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Background
The gold standard treatments in amblyopia are penalizing therapies, such as patching or blurring vision with atropine that are aimed at forcing the use of the amblyopic eye. However, in the last years, new therapies are being developed and validated, such as dichoptic visual training, aimed at stimulating the amblyopic eye and eliminatin...
Context in source publication
Context 1
... USA) which was run in the Oculus Rift OC DK2 virtual reality head mounted display (Oculus VR, LLC, Irvine, California, USA). The OC DK2 was equiped with an AMOLED display (5,7″ diagonal, reso- lution of 960 × 1080 pixels per eye), with 100° field of view, mounted with accelerometer, gyroscope and magnetometer sensor for positional tracking system (Fig. 1). Virtual reality head mounted display Oculus Rift was connected to a PC system (Intel i5 3,4 GHz, 8 GB RAM, Nvidia GeForce 970GT 4GB). Two games were available, a space game in which subjects were flying spaceship through a system of rings and a breaker game which is a typical block breaker game, but played in a virtual reality 3D ...
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Background/aims:
Computer games have been used to stimulate vision in amblyopia with varying degrees of success. The aim of this pilot study was to evaluate the feasibility of conducting a randomised controlled trial to test the effectiveness of computer game play compared to close work during occlusion treatment in children.
Method:
Children ag...
Citations
... The sample size was calculated based on the primary outcome (stereopsis at distance), the mean difference of stereoacuity at distance was expected to be 0.3 log arcsec between two groups with a common standard deviation of 0.2 log arcsec from previous studies [7,16,17]. After allowing for a maximum dropout rate of 20% during the 6 months follow-up, a sample size of 12 per group calculated using PASS 2021 (NCSS, LLC, Kaysville, UT, USA) was required to achieve 80% power at a two-sided significance level of 0.05 based on a two-sample t test. ...
Dichoptic training has emerged as a promising rehabilitation approach for improving binocular visual function in patients with strabismus. A prospective observational study design was employed to assess the effectiveness of online video game-based dichoptic training in rehabilitating binocular visual function in patients who had undergone an operation for intermittent exotropia.
A total of 64 patients who had undergone an operation for intermittent exotropia were recruited and divided into the training group and the control group based on whether they would receive the dichoptic training. The dichoptic training was conducted for 3 months in the training group and the control group would not accept any form of orthoptic therapy. Assessments of binocular visual functions and deviation were conducted at baseline, 3-month and 6-month follow-up.
Twenty-nine participants in the training group (mean 9.69 ± 2.66 years old) and 26 participants in the control group (mean 8.41 ± 2.64 years old) completed follow-up. At both 3- and 6-month follow-ups, the training group showed superior distance stereopsis compared to the control group, with near stereopsis only showing significant difference at the 6-month follow-up. Additionally, the training group exhibited significantly less distance exo-deviation drift than the control group at these times, and no significant difference was observed in near exo-deviation drift between the groups. The control group had a significantly higher rate of suboptimal surgical outcomes at both the 3- and 6-month follow-up. However, no significant differences were observed in simultaneous perception and fusion functions between the two groups.
Online video game-based dichoptic training has the potential to become a novel postoperative rehabilitation strategy for patients with intermittent exotropia.
... Furthermore, there are devices specifically engineered to address visual impairments such as "lazy eye" or amblyopia, prevalent among children. These conditions, characterized by a reduction in visual acuity in one eye without overt pathological signs, are tackled through the strategic deployment of virtual reality headsets that project specially crafted videos, aiming to stimulate and encourage the usage of the "lazy eye" for more effective treatment [8]. This innovative intersection of virtual reality and healthcare showcases the potential to transform diagnostic and therapeutic approaches, marking a paradigm shift in the medical landscape. ...
The integration of Virtual Reality with radiology is the focus of this study. A narrative review has been proposed to delve into emerging themes within the integration of Virtual Reality in radiology by scrutinizing reviews gathered from PubMed and Scopus. The proposed approach was based on a standard narrative checklist and a qualification process. The selection process identified 20 review studies. Integration of Virtual Reality (VR) in radiology offers potential transformative opportunities also integrated with other emerging technologies. In medical education, VR and AR, using 3D images from radiology, can enhance learning, emphasizing the need for standardized integration. In radiology, VR combined with Artificial Intelligence (AI) and Augmented Reality (AR) shows promising prospectives to give a complimentary contribution to diagnosis, treatment planning, and education. Challenges in clinical integration and User Interface design must be addressed. Innovations in medical education, like 3D modeling and AI, has the potential to enable personalized learning, but face standardization challenges. While robotics play a minor role, advancements and potential perspectives are observed in neurosurgery and endovascular systems. Ongoing research and standardization efforts are crucial for maximizing the potential of these integrative technologies in healthcare. In conclusion, the synthesis of these findings underscores the opportunities for advancements in digital radiology and healthcare through the integration of VR. However, challenges exist, and continuous research, coupled with technological refinements, is imperative to unlock the full potential of these integrative approaches in the dynamic and evolving field of medical imaging.
