Motion-Defined Form Perception in Deprivation Amblyopia.

Purpose: The purpose of this study was to assess motion-defined form perception, including the association with clinical and sensory factors that may drive performance, in each eye of children with deprivation amblyopia due to unilateral cataract. Methods: Coherence thresholds for orientation discrimination of motion-defined form were measured using a staircase procedure in 30 children with deprivation amblyopia and 59 age-matched controls. Visual acuity, stereoacuity, fusion, and interocular suppression were also measured. Fixation stability and fellow-eye global motion thresholds were measured in a subset of children. Results: Motion-defined form coherence thresholds were elevated in 90% of children with deprivation amblyopia when viewing with the amblyopic eye and in 40% when viewing with the fellow eye. The deficit was similar in children with a cataract that had been visually significant at birth (congenital) and in children for whom the cataract appeared later in infancy or childhood (developmental). Poorer motion-defined form perception in amblyopic eyes was associated with poorer visual acuity, poorer binocular function, greater interocular suppression, and the presence of nystagmus. Fellow-eye deficits were not associated with any of these factors, but a temporo-nasal asymmetry for global motion perception in favor of nasalward motion suggested a general disruption in motion perception. Conclusions: Deficits in motion-defined form perception are common in children with deprivation amblyopia and may reflect a problem in motion processing that relies on binocular mechanisms.

Objective assessment of control compared with clinical triple office control score in children with intermittent exotropia.

Poor control of intermittent exotropia may be used as an indication for surgery. However, control fluctuates during the day and from day to day. The standardized triple office control score (mean of three scores on a 6-point ordinal scale) is representative of repeated assessments throughout the day, but lacks validation against an objective measure of eye movements. We report the agreement between the triple office control score measured by the referring eyecare professional and lab-measured vergence instability using an EyeLink video eye tracker. Near and distance triple office control scores were moderately correlated with vergence instability. Near, but not distance, triple office control score was moderately correlated with the percentage of time intermittent exotropia was manifest during EyeLink recording. Larger triple office control scores for intermittent exotropia provide a meaningful description of larger vergence instability, supporting its use in clinical decisions and as a measure in clinical trials.

Risk of recurrence after cessation of dichoptic, binocular treatment of amblyopia.

Contrast-rebalanced dichoptic games and videos have been shown to be an effective treatment for childhood amblyopia. Whether the visual acuity gains achieved with these binocular treatments are long-lasting has not been determined. In this prospective cohort study of 100 consecutive amblyopic children who improved by ≥0.2 logMAR or obtained ≤0.2 logMAR amblyopic eye visual acuity during a binocular treatment clinical trial, risk of recurrence was 24% (95% CI, 16%-35%) at up to 3 years' follow-up according to Kaplan-Meier survival analysis, which accounts for censored, truncated, and missing data. Risk of recurrence was similar among children who required additional treatment for residual amblyopia after 4-8 weeks of dichoptic treatment (n = 62 [19%]; 95% CI, 10%-34%) and those who did not (n = 38 [32%]; 95% CI, 18%-52%; P = 0.12). There was no association between recurrence and age, visual acuity at the end of binocular treatment, stereoacuity, or ocular alignment. In a secondary analysis to compare rates of recurrence with published data, risk of recurrence in the subset of children who had no additional treatment for residual amblyopia (28%) was similar to the reported recurrence after cessation of successful patching and atropine (24%) at 12 months. Children with successful binocular treatment of amblyopia require monitoring for recurrence of amblyopia.

Slow Binocular Reading in Amblyopic Children Is a Fellow Eye Deficit.

