Angie Katerine de la Cruz (original) (raw)

Papers by Angie Katerine de la Cruz

Investigative Ophthalmology & Visual Science, 2017

Investigative Ophthalmology & Visual Science, 2015

Investigative Ophthalmology & Visual Science, 2016

Investigative Ophthalmology & Visual Science, 2015

Investigative Ophthalmology & Visual Science, 2015

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2019

Background-Binocular amblyopia treatments promote visual acuity recovery and binocularity by reba... more Background-Binocular amblyopia treatments promote visual acuity recovery and binocularity by rebalancing the signal strength of dichoptic images. Most require active participation by the amblyopic child to play a game or perform a repetitive visual task. The purpose of this study was to investigate a passive form of binocular treatment with contrast-rebalanced dichoptic movies. Methods-A total of 27 amblyopic children, 4-10 years of age, wore polarized glasses to watch 6 contrast-rebalanced dichoptic movies on a passive 3D display during a 2-week period. Amblyopic eye contrast was 100%; fellow eye contrast was initially set to a lower level (20% −60%), which allowed the child to overcome suppression and use binocular vision. Fellow eye contrast was incremented by 10% for each subsequent movie. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and at 2 weeks. Results-Amblyopic eye best-corrected visual acuity improved from 0.57 ± 0.22 at baseline to 0.42 ± 0.23 logMAR (t 26 = 8.09; P < 0.0001; 95% CI for improvement, 0.11-0.19 logMAR). Children aged 3-6 years had more improvement (0.21 ± 0.11 logMAR) than children aged 7-10 years (0.11 ± 0.06 logMAR; t 25 = 3.05; P = 0.005). Children with severe amblyopia (≥0.7 logMAR) at baseline experienced greater improvement (0.24 ± 0.12 logMAR) than children with moderate amblyopia at baseline (0.12 ± 0.06 logMAR; t 25 = 3.49; P = 0.002). Conclusions-In this cohort, passive viewing of contrast-rebalanced dichoptic movies effectively improved visual acuity in amblyopic subjects. The degree of improvement observed was similar to that previously reported for 2 weeks of binocular games treatment and with 3-4 months of occlusion therapy.

JAMA ophthalmology, 2018

Abnormal binocular experience during infancy or childhood from strabismus and/or anisometropia re... more Abnormal binocular experience during infancy or childhood from strabismus and/or anisometropia results in visual acuity deficits (eg, amblyopia) and impaired stereoacuity. These pediatric eye conditions have also been linked to slow reading and fine motor impairment. To assess an academic-related fine motor outcome-multiple-choice answer form completion time-in children with amblyopia and strabismus. In this cross-sectional study completed between May 2014 and November 2017 at a nonprofit eye research institute, 47 children with amblyopia treated for strabismus, anisometropia, or both, 18 children with nonamblyopic strabismus, and 20 normal controls were enrolled. Children were asked to transfer the correct answers from a standardized reading achievement test booklet to a multiple-choice answer form as quickly as possible without making mistakes or reading the text. The time to complete the task was recorded and analyzed between groups. Of the 85 included children, 40 (47%) were fem...

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2017

Background-Previous studies show slow reading in strabismic amblyopia. We recently identified amb... more Background-Previous studies show slow reading in strabismic amblyopia. We recently identified amblyopia, not strabismus, as the key factor in slow reading in children. No studies have focused on reading in amblyopic children without strabismus. We examined reading in anisometropic children and evaluated whether slow reading was associated with ocular motor dysfunction in children with amblyopia. Methods-Anisometropic children (7-12 years) with or without amblyopia were compared to age-similar normal controls. Children silently read a grade-appropriate paragraph during binocular viewing. Reading rate (words/min), number of forward and regressive saccades (per 100 words) and fixation duration were recorded with the ReadAlyzer. Binocular fixation instability was also evaluated (EyeLink 1000). Results-Amblyopic anisometropic children read more slowly (n = 25; mean with standard deviation, 149 ± 42 words/min) than nonamblyopic anisometropic children (n = 15; 196 ± 80 words/min; P = 0.024) and controls (n = 25; 191 ± 65 words/min; P = 0.020). Nonamblyopic anisometropic children read at a comparable rate to controls (P = 0.81). Slow reading in amblyopic anisometropic children was correlated with increased forward saccades (r = −0.84, P < 0.001), increased regressive saccades (r = −0.85, P < 0.001), and fellow eye instability during binocular viewing (r = −0.52, P = 0.019). Conclusions-Slow reading in school-age children with anisometropic amblyopia is related to increased frequency of saccades and fixation instability of the fellow eye. Further research should consider the effects of slower reading on academic performance.

