment and compare this binocular treatment with patching, the current standard of care.\nDesign, Setting, and Participants: This investigation was a randomized clinical trial with a crossover design at a nonprofit eye research institute. Between February 20, 2015, and January 4, 2016, a total of 28 patients were enrolled in the study, with 14 randomized to binocular game treatment and 14 to patching treatment.\nInterventions: Binocular game and patching as amblyopia treatments.\nMain Outcomes and Measures: The primary outcome was change in amblyopic eye best-corrected visual acuity (BCVA) at the 2-week visit. Secondary outcomes were change in stereoacuity and suppression at the 2-week visit and change in BCVA at the 4-week visit.\nResults: Among 28 children, the mean (SD) age at baseline was 6.7 (1.4) years (age range, 4.6-9.5 years), and 7 (25%) were female. At baseline, the mean (SD) amblyopic eye BCVA was 0.48 (0.14) logMAR (approximately 20/63; range, 0.3-0.8 logMAR [20/40 to 20/125]), with 14 children randomized to the binocular game and 14 to patching for 2 weeks. At the 2-week visit, improvement in amblyopic eye BCVA was greater with the binocular game compared with patching, with a mean (SD) improvement of 0.15 (0.08) logMAR (mean [SD], 1.5 [0.8] lines) vs 0.07 (0.08) logMAR (mean [SD], 0.7 [0.8] line; P = .02) after 2 weeks of treatment. These improvements from baseline were significant for the binocular game (mean [SD] improvement, 1.5 [0.8] lines; P \u003c .001) and for patching (mean [SD] improvement, 0.7 [0.8] line; P = .006). Depth of suppression improved from baseline at the 2-week visit for the binocular game (mean [SD], 4.82 [2.82] vs 3.24 [2.87]; P = .03) and for patching (mean [SD], 4.77 [3.10] vs 2.57 [1.67]; P = .004). Patching children crossed over to binocular game treatment, and all 28 children played the game for another 2 weeks. At the 4-week visit, no group difference was found in BCVA change, with children who crossed over to the binocular games catching up with children treated with binocular games, for a mean (SD) improvement of 0.17 (0.10) logMAR (mean [SD], 1.7 [1.0] lines) for the binocular game vs a mean (SD) improvement of 0.16 (0.12) logMAR (mean [SD], 1.6 [1.2] lines) for the patching crossover (P = .73).\nConclusions and Relevance: A binocular iPad game was effective in treating childhood amblyopia and was more efficacious than patching at the 2-week visit. Binocular games that rebalance contrast to overcome suppression are a promising additional option for treating amblyopia.\nTrial Registration: clinicaltrials.gov Identifier: NCT02365090.","tracks":[{"project":"luoyt2021_800_3","denotations":[{"id":"T1","span":{"begin":49,"end":58},"obj":"DP"},{"id":"T10","span":{"begin":2956,"end":2965},"obj":"DP"},{"id":"T11","span":{"begin":3137,"end":3146},"obj":"DP"},{"id":"T2","span":{"begin":174,"end":183},"obj":"DP"},{"id":"T3","span":{"begin":265,"end":274},"obj":"DP"},{"id":"T4","span":{"begin":483,"end":492},"obj":"DP"},{"id":"T5","span":{"begin":584,"end":593},"obj":"DP"},{"id":"T6","span":{"begin":1057,"end":1066},"obj":"DP"},{"id":"T7","span":{"begin":1141,"end":1150},"obj":"DP"},{"id":"T8","span":{"begin":1493,"end":1502},"obj":"DP"},{"id":"T9","span":{"begin":1717,"end":1726},"obj":"DP"}],"attributes":[{"subj":"T1","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T10","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T11","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T2","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T3","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T4","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T5","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T6","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T7","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T8","pred":"source","obj":"luoyt2021_800_3"},{"subj":"T9","pred":"source","obj":"luoyt2021_800_3"}]},{"project":"Linmchun_800_3","denotations":[{"id":"T1","span":{"begin":174,"end":183},"obj":"DP"},{"id":"T2","span":{"begin":49,"end":58},"obj":"DP"},{"id":"T3","span":{"begin":265,"end":274},"obj":"DP"},{"id":"T4","span":{"begin":483,"end":492},"obj":"DP"},{"id":"T5","span":{"begin":584,"end":593},"obj":"DP"},{"id":"T6","span":{"begin":1057,"end":1066},"obj":"DP"},{"id":"T7","span":{"begin":2956,"end":2965},"obj":"DP"},{"id":"T8","span":{"begin":3137,"end":3146},"obj":"DP"},{"id":"T12","span":{"begin":1141,"end":1150},"obj":"DP"},{"id":"T13","span":{"begin":1717,"end":1726},"obj":"DP"},{"id":"T14","span":{"begin":1493,"end":1502},"obj":"DP"}],"attributes":[{"subj":"T1","pred":"source","obj":"Linmchun_800_3"},{"subj":"T2","pred":"source","obj":"Linmchun_800_3"},{"subj":"T3","pred":"source","obj":"Linmchun_800_3"},{"subj":"T4","pred":"source","obj":"Linmchun_800_3"},{"subj":"T5","pred":"source","obj":"Linmchun_800_3"},{"subj":"T6","pred":"source","obj":"Linmchun_800_3"},{"subj":"T7","pred":"source","obj":"Linmchun_800_3"},{"subj":"T8","pred":"source","obj":"Linmchun_800_3"},{"subj":"T12","pred":"source","obj":"Linmchun_800_3"},{"subj":"T13","pred":"source","obj":"Linmchun_800_3"},{"subj":"T14","pred":"source","obj":"Linmchun_800_3"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"luoyt2021_800_3","color":"#ec93dc","default":true},{"id":"Linmchun_800_3","color":"#93ece1"}]}]}}