SIGNIFICANCE: Amblyopic children read 25% slower than their peers during binocular silent reading. PURPOSE: We compared binocular reading to fellow eye reading to determine whether slow reading in amblyopic children is due to binocular inhibition; that is, the amblyopic eye is interfering during binocular reading. METHODS: In a cross-sectional study, 38 children with amblyopia and 36 age-similar control children who completed grades 1 to 6 were enrolled. Children silently read grade-appropriate paragraphs during binocular reading and fellow eye reading while wearing ReadAlyzer eye-tracking goggles (Compevo AB, Stockholm, Sweden). Reading rate, number of forward saccades, number of regressive saccades, and fixation duration were analyzed between groups and between viewing conditions. We also examined whether sensory factors (amblyopia severity, stereoacuity, suppression) were related to slow reading. RESULTS: For amblyopic children, binocular reading versus fellow eye reading did not differ for reading rate (176 ± 60 vs. 173 ± 53 words per minute, P = .69), number of forward saccades (104 ± 35 vs. 97 ± 33 saccades/100 words, P = .18), number of regressive saccades (21 ± 15 vs. 22 ± 13 saccades/100 words, P = .75), or fixation duration (0.31 ± 0.06 vs. 0.32 ± 0.07 seconds, P = .44). As expected, amblyopic children had a slower reading rate and more forward saccades than control children during binocular reading and fellow eye reading. Slow reading was not related to any sensory factors. CONCLUSIONS: Binocular reading did not differ from fellow eye reading in amblyopic children. Thus, binocular inhibition is unlikely to play a role in slow binocular reading and is instead a fellow eye deficit that emerges from a disruption in binocular visual experience during development.

Binocular amblyopia treatment improves manual dexterity.

PURPOSE: To determine whether deficits in manual dexterity in children with amblyopia improve after binocular amblyopia treatment and whether improvements are related to age at treatment, baseline sensory status, or amount of improvement in sensory status with treatment. METHODS: Manual dexterity (Movement Assessment Battery for Children-2), visual acuity, fusion, suppression, and stereoacuity were measured at baseline and after 4-8 weeks of binocular amblyopia in 134 children with amblyopia, including 75 children in the "younger group" (aged 3 to <7 years) and 59 in the "older group" (aged 7-10 years), and in 40 age-similar control children. RESULTS: Baseline manual dexterity standard scores of amblyopic children were significantly below those of controls in both the younger (8.81 ± 0.33 vs 11.80 ± 0.60 [P < 0.0001]) and older groups (7.19 ± 0.34 vs 9.75 ± 0.57 [P = 0.00013]). After 4-8 weeks of binocular amblyopia treatment, the younger group standard score improved to 9.85 ± 0.35 and the older group improved to 8.08 ± 0.39, but both groups remained significantly lower than controls (P = 0.03 and P = 0.01, resp.). Improvement in manual dexterity standard score was not associated with any baseline factors but was weakly correlated with the amount of visual acuity improvement (rs = 0.26; 95% CI, 0.09-0.41) CONCLUSIONS: Manual dexterity impairments are common among children with amblyopia. In our study cohort, binocular amblyopia treatment improved visual acuity and manual dexterity.

Temporal Eye-Hand Coordination During Visually Guided Reaching in 7- to 12-Year-Old Children With Strabismus.

Purpose: We recently found slow visually guided reaching in strabismic children, especially in the final approach. Here, we expand on those data by reporting saccade kinematics and temporal eye-hand coordination during visually guided reaching in children treated for strabismus compared with controls. Methods: Thirty children diagnosed with esotropia, a form of strabismus, 7 to 12 years of age and 32 age-similar control children were enrolled. Eye movements and index finger movements were recorded. While viewing binocularly, children reached out and touched a small dot that appeared randomly in one of four locations along the horizontal meridian (±5° or ±10°). Saccade kinematic measures (latency, accuracy and precision, peak velocity, and frequency of corrective and reach-related saccades) and temporal eye-hand coordination measures (saccade-to-reach planning interval, saccade-to-reach peak velocity interval) were compared. Factors associated with impaired performance were also evaluated. Results: During visually guided reaching, strabismic children had longer primary saccade latency (strabismic, 195 ± 29 ms vs. control; 175 ± 23 ms; P = 0.004), a 25% decrease in primary saccade precision (0.15 ± 0.06 vs. 0.12 ± 0.03; P = 0.007), a 45% decrease in the final saccade precision (0.16 ± 0.06 vs. 0.11 ± 0.03; P < 0.001), and more reach-related saccades (16 ± 13% of trials vs. 8 ± 6% of trials; P = 0.001) compared with a control group. No measurable stereoacuity was related to poor saccade kinematics. Conclusions: Strabismus impacts saccade kinematics during visually guided reaching in children, with poor binocularity playing a role in performance. Coupled with previous data showing slow reaching in the final approach, the current saccade data suggest that children treated for strabismus have not yet adapted or formed an efficient compensatory strategy during visually guided reaching.