Investigative Opthalmology & Visual Science, 2016

PURPOSE. Suppression has a key role in the etiology of amblyopia, and contrast-balanced binocular... more PURPOSE. Suppression has a key role in the etiology of amblyopia, and contrast-balanced binocular treatment can overcome suppression and improve visual acuity. Quantitative assessment of suppression could have a role in managing amblyopia. We describe a novel eye chart to assess suppression in children. METHODS. We enrolled 100 children (7-12 years; 63 amblyopic, 25 nonamblyopic with strabismus or anisometropia, 12 controls) in the primary cohort and 22 children (3-6 years; 13 amblyopic, 9 nonamblyopic) in a secondary cohort. Letters were presented on a dichoptic display (5 letters per line). Children wore polarized glasses so that each eye saw a different letter chart. At each position, the identity of the letter and its contrast on each eye's chart differed. Children read 8 lines of letters for each of 3 letter sizes. The contrast balance ratio was the ratio at which 50% of letters seen by the amblyopic eye were reported. RESULTS. Amblyopic children had significantly higher contrast balance ratios for all letter sizes compared to nonamblyopic children and controls, requiring 4.6 to 5.6 times more contrast in the amblyopic eye compared to the fellow eye (P < 0.0001). Amblyopic eye visual acuity was correlated with contrast balance ratio (r ranged from 0.49-0.57 for the 3 letter sizes). Change in visual acuity with amblyopia treatment was correlated with change in contrast balance ratio (r ranged from 0.43-0.62 for the 3 letter sizes). CONCLUSIONS. Severity of suppression can be monitored as part of a routine clinical exam in the management of amblyopia in children.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Background and Purpose-Stereoacuity measurement is a common element of pediatric ophthalmic exami... more Background and Purpose-Stereoacuity measurement is a common element of pediatric ophthalmic examinations. Although the Stereo Fly Test is routinely used to establish the presence of coarse stereopsis (3000 arcsecs), it often yields a false negative "pass" due to learned responses and non-stereoscopic cues. We developed and evaluated a modified Stereo Fly Test protocol aimed at increasing sensitivity, thus reducing false negatives. Patients and Methods-The Stereo Fly Test was administered according to manufacturer instructions to 321 children aged 3-12 years. Children with a "pass" outcome (n = 147) were retested wearing glasses fitted with polarizers of matching orientation for both eyes to verify that they were responding to stereoscopic cues (modified protocol). The response to the standard Stereo Fly Test was considered a false negative (pass) if the child still pinched above the plate after disparity cues were eliminated. Randot ® Preschool Stereoacuity and Butterfly Tests were used as gold standards. Results and Conclusions-Sensitivity was 81% (95% CI: 0.75-0.86) for standard administration of the Stereo Fly Test (19% false negative "pass"). The modified protocol increased sensitivity to 90% (95% CI: 0.85-0.94). The modified two-step protocol is a simple and convenient way to administer the Stereo Fly Test with increased sensitivity in a clinical setting.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Investigative Opthalmology & Visual Science, 2016