... The results indicated a reduction in accommodative lag and an enhancement in accommodative facility post-training. Furthermore, analogous research has been carried out on the use of VR in treating other ocular conditions like amblyopia [4][5][6][7]. Taken together, VR devices exhibit strong promise as a treatment modality. ...
... The advent of novel dichoptic stimulation techniques using VR technology 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 has sparked renewed interest in the use of these techniques for amblyopia therapy. 14,15 Still, the answer to the question regarding the value of these new modalities is unclear. The aim of this study is to compare the effectiveness of conventional patching to dichoptic training using virtual reality (VR) within a head-mounted display (HMD) in subjects with unilateral anisometropic or mixed amblyopia. ...
... The VA improvement noted in the VR group was comparable to those reported by other studies evaluating VR for amblyopia therapy (0.7 -2 lines). 14,15,[20][21][22][23] However, that VA improvement was more than those reported by the PEDIG studies evaluating the dichoptic falling blocks game 705 706 707 708 709 710 711 712 713 714 715 716 717 718 719 720 721 722 723 724 725 726 727 728 729 730 731 732 733 734 735 736 737 738 739 740 741 742 743 744 745 746 747 748 749 750 751 752 753 754 755 756 757 758 759 760 761 762 763 764 765 766 767 768 769 770 771 772 773 774 775 776 777 778 779 780 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 10,11 and the Dig Rush game (2.3 letters). 12 The stark difference in VA improvement may be due to the more immersive nature of the VR games employed in this study compared to those two games, thus leading to better compliance. ...
... Many studies have demonstrated significant VA improvement with dichoptic stimulation that was maintained for up to a year of follow-up. 12,14,[27][28][29][30] However, to our knowledge, only one study in the existing literature similarly reported additional significant VA improvement (0.68 line; p < 0.001) during the subsequent month after cessation of their altered-reality dichoptic therapy. 31 The exact mechanism behind this further VA improvement is unknown. ...
Purpose
To compare the outcomes of patching to dichoptic stimulation using virtual reality (VR) in moderate and severe amblyopia.
Methods
This randomized controlled trial (RCT) was conducted on 86 subjects with unilateral anisometropic and mixed amblyopia. The subjects were randomized to the VR or patching group. The VR group received treatment using a VR dichoptic digital therapeutic. Each subject received weekly 2 hour-sessions for 10 weeks. The patching group was prescribed patching for 10 weeks. Best-corrected visual acuity (BCVA) was measured using a single crowded letter in an ETDRS chart before, after 10 weeks of treatment, and after another 10 weeks of cessation of treatment. Near stereoacuity was measured using the TNO test.
Results
Forty-two patients were randomized to the patching group and 44 to the VR group. The median age of the subjects was 12.0 (range 6.0 to 37.0) years. In the VR group, mean amblyopic eye BCVA showed statistically significant improvement by 0.89 line (95% confidence interval {CI}, 0.73 to 1.35 lines; P< 0.001) after 10 weeks of therapy, and after another 10 weeks of follow-up by 1.32 lines from baseline (95% CI, 1.15 to 1.7 lines; P < 0.001). Regarding the patching group, mean BCVA showed statistically significant improvement after 10 weeks by 1.38 lines (95% CI, 0.82 to 1.8 lines; P <0.001), and after another 10 weeks by 1 line from baseline (95% CI, 0.06 - 0.147; 0.6 to 1.47 lines; P <0.001). There was no significant difference between both groups at any time-point (P values > 0.05). No serious adverse events were noted. Adults and severe amblyopes in the VR group showed more significant VA improvement than their counterparts in the patching group.
Conclusions
Amblyopes treated using VR dichoptic treatment demonstrated statistically significant VA improvement after 10 and 20 weeks of follow-up that is comparable to patching.
... Movies or video game stimuli have been used to promote patient engagement and treatment compliance. These and similar therapies have produced a promising degree of visual recovery in children and adults with anisometropic and/or strabismic amblyopia Li et al., 2010;Vedamurthy et al., 2015;Holmes et al., 2016;Žiak et al., 2017;Birch et al., 2019b;Xiao et al., 2022). However, an efficacy review by The American Academy of Ophthalmology concluded that there was no evidence to support the use of binocular treatment as a substitute for standard patching or penalization for the common forms of amblyopia (Pineles et al., 2020). ...