Dichoptic and Monocular Visual Acuity in Amblyopia.

PURPOSE: Standard-of-care assessment for children with amblyopia includes measuring amblyopic eye best-corrected visual acuity (AE BCVA) with the fellow eye occluded. By definition, this abolishes the interocular suppression fundamental to amblyopia. Thus, measured AE BCVA may not accurately represent that eye's contribution to natural binocular viewing. We compared dichoptic and monocular AE BCVA and examined whether any differences were associated with eye-hand coordination or reading speed. DESIGN: Cross-sectional study. METHODS: Dichoptic and monocular AE BCVA of children aged 6-12 years (42 with amblyopia, 24 with recovered normal AE BCVA, 30 control) were measured. Stereoacuity, suppression, eye-hand coordination, and reading speed were also assessed. RESULTS: Overall, 81% of amblyopic children had worse dichoptic than monocular AE BCVA (mean difference=0.15±0.11 logMAR; P < .0001), and 71% of children with recovered normal AE BCVA had worse dichoptic than monocular AE BCVA (mean difference = 0.20±0.17 logMAR, P < .0001). Controls had no significant difference. The difference between dichoptic and monocular AE BCVA was correlated with performance in standardized aiming/catching (r = -0.48, 95% CI -0.72, -0.14) and manual dexterity tasks (r = -0.37, 95% CI -0.62, -0.06), and with reading speed (r = -0.38, 95% CI -0.65, -0.03). CONCLUSIONS: Dichoptic AE BCVA deficits were worse than monocular AE BCVA deficits and were associated with reduced stereoacuity and suppression, consistent with the hypothesis that binocular dysfunction plays a role. Further, impaired eye-hand coordination and slow reading were associated with dichoptic, but not monocular, AE BCVA. Some children with amblyopia may benefit from extra time for school tasks requiring eye-hand coordination or reading.

Randomized clinical trial of streaming dichoptic movies versus patching for treatment of amblyopia in children aged 3 to 7 years.

Contrast-rebalanced dichoptic movies have been shown to be an effective binocular treatment for amblyopia in the laboratory. Yet, at-home therapy is a more practical approach. In a randomized clinical trial, we compared dichoptic movies, streamed at-home on a handheld 3D-enabled game console, versus patching as amblyopia treatment. Sixty-five amblyopic children (3-7 years; 20/32-125) were randomly assigned to one of two parallel arms, binocular treatment (3 movies/week) or patching (14 h/week). The primary outcome, change in best corrected visual acuity (BCVA) at the 2-week visit was completed by 28 and 30, respectively. After the primary outcome, both groups of children had the option to complete up to 6 weeks of binocular treatment. At the 2-week primary outcome visit, BCVA had improved in the movie (0.07 ± 0.02 logMAR; p < .001) and patching (0.06 ± 0.01 logMAR; p < 0.001) groups. There was no significant difference between groups (CI95%: - 0.02 to 0.04; p = .48). Visual acuity improved in both groups with binocular treatment up to 6 weeks (0.15 and 0.18 logMAR improvement, respectively). This novel, at-home, binocular movie treatment improved amblyopic eye BCVA after 2 weeks (similar to patching), with additional improvement up to 6 weeks. Repeated binocular visual experience with contrast-rebalanced binocular movies provides an additional treatment option for amblyopia.Clincaltrials.gov identifier: NCT03825107 (31/01/2019).