PURPOSE. We investigated longitudinal changes of refractive error in children with accommodative ... more PURPOSE. We investigated longitudinal changes of refractive error in children with accommodative esotropia (ET) throughout the first 12 years of life, its dependence on age at onset of ET, and whether amblyopia or anisometropia are associated with defective emmetropization. METHODS. Longitudinal refractive errors in children with accommodative ET were analyzed retrospectively. Eligibility criteria included: initial hyperopia ‡þ4.00 diopters (D), initial cycloplegic refraction before 4 years, at least 3 visits, and at least one visit between 7 and 12 years. Children were classified as having infantile (N ¼ 30; onset 12 months) or late-onset (N ¼ 78; onset at 18-48 months) accommodative ET. Cycloplegic refractions culled from medical records were converted into spherical equivalent (SEQ). RESULTS. Although the initial visit right eye SEQ was similar for the infantile and late-onset groups (þ5.86 6 1.28 and þ5.67 6 1.26 D, respectively), there were different developmental changes in refractive error. Neither group had a significant decrease in hyperopia before age 7 years, but after 7 years, the infantile group experienced a myopic shift of À0.43 D/y. The late-onset group did not experience a myopic shift at 7 to 12 years. Among amblyopic children, a slower myopic shift was observed for the amblyopic eye. Among anisometropic children, the more hyperopic eye experienced more myopic shift than the less hyperopic eye. CONCLUSIONS. Children with infantile accommodative ET experienced prolonged hyperopia followed by a myopic shift after 7 years of age, consistent with dissociation between infantile emmetropization and school age myopic shift. In contrast, children with late-onset accommodative ET had little myopic shift before or after 7 years.

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 2015

Recent evidence suggests that amblyopia results in fixation instability and atypical saccades. Re... more Recent evidence suggests that amblyopia results in fixation instability and atypical saccades. Reading is a vision-reliant ability that requires sequential eye movements, including forward and regressive saccades. This study investigated reading and associated eye movements in school-age amblyopic children. Amblyopic children with strabismus and/or anisometropia (n = 29) were compared to nonamblyopic children treated for strabismus (n = 23) and normal control children (n = 21). While fitted with the ReadAlyzer, an eye movement recording system, children silently read a grade-level paragraph of text during binocular viewing. Reading rate, number of forward and regressive saccades per 100 words, and fixation duration were determined. Comprehension was evaluated with a 10-item quiz; only data from children with at least 80% correct responses were included. Amblyopic children read more slowly and had more saccades compared with nonamblyopic children with treated strabismus and normal co...

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Background-Contrast-balanced dichoptic experience with perceptual-learning tasks or simple games ... more Background-Contrast-balanced dichoptic experience with perceptual-learning tasks or simple games has been shown to improve visual acuity significantly in amblyopia. However, these tasks are intensive and repetitive, and up to 40% of unsupervised patients are noncompliant. We investigated the efficacy of a potentially more engaging movie method to provide contrastbalanced binocular experience via complementary dichoptic stimulation. Methods-Eight amblyopic children 4-10 years of age were enrolled in a prospective cohort study to watch 3 dichoptic movies per week for 2 weeks on a passive 3D display. Dichoptic versions of 18 popular animated feature films were created. A patterned image mask of irregularly shaped blobs was multiplied with the movie images seen by the amblyopic eye and an inverse mask was multiplied with the images seen by the fellow eye. Fellow-eye contrast was initially set at a reduced level that allowed binocular vision and was then incremented by 10% at each visit. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and 2 weeks. Results-Mean amblyopic eye visual acuity (with standard error of the mean) improved from a logarithm of minimum angle of resolution of 0.72 ± 0.08 at baseline to 0.52 ± 0.09 (P = 0.003); that is, 2.0 lines of improvement at the 2-week outcome visit. No significant change in interocular suppression or stereoacuity was found.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014

Background-Recent experimental evidence supports a role for binocular visual experience in the tr... more 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 (t 4 = 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 t 44 = 4.93; P < 0.0001). Stereoacuity did not significantly improve (t 44 = 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 (t 43 = 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.

JAMA Ophthalmology, 2015

Repeated experience with dichoptic perceptual learning tasks and dichoptic game play have been sh... more Repeated experience with dichoptic perceptual learning tasks and dichoptic game play have been shown to be effective in improving the visual acuity of amblyopic children and adults. 1-4 However, whether the visual acuity gains achieved with binocular treatment are long lasting has not yet been addressed. We examined the durability of visual acuity improvements obtained as a result of binocular iPad game play in childhood amblyopia.