Amblyopia is a common visual impairment that develops during the early years of postnatal life. It emerges as a sequela to eye misalignment, an imbalanced refractive state, or obstruction to form vision. All of these conditions prevent normal vision and derail the typical development of neural connections within the visual system. Among the subtypes of amblyopia, the most debilitating and recalcitrant to treatment is deprivation amblyopia. Nevertheless, human studies focused on advancing the standard of care for amblyopia have largely avoided recruitment of patients with this rare but severe impairment subtype. In this review, we delineate characteristics of deprivation amblyopia and underscore the critical need for new and more effective therapy. Animal models offer a unique opportunity to address this unmet need by enabling the development of unconventional and potent amblyopia therapies that cannot be pioneered in humans. Insights derived from studies using animal models are discussed as potential therapeutic innovations for the remediation of deprivation amblyopia. Retinal inactivation is highlighted as an emerging therapy that exhibits efficacy against the effects of monocular deprivation at ages when conventional therapy is ineffective, and recovery occurs without apparent detriment to the treated eye.
... These studies also made use of different forms of experiments and methods, and immersive VR technology was compared to other forms of media and non-immersive VR technology. The results of the studies indicated that immersive VR had the highest impact [56,57,135,145]. However, high immersion does not guarantee success of VR technology as a learning tool. ...
... Immersion was perceived as the main benefit by the participants, which was supported by the heightened engagement noticed during the observations. This endorsed and added to the literature by spotlighting the impact of immersion as a value addition to VR technology in the context of a learning tool [8,56,57,135,145]. There is a strong correlation between immersion and engagement where both can be considered as intrinsically linked [8,23,34]. ...
While Virtual Reality has shown the potential to improve learning experiences, its acceptance and adaptation within curriculum remains significantly limited. One possible reason for this is the lack of information regarding how faculty from different disciplines and with different levels of expertise in using VR perceive the challenges and benefits of its implementation. As such, this study uses a Phenomenography approach to share the views of faculty from Business, Instructional Design and English in this context. Interview and observation data findings suggest that while faculty are keenly interested in VR technology, the challenges posed by cost, hardware and software can sometimes be prohibitive to VR adaptation. The study offers multiple suggestions to mitigate such challenges so that students and faculty can benefit from a technology that is highly immersive and engaging. The recommendations support and add to the literature and highlight the deeper details of issues and recommendations for VR integration in curriculum.
... In any case, this is not the first experience reporting the efficacy of dichoptic training in adult anisometropic amblyopia, with several previous case series confirming this finding. 17,[18][19][20][21][22][23][24][25][26] However, to our knowledge, there are no previous experiences comparing the visual improvement achieved after dichoptic training in children and adults. In our series, no significant differences were found between children and adult groups in the visual and binocular function improvements achieved with therapy, suggesting a similarity in the potential range of improvement in anisometropic amblyopia in children and adults. ...
Purpose:
To evaluate and compare the results of dichoptic training in Argentinian children and adults with anisometropic amblyopia.
Methods:
Prospective non-comparative study enrolling 41 subjects with anisometropic amblyopia (age, 6-60 years old). Two groups were differentiated according to age, children (6-16 years, 24 subjects) and adults (>17 years, 17 subjects). All patients were treated with the Bynocs® platform (Kanohi Eye Pvt. Ltd, India) following a protocol of 30 sessions of training of 30 min daily 5 times a week for 6 weeks. Changes in corrected distance visual acuity (CDVA) and binocular function (BF) score with treatment were analyzed.
Results:
In the whole sample, CDVA in the amblyopic eye improved significantly, with a mean change of 0.30 logMAR (p < .001). Likewise, a significant improvement was also found in BF score (p < .001), with a mean change of 1.14 log units. The change achieved in CDVA was significantly correlated with the baseline CDVA in the amblyopic eye (r=-0.568, p < .001). Furthermore, no significant differences were found between age groups in the change achieved in CDVA (p = .431) and BF with therapy (p = .760).
Conclusions:
Dichoptic training with the digital platform evaluated provides an effective improvement of visual acuity and binocular function in children and adults with anisometropic amblyopia.
... Recently, a Tetris game is being used, in which blocks were seen by the two eyes separately with red green anaglyph filters along with contrast of the two eyes changed to stimulate fusion to successful completion of the game (31,32). Recent studies have showed improvement of visual acuity, contrast sensitivity, stereopsis in both children and adult amblyopic patient employing this new mode of dichoptic therapy (33,34). Dichoptic therapy using tetris (puzzle video game) video game is available on ipod and different mobile based software which become very convenient for the mode of treatment. ...