Web-based visual acuity testing for children.

PURPOSE: To evaluate a newly developed, web-based system for at-home pediatric visual acuity testing and to compare results with standard in-office visual acuity test results. METHODS: Children aged 3-12 years with and without visual deficits were enrolled (N = 65; 130 eyes). Monocular visual acuity was tested in-office using the ATS-HOTV (ages 3-6) or E-ETDRS (ages 7-12) protocol. Each child's family was emailed a link to a web-based version of the same visual acuity test for at-home testing. Equivalence was evaluated by using a linear mixed model to estimate the mean difference between in-office and at-home visual acuity test results and the corresponding two-sided 95% confidence interval. RESULTS: For children tested with the ATS-HOTV protocol, the mean difference between in-office and at-home visual acuity test results was 0.01 log MAR (95% CI, -0.06 to 0.09). For children tested with the E-ETDRS protocol, the mean difference was 0.04 log MAR (95% CI, -0.06 to 0.14). CONCLUSIONS: At-home, web-based ATS-HOTV and E-ETDRS visual acuity test results had excellent concordance with in-office visual acuity testing. If the burden of travel is significant, at-home testing of children's visual acuity may provide the information needed to continue care when it might otherwise be discontinued or delayed.

Reach Kinematics During Binocular Viewing in 7- to 12-Year-Old Children With Strabismus.

Purpose: Eye-hand coordination is essential for normal development and learning. Discordant binocular experience from childhood strabismus results in sensory and ocular motor impairments that can affect eye-hand coordination. We assessed reach kinematics during visually guided reaching in children treated for strabismus compared with controls. Methods: Thirty-six children aged 7 to 12 years diagnosed with esotropia, a form of strabismus, and a group of 35 age-similar control children were enrolled. Reach movements during visually guided reaching were recorded using the LEAP Motion Controller. While viewing binocularly, children reached out and touched a small dot that appeared randomly in one of four locations (±5° or ±10°). Kinematic measures were reach reaction time, total reach duration, peak velocity, acceleration duration, and deceleration duration. Touch accuracy and factors associated with impaired reach kinematics were evaluated. Results: Strabismic children had longer total reach duration (545 ± 60 ms vs. 504 ± 43 ms; P = 0.002), had longer deceleration duration (343 ± 54 ms vs. 312 ± 45 ms; P = 0.010), and were less accurate (93% ± 6% vs. 96% ± 5%, P = 0.007) than controls. No differences were found for reach reaction time, peak velocity, or acceleration duration (all Ps ≥ 0.197). Binocular dysfunction was more related to slow reaching than amblyopic eye visual acuity. Conclusions: Strabismus affects visually guided reaching in children, with slower reaching in the final approach and reduced endpoint accuracy. Binocular dysfunction was predictive of slow reaching. Unlike strabismic adults who show longer acceleration duration, longer deceleration in the final approach in strabismic children indicates a difference in control that could be due to reduced ability to use visual feedback.

Normative pediatric visual acuity using electronic early treatment for diabetic retinopathy protocol.

There is a lack of normative data for children tested with the electronic Early Treatment for Diabetic Retinopathy Study (E-ETDRS) protocol. In the current cross-sectional study, the mean best-corrected normal and 95% lower tolerance limit for E-ETDRS visual acuity by year in children 7-12 years of age was measured. Our objective was to provide a large normative data set for E-ETDRS visual acuity in children for use in clinical management and clinical trials.

Normative Values, Testability, and Validity for a New Preferential Looking Stereoacuity Test.

