Binocular Amblyopia Treatment

To evaluate the effectiveness of enhanced binocular amblyopia treatments in achieving a more complete and stable recovery.

To date, all studies of contrast-rebalanced binocular amblyopia treatment games used the same 10% per day contrast-increment that was designed for short-term intervention studies lasting 1-4 weeks; i.e., after 18 days of successful game play, both eyes viewed 100% contrast (no contrast-rebalancing).This study will investigate two alternative protocols designed to extend the game treatment period beyond 4 weeks to allow for more complete recovery of visual acuity. The new protocols will be compared with the original 10% contrast-increment game protocol in an 8-week 3-arm RCT to determine whether one or both of the new protocols is more effective than the current 10% increment. Based on pilot data, we expect about 40% of amblyopic children to achieve normal visual acuity in 8 weeks. In an effort to also promote recovery of binocular vision, children who attain ≤0.4 logMAR at 8 weeks will be enrolled in stereoacuity training at the 8-week visit for the next 4 weeks. Children with residual amblyopia (BCVA >0.4 logMAR) at the 8-week visit will be provided with dichoptic movies for additional amblyopia treatment for another 4 weeks.

playing binocular games on a tablet platform 1 hour per day 5 days per week with reduced contrast for the fellow eye and high contrast for the amblyopic eye

Inclusion Criteria: age 4-10 y male and female strabismic, anisometropic, or combined mechanism amblyopia amblyopic eye best-corrected visual acuity 0.3-0.8 logMAR fellow eye best-corrected visual acuity ≤0.1 logMAR interocular visual acuity difference ≥0.3 logMAR wearing glasses (if needed) for 8 weeks or no change visual acuity with glasses at 2 visits 4 weeks apart. child's ophthalmologist and family must be willing to forgo patching treatment during the 12-week study period parent's informed consent child must demonstrate understanding and ability to play binocular games Exclusion Criteria: prematurity ≥8 weeks coexisting ocular or systemic disease developmental delay strabismus >5pd any binocular amblyopia treatment in the past 3 months

Jost RM, Kelly KR, Hunter JS, Stager DR Jr, Luu B, Leffler JN, Dao L, Beauchamp CL, Birch EE. A randomized clinical trial of contrast increment protocols for binocular amblyopia treatment. J AAPOS. 2020 Oct;24(5):282.e1-282.e7. doi: 10.1016/j.jaapos.2020.06.009. Epub 2020 Oct 9.