... Similarly, compared to the traditional therapy, there was a significant improvement in stereopsis in adult anisometropic amblyopia patients with the dichoptic therapy (34). These results are similar with treating children with amblyopia with dichoptic therapy (61)(62)(63)(64). ...
... In this study, 8 patients gained a visual acuity of 20/40 or better after the training. Mean stereoacuity changed from a value of 263.3 ± 135.1 to 176.7 ± 152.4 seconds of arc after dichotic training(34). Vedamurthy et al. developed dichoptic version of a commercial first-person-shooter action video game and evaluated the efficacy of the same in treating adults with amblyopia and reported a reduced suppression, improved visual acuity and stereopsis with the said videogame. In this study, 23 adult amblyopes with 10 anisometropic amblyope, 13 strabismic and mixed amblyope were evaluated. ...
Introduction: Amblyopia is a condition with reduced best corrected visual acuity in absence of any ocular pathology. Different treatment approaches of amblyopia have been researched for decades. Recent studies on binocular dichoptic therapy using different software and video game based training showed drastic improvement in visual functions in amblyopic adults. Aim of this review is to assess the effect of vision therapy with dichoptic training in adults with anisometropic amblyopes. Method: Review was conducted in articles published within last 25 years from databases like PubMed, research gate, google scholar. Results: Dichoptic therapy has promising results in treatment of adults with anisometropic amblyopia. However, several limitations of these said researches were observed. Conclusion: Further studies particularly RCTs with strict methodology and treatment protocol, larger sample size and longer follow ups are recommended before clinicians could impart dichoptic therapy as a management option of adults with amblyopia into their evidence based practice.
... In recent years, VR has integrated ET technologies and emerged in the field of vision science, integrating built-in eye trackers into HMDs [16]. Therefore, today, VR has the potential to be an effective tool in complementing the treatment of a variety of vision disorders requiring ET technologies for identification or treatment, e.g., treating amblyopia [36] and convergence insufficiency [37]. VR and augmented reality (AR) are used for treating strabismus [38], amblyopia, and retinal diseases [17]. ...
... These limitations are discussed further in the study's related MSc thesis by Daehlen [63], which suggests some FVP screening tasks that may be better suited for VR. This includes visual field screening, which was shown to be compatible with HMDs by Mees et al. [64], and amblyopia testing, which was proven measurable in VR by multiple research teams [36,41,65]. ...
Oculomotor dysfunctions (OMDs) are problems relating to coordination and accuracy of eye movements for processing visual information. Eye-tracking (ET) technologies show great promise in the identification of OMDs. However, current computer technologies for vision screening are specialized devices with limited screen size and the inability to measure depth, while visual field and depth are important information for detecting OMDs. In this experimental study, we examine the possibilities of immersive virtual reality (VR) technologies compared with laptop technologies for increased user experiences, presence, immersiveness, and the use of serious games for identifying OMDs. The results present increased interest in VR-based screening, motivating users to focus better using VR applications free from outside distractions. These limitations currently include lower performance and confidence in results of identifying OMDs with the used HMDs. Using serious games for screening in VR is also estimated to have great potential for developing a more robust vision screening tool, especially for younger children.
... The same problems may have patients after single cataract surgery also. [20][21][22] It is common for vision to be temporarily blurred in the first few days after surgery. Patients may experience redness, irritation, swelling and a foreign body sensation. ...
Purpose
Implementation of quality-of-life standards for patients with secondary glaucoma after surgery.
Material and methods
Data analysis included secondary surgical glaucoma patients with a time interval of 4 years. Patients were followed up to 3 years after surgery to answer questions related to subjective perceptions after the surgical intervention (pain, discomfort, near vision, distance vision, intermediate vision, and normal activity). We were also interested in the overall quality of life and the effect on the patient's psyche when performing certain surgical techniques.
Results
As part of the questionnaire, patients were asked 36 questions. Responses were received from 98 patients. Thirty-five respondents (97.2%) of patients who underwent cyclocryopexy reported tolerable, minimal, or no pain during and immediately after surgery, with the majority of patients reporting minimal pain. Twenty-one patients (58.3%) did not complain of pain until one year after surgery.
According to the survey, 16 respondents (25%) had undergone trabeculectomy. Most respondents reported tolerable pain during surgery, minimal pain for 2 weeks after surgery, and no or minimal pain 2 years after surgery. Eleven respondents (68.8%) answered that their eyesight improved in daily life, but the majority of nine (56.3%) did not notice any change in their vision during short-distance movement, short-distance work, or reading. Most serious problems had patients after cyclocryocoagulation or enucleation of the eye globe.
Conclusion
Secondary glaucoma surgery for every patient should be personalized and tailored to the patient's every need, taking into account the patient's current health status, knowledge and skills as well as socioeconomic circumstances.
