Preliminary results from the use of the novel Interactive binocular treatment (I-BiT) system, in the treatment of strabismic and anisometropic amblyopia.

BACKGROUND: We have developed a novel application of adapted virtual reality (VR) technology, for the binocular treatment of amblyopia. We describe the use of the system in six children. METHODS: Subjects consisted of three conventional treatment 'failures' and three conventional treatment 'refusers', with a mean age of 6.25 years (5.42-7.75 years). Treatment consisted of watching video clips and playing interactive games with specifically designed software to allow streamed binocular image presentation. RESULTS: Initial vision in the amblyopic eye ranged from 6/12 to 6/120 and post-treatment 6/7.5 to 6/24-1. Total treatment time was a mean of 4.4 h. Five out of six children have shown an improvement in their vision (average increase of 10 letters), including those who had previously failed to comply with conventional occlusion. CONCLUSIONS: Improvements in vision were demonstrable within a short period of time, in some children after 1 h of treatment. This system is an exciting and promising application of VR technology as a new treatment for amblyopia.

Modified virtual reality technology for treatment of amblyopia.

PURPOSE: The conventional patching/occlusion treatment for amblyopia sometimes gives disappointing results for a number of reasons: it is unpopular, prolonged, frequently resulting in poor or noncompliance, and also disrupts fusion. The aim of this research was to develop a novel virtual-reality (VR)-based display system that facilitates the treatment of amblyopia with both eyes stimulated simultaneously. METHODS: We have adopted a multidisciplinary approach, combining VR expertise with a team of ophthalmologists and orthoptists to develop the Interactive Binocular Treatment (I-BiT) system. This system incorporates adapted VR technology and specially written software providing interactive 2D and 3D games and videos to the patient via a stereo (binocular) display, and a control screen for the clinician. RESULTS: We developed a prototype research system designed for treatment of amblyopia in children. CONCLUSIONS: The result is a novel way to treat amblyopia, which allows binocular treatment. It is interactive, and as it is partially software based, can be adapted to suit the age/ability, and needs of the patient. This means that the treatment can be made captivating and enjoyable. Further research is on-going to determine the efficacy of this new modality in the treatment of amblyopia.

Infective keratitis in older patients: a 4 year review, 1998-2002.

BACKGROUND/AIM: There are few clinical series in the literature of infective keratitis in the elderly, even though this age group constitutes a significant proportion of those affected by this condition. The authors aimed to determine the incidence and risk factors for infective keratitis in those over 60 years, the causative organisms, antibiotic susceptibilities, visual and tectonic outcome, and surgical intervention rate. METHODS: A retrospective review of all patients aged 60 years and over admitted to the Sydney Eye Hospital with a diagnosis of infective keratitis, between September 1998 and December 2002. RESULTS: 190 patients were identified with a mean age of 75.5 (SD 9.6) years (range 60-101). Local risk factors were found in 93.7%, and systemic risk factors in 27.9%. Organisms were cultured in 62.8%, and 7.9% had positive herpes simplex virus (HSV) polymerase chain reaction (PCR). Perforation or severe thinning occurred in 36% overall, but in 80% with positive HSV PCR. Acute surgical intervention was required in 43.7%, with acute penetrating keratoplasty performed in 17.9%, and 8.9% required evisceration. Mean presenting visual acuity was 1.82 (SD 1.24), equivalent to 6/300, excluding 26.3% with vision of light perception (LP) or worse. Mean final visual acuity was 1.24 (SD 1.16), equivalent to 6/100, excluding 19.5% with vision of LP or worse (p<0.0005). CONCLUSIONS: The elderly represent a distinct clinical group in the context of microbial keratitis. Predisposing factors are very common, they present with poor vision, have a high complication and surgical intervention rate, and a poor visual outcome compared to younger patients. The microbiological spectrum is similar to younger age groups, except that HSV is more common and may increase the risk of severe corneal thinning and perforation. Most bacterial isolates remain sensitive to currently available antibiotic preparations.