Paper 6

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Novel Binocular iPad Cartoon Video Program Improves Stereoacuity and Central Fusion in Treated and Untreated Amblyopes

Vicki M. Chen; Nicole Quinn; Sylvia Yoo; Catherine Choi; Paul D. Reese; Shelley Klein; Mitchell B. Strominger
New England Eye Center/ Tufts Medical Center
Boston, MA

Introduction:  Several dichoptic strategies reveal promising therapeutic results but require expensive equipment[1-2]. Other low-cost dichoptic therapies do not improve stereoacuity[3]. This study demonstrates rapid recovery of stereoacuity and central fusion in amblyopic children who viewed modified ‘Clifford the Big Red Dog’ cartoons at home for 4 weeks.

Methods:  Twenty-two amblyopes ages 4-15 years viewed videos 40 minutes daily on an iPad while wearing anaglyph glasses. Visual acuity at distance and near, stereoacuity, ocular alignment, suppression, compliance, and subjective experience were assessed at baseline, 2, 4, 8 and 16 weeks. Stereoacuity was tested using Linear (non-Randot), Randot Stereo, and Randot Preschool Stereoacuity tests with the highest arc seconds measured used for analysis.

Results:  After 4 weeks, mean stereoacuity improved  0.362 logMAR (CI 0.167-0.557; p=0.0009). Mean distance VA improved 0.043 logMAR (CI 0.007-0.08; p=0.022). Stereoacuity improved in 63% of children (CI 41%-82%). Worth-4-dot testing showed recovery of central fusion in 56% of children.  Compliance with 80% of prescribed viewing time was 77%. No adverse effects were reported.

Discussion:  Clinically and statistically significant improvement in stereoacuity, defined as greater than 0.2 logMAR, was achieved in the majority of children. Stereoacuity and central fusion improved even in fully treated older amblyopes who initially presented with nil stereoacuity. Vision improvement was modest and variable.

Conclusion:  This low-cost, home-based therapy improves stereoacuity and central fusion in amblyopic children as old as 15 years. Exploration of the pathways activated by this program may elucidate mechanisms to unlock stereoacuity development.

References:  1. Hess RF, Mansouri B, Thompson B. Restoration of binocular vision in amblyopia. Strabismus. 2011;19(3):110-8.
2. Li SL, Reynaud A, Hess RF, Wang YZ, Jost RM, Morale SE, et al. Dichoptic movie viewing treats childhood amblyopia. J AAPOS. 2015;19(5):401-5.
3. Holmes JM, Manh VM, Lazar EL, Beck RW, Birch EE, Kraker RT, et al. Effect of a Binocular iPad Game vs Part-time Patching in Children Aged 5 to 12 Years With Amblyopia: A Randomized Clinical Trial. JAMA Ophthalmol. 2016;134(12):1391-400.

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