Investigative Ophthalmology & Visual Science, 2017

Investigative Ophthalmology & Visual Science, 2015

Investigative Ophthalmology & Visual Science, 2016

Investigative Ophthalmology & Visual Science, 2015

Investigative Ophthalmology & Visual Science, 2015

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2019

Background-Binocular amblyopia treatments promote visual acuity recovery and binocularity by reba... more Background-Binocular amblyopia treatments promote visual acuity recovery and binocularity by rebalancing the signal strength of dichoptic images. Most require active participation by the amblyopic child to play a game or perform a repetitive visual task. The purpose of this study was to investigate a passive form of binocular treatment with contrast-rebalanced dichoptic movies. Methods-A total of 27 amblyopic children, 4-10 years of age, wore polarized glasses to watch 6 contrast-rebalanced dichoptic movies on a passive 3D display during a 2-week period. Amblyopic eye contrast was 100%; fellow eye contrast was initially set to a lower level (20% −60%), which allowed the child to overcome suppression and use binocular vision. Fellow eye contrast was incremented by 10% for each subsequent movie. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and at 2 weeks. Results-Amblyopic eye best-corrected visual acuity improved from 0.57 ± 0.22 at baseline to 0.42 ± 0.23 logMAR (t 26 = 8.09; P < 0.0001; 95% CI for improvement, 0.11-0.19 logMAR). Children aged 3-6 years had more improvement (0.21 ± 0.11 logMAR) than children aged 7-10 years (0.11 ± 0.06 logMAR; t 25 = 3.05; P = 0.005). Children with severe amblyopia (≥0.7 logMAR) at baseline experienced greater improvement (0.24 ± 0.12 logMAR) than children with moderate amblyopia at baseline (0.12 ± 0.06 logMAR; t 25 = 3.49; P = 0.002). Conclusions-In this cohort, passive viewing of contrast-rebalanced dichoptic movies effectively improved visual acuity in amblyopic subjects. The degree of improvement observed was similar to that previously reported for 2 weeks of binocular games treatment and with 3-4 months of occlusion therapy.

JAMA ophthalmology, 2018

Abnormal binocular experience during infancy or childhood from strabismus and/or anisometropia re... more Abnormal binocular experience during infancy or childhood from strabismus and/or anisometropia results in visual acuity deficits (eg, amblyopia) and impaired stereoacuity. These pediatric eye conditions have also been linked to slow reading and fine motor impairment. To assess an academic-related fine motor outcome-multiple-choice answer form completion time-in children with amblyopia and strabismus. In this cross-sectional study completed between May 2014 and November 2017 at a nonprofit eye research institute, 47 children with amblyopia treated for strabismus, anisometropia, or both, 18 children with nonamblyopic strabismus, and 20 normal controls were enrolled. Children were asked to transfer the correct answers from a standardized reading achievement test booklet to a multiple-choice answer form as quickly as possible without making mistakes or reading the text. The time to complete the task was recorded and analyzed between groups. Of the 85 included children, 40 (47%) were fem...

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2017

Background-Previous studies show slow reading in strabismic amblyopia. We recently identified amb... more Background-Previous studies show slow reading in strabismic amblyopia. We recently identified amblyopia, not strabismus, as the key factor in slow reading in children. No studies have focused on reading in amblyopic children without strabismus. We examined reading in anisometropic children and evaluated whether slow reading was associated with ocular motor dysfunction in children with amblyopia. Methods-Anisometropic children (7-12 years) with or without amblyopia were compared to age-similar normal controls. Children silently read a grade-appropriate paragraph during binocular viewing. Reading rate (words/min), number of forward and regressive saccades (per 100 words) and fixation duration were recorded with the ReadAlyzer. Binocular fixation instability was also evaluated (EyeLink 1000). Results-Amblyopic anisometropic children read more slowly (n = 25; mean with standard deviation, 149 ± 42 words/min) than nonamblyopic anisometropic children (n = 15; 196 ± 80 words/min; P = 0.024) and controls (n = 25; 191 ± 65 words/min; P = 0.020). Nonamblyopic anisometropic children read at a comparable rate to controls (P = 0.81). Slow reading in amblyopic anisometropic children was correlated with increased forward saccades (r = −0.84, P < 0.001), increased regressive saccades (r = −0.85, P < 0.001), and fellow eye instability during binocular viewing (r = −0.52, P = 0.019). Conclusions-Slow reading in school-age children with anisometropic amblyopia is related to increased frequency of saccades and fixation instability of the fellow eye. Further research should consider the effects of slower reading on academic performance.

Investigative Opthalmology & Visual Science, 2016

PURPOSE. Suppression has a key role in the etiology of amblyopia, and contrast-balanced binocular... more PURPOSE. Suppression has a key role in the etiology of amblyopia, and contrast-balanced binocular treatment can overcome suppression and improve visual acuity. Quantitative assessment of suppression could have a role in managing amblyopia. We describe a novel eye chart to assess suppression in children. METHODS. We enrolled 100 children (7-12 years; 63 amblyopic, 25 nonamblyopic with strabismus or anisometropia, 12 controls) in the primary cohort and 22 children (3-6 years; 13 amblyopic, 9 nonamblyopic) in a secondary cohort. Letters were presented on a dichoptic display (5 letters per line). Children wore polarized glasses so that each eye saw a different letter chart. At each position, the identity of the letter and its contrast on each eye's chart differed. Children read 8 lines of letters for each of 3 letter sizes. The contrast balance ratio was the ratio at which 50% of letters seen by the amblyopic eye were reported. RESULTS. Amblyopic children had significantly higher contrast balance ratios for all letter sizes compared to nonamblyopic children and controls, requiring 4.6 to 5.6 times more contrast in the amblyopic eye compared to the fellow eye (P < 0.0001). Amblyopic eye visual acuity was correlated with contrast balance ratio (r ranged from 0.49-0.57 for the 3 letter sizes). Change in visual acuity with amblyopia treatment was correlated with change in contrast balance ratio (r ranged from 0.43-0.62 for the 3 letter sizes). CONCLUSIONS. Severity of suppression can be monitored as part of a routine clinical exam in the management of amblyopia in children.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Background and Purpose-Stereoacuity measurement is a common element of pediatric ophthalmic exami... more Background and Purpose-Stereoacuity measurement is a common element of pediatric ophthalmic examinations. Although the Stereo Fly Test is routinely used to establish the presence of coarse stereopsis (3000 arcsecs), it often yields a false negative "pass" due to learned responses and non-stereoscopic cues. We developed and evaluated a modified Stereo Fly Test protocol aimed at increasing sensitivity, thus reducing false negatives. Patients and Methods-The Stereo Fly Test was administered according to manufacturer instructions to 321 children aged 3-12 years. Children with a "pass" outcome (n = 147) were retested wearing glasses fitted with polarizers of matching orientation for both eyes to verify that they were responding to stereoscopic cues (modified protocol). The response to the standard Stereo Fly Test was considered a false negative (pass) if the child still pinched above the plate after disparity cues were eliminated. Randot ® Preschool Stereoacuity and Butterfly Tests were used as gold standards. Results and Conclusions-Sensitivity was 81% (95% CI: 0.75-0.86) for standard administration of the Stereo Fly Test (19% false negative "pass"). The modified protocol increased sensitivity to 90% (95% CI: 0.85-0.94). The modified two-step protocol is a simple and convenient way to administer the Stereo Fly Test with increased sensitivity in a clinical setting.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2016

Investigative Opthalmology & Visual Science, 2016

PURPOSE. We investigated longitudinal changes of refractive error in children with accommodative ... more PURPOSE. We investigated longitudinal changes of refractive error in children with accommodative esotropia (ET) throughout the first 12 years of life, its dependence on age at onset of ET, and whether amblyopia or anisometropia are associated with defective emmetropization. METHODS. Longitudinal refractive errors in children with accommodative ET were analyzed retrospectively. Eligibility criteria included: initial hyperopia ‡þ4.00 diopters (D), initial cycloplegic refraction before 4 years, at least 3 visits, and at least one visit between 7 and 12 years. Children were classified as having infantile (N ¼ 30; onset 12 months) or late-onset (N ¼ 78; onset at 18-48 months) accommodative ET. Cycloplegic refractions culled from medical records were converted into spherical equivalent (SEQ). RESULTS. Although the initial visit right eye SEQ was similar for the infantile and late-onset groups (þ5.86 6 1.28 and þ5.67 6 1.26 D, respectively), there were different developmental changes in refractive error. Neither group had a significant decrease in hyperopia before age 7 years, but after 7 years, the infantile group experienced a myopic shift of À0.43 D/y. The late-onset group did not experience a myopic shift at 7 to 12 years. Among amblyopic children, a slower myopic shift was observed for the amblyopic eye. Among anisometropic children, the more hyperopic eye experienced more myopic shift than the less hyperopic eye. CONCLUSIONS. Children with infantile accommodative ET experienced prolonged hyperopia followed by a myopic shift after 7 years of age, consistent with dissociation between infantile emmetropization and school age myopic shift. In contrast, children with late-onset accommodative ET had little myopic shift before or after 7 years.

Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 2015

Recent evidence suggests that amblyopia results in fixation instability and atypical saccades. Re... more Recent evidence suggests that amblyopia results in fixation instability and atypical saccades. Reading is a vision-reliant ability that requires sequential eye movements, including forward and regressive saccades. This study investigated reading and associated eye movements in school-age amblyopic children. Amblyopic children with strabismus and/or anisometropia (n = 29) were compared to nonamblyopic children treated for strabismus (n = 23) and normal control children (n = 21). While fitted with the ReadAlyzer, an eye movement recording system, children silently read a grade-level paragraph of text during binocular viewing. Reading rate, number of forward and regressive saccades per 100 words, and fixation duration were determined. Comprehension was evaluated with a 10-item quiz; only data from children with at least 80% correct responses were included. Amblyopic children read more slowly and had more saccades compared with nonamblyopic children with treated strabismus and normal co...

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Background-Contrast-balanced dichoptic experience with perceptual-learning tasks or simple games ... more Background-Contrast-balanced dichoptic experience with perceptual-learning tasks or simple games has been shown to improve visual acuity significantly in amblyopia. However, these tasks are intensive and repetitive, and up to 40% of unsupervised patients are noncompliant. We investigated the efficacy of a potentially more engaging movie method to provide contrastbalanced binocular experience via complementary dichoptic stimulation. Methods-Eight amblyopic children 4-10 years of age were enrolled in a prospective cohort study to watch 3 dichoptic movies per week for 2 weeks on a passive 3D display. Dichoptic versions of 18 popular animated feature films were created. A patterned image mask of irregularly shaped blobs was multiplied with the movie images seen by the amblyopic eye and an inverse mask was multiplied with the images seen by the fellow eye. Fellow-eye contrast was initially set at a reduced level that allowed binocular vision and was then incremented by 10% at each visit. Best-corrected visual acuity, random dot stereoacuity, and interocular suppression were measured at baseline and 2 weeks. Results-Mean amblyopic eye visual acuity (with standard error of the mean) improved from a logarithm of minimum angle of resolution of 0.72 ± 0.08 at baseline to 0.52 ± 0.09 (P = 0.003); that is, 2.0 lines of improvement at the 2-week outcome visit. No significant change in interocular suppression or stereoacuity was found.

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2015

Journal of American Association for Pediatric Ophthalmology and Strabismus, 2014

Background-Recent experimental evidence supports a role for binocular visual experience in the tr... more 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 (t 4 = 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 t 44 = 4.93; P < 0.0001). Stereoacuity did not significantly improve (t 44 = 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 (t 43 = 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.

JAMA Ophthalmology, 2015

Repeated experience with dichoptic perceptual learning tasks and dichoptic game play have been sh... more Repeated experience with dichoptic perceptual learning tasks and dichoptic game play have been shown to be effective in improving the visual acuity of amblyopic children and adults. 1-4 However, whether the visual acuity gains achieved with binocular treatment are long lasting has not yet been addressed. We examined the durability of visual acuity improvements obtained as a result of binocular iPad game play in childhood amblyopia.