Binocular iPad treatment for amblyopia in preschool children.
BACKGROUND
Recent experimental evidence supports a role for binocular visual experience in the treatment of amblyopia. The purpose of this study was to determine whether repeated binocular visual experience with dichoptic iPad games could effectively treat amblyopia in preschool children.


METHODS
A total of 50 consecutive amblyopic preschool children 3-6.9 years of age were assigned to play sham iPad games (first 5 children) or binocular iPad games (n = 45) for at least 4 hours per week for 4 weeks. Thirty (67%) children in the binocular iPad group and 4 (80%) in the sham iPad group were also treated with patching at a different time of day. Visual acuity and stereoacuity were assessed at baseline, at 4 weeks, and at 3 months after the cessation of game play.


RESULTS
The sham iPad group had no significant improvement in visual acuity (t4 = 0.34, P = 0.75). In the binocular iPad group, mean visual acuity (plus or minus standard error) improved from 0.43 ± 0.03 at baseline to 0.34 ± 0.03 logMAR at 4 weeks (n = 45; paired t44 = 4.93; P < 0.0001). Stereoacuity did not significantly improve (t44 = 1.35, P = 0.18). Children who played the binocular iPad games for ≥8 hours (≥50% compliance) had significantly more visual acuity improvement than children who played 0-4 hours (t43 = 4.21, P = 0.0001).


CONCLUSIONS
Repeated binocular experience, provided by dichoptic iPad game play, was more effective than sham iPad game play as a treatment for amblyopia in preschool children.
Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: ebirch@retinafoundation.org.
Eileen E
EE
Birch
Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas.
Simone L
SL
Li
Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas.
Reed M
RM
Jost
Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas.
Sarah E
SE
Morale
Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, Texas.
Angie
A
De La Cruz
Pediatric Ophthalmology & Adult Strabismus, Plano, Texas.
David
D
Stager
Pediatric Ophthalmology & Adult Strabismus, Plano, Texas.
Lori
L
Dao
Pediatric Ophthalmology & Adult Strabismus, Dallas, Texas.
David R
DR
Stager
D000550:Amblyopia / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D034201:Computers, Handheld; D003867:Depth Perception / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D018910:Video Games; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology