Patch-free streaming contrast-rebalanced dichoptic cartoons versus patching for treatment of amblyopia in children aged 3 to 5 years: a pilot, randomized clinical trial.

BACKGROUND: We developed and tested a dichoptic treatment designed for younger children that can be viewed freely and involves a dichoptic manipulation of a popular animation series that enables contrast-rebalancing without disrupting fusion. Our aim was to assess whether this novel amblyopia treatment is superior to patching in children aged 3-5 years. METHODS: A total of 34 children with amblyopia were randomly assigned to contrast-rebalanced dichoptic cartoons (4 hours/week) or patching (14 hours/week) for 2 weeks. Children in the cartoon group continued watching cartoons for an additional 2 weeks. Designed to target the youngest and most treatable children, the dichoptic cartoons presented the entire scene to the amblyopic eye at 100% contrast, while the fellow eye view was presented at reduced contrast with the main character omitted. Best-corrected visual acuity (BCVA), stereoacuity, suppression, and manual dexterity were measured at each visit. RESULTS: After 2 weeks, improvement in amblyopic eye BCVA was greater for dichoptic treatment than for patching, with a mean improvement of 0.11 ± 0.08 versus 0.06 ± 0.09 logMAR, respectively (P = 0.04). Stereoacuity, suppression, and manual dexterity did not improve significantly more in the dichoptic group than the patching group at 2 weeks. After 4 weeks of dichoptic cartoon treatment, mean visual acuity improvement in the dichoptic group was 0.16 logMAR (95% CI, 0.10-0.21). CONCLUSIONS: In our study cohort, a contrast-rebalanced dichoptic cartoon was more effective than patching in treating childhood amblyopia after 2 weeks. Dichoptic cartoons that rebalance contrast to overcome suppression provide an additional treatment option for amblyopia in young children.

Kinematic Assessment of Fine Motor Skills in Children: Comparison of a Kinematic Approach and a Standardized Test.

Deficits in fine motor skills have been reported in some children with neurodevelopmental disorders such as amblyopia or strabismus. Therefore, monitoring the development of motor skills and any potential improvement due to therapy is an important clinical goal. The aim of this study was to test the feasibility of performing a kinematic assessment within an optometric setting using inexpensive, portable, off-the-shelf equipment. The study also assessed whether kinematic data could enhance the information provided by a routine motor function screening test (the Movement Assessment Battery for Children, MABC). Using the MABC-2, upper limb dexterity was measured in a cohort of 47 typically developing children (7-15 years old), and the Leap motion capture system was used to record hand kinematics while children performed a bead-threading task. Two children with a history of amblyopia were also tested to explore the utility of a kinematic assessment in a clinical population. For the typically developing children, visual acuity and stereoacuity were within the normal range; however, the average standardized MABC-2 scores were lower than published norms. Comparing MABC-2 and kinematic measures in the two children with amblyopia revealed that both assessments provide convergent results and revealed deficits in fine motor control. In conclusion, kinematic assessment can augment standardized tests of fine motor skills in an optometric setting and may be useful for measuring visuomotor function and monitoring treatment outcomes in children with binocular vision anomalies.

Amblyopia is associated with impaired balance in 3-6-year-old children in China.

Purpose: School-age children in China have more advanced motor development than their North American counterparts. This is likely due to cultural differences in children's regular motor activities. It is unknown whether the motor function impairments associated with binocular visual disorders (BVDs) such as amblyopia in children raised in North America exist for children raised in China. Design: Prospective case-control study. Methods: A major tertiary eye hospital in China tested children aged 3 to <7 (n = 63) belonging to three groups: anisometropic or strabismic amblyopia (n = 22), anisometropia or strabismus without amblyopia (n = 20), or controls (n = 21). The main outcome measure was motor function scores (Movement Assessment Battery for Children 2nd edition). Results: Balance scores varied significantly across groups (F 2,61 = 4.2, p = 0.02) with the amblyopia group (mean ± SD: 12.5 ± 3.0) exhibiting significantly poorer scores than controls (14.8 ± 2.3). The no-amblyopia BVD group (12.8 ± 3.1) did not differ significantly from the other groups. Manual dexterity, catching and throwing and total scores did not vary significantly across the three groups. A separate pre-planned comparison of only the amblyopia and control groups revealed significantly poorer total motor scores in the amblyopia group (10.1 ± 3.2) vs. controls (12 ± 2.4). A linear regression model was unable to significantly predict associations between total motor score and binocular function score (standardized ß = -0.09, 95%, p = 0.7), amblyopia etiology (standardized ß = 0.14, 95%, p = 0.4), or inter-ocular acuity difference (standardized ß = -0.18, 95%, p = 0.4), in the amblyopia group. Conclusion: Amblyopia is associated with motor function impairment in children raised in China. Motor deficits that may impact everyday activities have been observed in patients with amblyopia across multiple cultures.

Vection Responses in Patients With Early Glaucoma.

PURPOSE: Our lab has previously shown that patients with early glaucoma have longer vection latencies than controls. We attempted to explain this finding using a combined index of structure and function (CSFI), as proposed by Medeiros and colleagues. The CSFI estimates the proportion of retinal ganglion cell loss. METHODS: Roll and circular vection were evoked using a back-projected screen (experiment 1) and the Oculus Rift system (experiment 2). Vection latency and duration were measured using a button response box. In experiment 1, tilt angles were measured with a tilt sensor, whereas subjective tilt was determined using a joystick attached to a protractor. In experiment 2, subjective vection strength was rated on a 1 to 10 scale. These measurements were compared with the CSFI, which utilizes visual field and optical coherence tomography data. RESULTS: For experiment 1 we tested 22 patients (mean age, 70.3±6 y) with glaucoma and 18 controls (mean age, 54.6±9 y); and for experiment 2 we tested 24 patients (mean age, 71.1 ±5 y) and 23 controls (mean age 61.4±10 y), but not all patients experienced vection. In both experiments, vection latency was significantly longer for patients than for controls (smallest P=0.02). The CSFI was not related to vection latency, duration, or objective and subjective measures of vection strength (smallest P=0.06) in either experiment. CONCLUSIONS: Two experiments have replicated the finding that vection responses are longer in patients with glaucoma than in controls; however, the CSFI is not related to vection responses.

Repeatability of Nidek MP-1 Fixation Measurements in Patients With Bilateral Central Field Loss.

PURPOSE: Visual performance in patients with bilateral central field loss is related to fixation stability. This study evaluated the repeatability of visual-fixation parameters in patients with bilateral central field loss, measured with the MP-1 microperimeter for fixation durations on the order of 15 to 30 seconds. METHODS: Bivariate contour ellipse area (BCEA), and the eccentricity and meridian of the preferred retinal locus (PRL) were determined in 56 eyes of 56 patients, sampled at two investigational sites. Repeatability and agreement were assessed by estimating 95% limits of agreement for each parameter from two fixation examinations conducted on the same day. RESULTS: The 95% confidence intervals (CI) for log BCEA and for PRL eccentricity and meridian were ±0.67 log deg2, ±2.0°, and ±65.9°, respectively. Each CI decreased substantially if a small number of outlying data points were excluded. For all parameters, the mean difference between the two fixation examinations was close to zero. CONCLUSIONS: For most patients with bilateral central field loss, the repeatability of estimated BCEA and PRL eccentricity and meridian is good. When repeated estimates of fixation parameters do not agree, the absence of a well-developed PRL or the use of multiple PRLs may be suspected.