Introduction: Age norms and testability for 3-5 year old children have been reported for the PASS III stereotest using a pointing response. We aimed to expand the normative data to children as young as 6 months, assess testability, and evaluate validity use of the PASS III as a preferential-looking test for younger children and children with special needs. Methods: 68 control children, 362 children with eye conditions, and 167 children with special needs were tested with the PASS III. Percent testable was calculated for children with and without special needs, normal tolerance limits were determined, and test validity was assessed. Results: In controls, mean PASS III stereoacuity improved from 371 arcsec at 12 months to 174 arcsec at 24 months, and 87 arcsec at 36 months. Testability in the 12, 24, and 36 months age groups were 81%, 87%, and 97% respectively and 92% for special needs children. Comparison to previously published norms and testing in a known nil stereoacuity cohort supported PASS III test validity. Compared to gold standard stereoacuity tests, accuracy of the PASS was 89%. Conclusion: Overall, preferential-looking tests using the PASS III provide a sensitive and specific measure of stereoacuity with high testability for young children and children with special needs.

A pilot randomized trial of contrast-rebalanced binocular treatment for deprivation amblyopia.

BACKGROUND: Binocular neural architecture may be preserved in children with deprivation amblyopia due to unilateral cataract. The purpose of this study was to investigate whether a contrast-rebalanced binocular treatment, recently used with success to treat the interocular suppression and amblyopia in strabismic and anisometropic children, can contribute to rehabilitation of visual acuity in children with deprivation amblyopia secondary to monocular cataract. METHODS: In a pilot randomized trial, 15 children (4-13 years of age) were enrolled and randomized to continue with their current treatment only (n = 7) or to continue with their current treatment and add contrast-rebalanced binocular iPad game play 5 hours/week for 4 weeks (n = 8). The primary outcome was change in visual acuity at 4 weeks. RESULTS: Although 10 of 15 participants were patching, there was little change in visual acuity during the 3 months prior to enrollment. At the 4-week primary outcome visit, the mean improvement in visual acuity for the binocular game group was significantly greater than that for the current-treatment group (0.08 ± 0.10 logMAR vs -0.03 ± 0.05 logMAR [t10.2 = 2.53, P = 0.03]). None of the children who had dense congenital cataract achieved improved visual acuity with binocular treatment. CONCLUSIONS: In this study cohort, visual acuity improved over 8 weeks in children with unilateral deprivation amblyopia who played a binocular contrast-rebalanced binocular iPad game.

A randomized clinical trial of contrast increment protocols for binocular amblyopia treatment.

BACKGROUND: Most clinical trials of contrast-rebalanced binocular amblyopia treatment used a contrast increment protocol of 10% daily with successful play. Paired with a definition of success requiring only 15-30 min/day of gameplay, this increment protocol could allow children to reach 100% fellow eye contrast in 3-9 hours; however, this may not provide adequate therapeutic time with reduced fellow eye contrast. The purpose of this study was to compare the original protocol against three alternative contrast increment protocols designed to increase the number of treatment hours. METHODS: In this prospective study, 63 amblyopic children (4-10 years; amblyopic eye visual acuity, 20/40-125) were randomly assigned one of four daily contrast increment protocols for 4 weeks, all starting with 20% fellow eye contrast: 10%, 5%, 0%, or 10% for first 4 weeks then reset to 20% and repeat 10% increment for the final 4 weeks. Children played contrast-rebalanced games for 1 hour/day, 5 days/week. Best-corrected visual acuity, stereoacuity, and suppression were assessed at baseline and every 2 weeks until the 8-week outcome visit. RESULTS: At baseline, mean amblyopic eye best-corrected visual acuity was 0.47 ± 0.14 logMAR (20/60), improving overall 0.14 ± 0.08 logMAR (1.4 lines; P < 0.0001) at 8 weeks. All four protocols resulted in similar improvement in visual acuity (0.13-0.16 logMAR; all Ps < 0.0002). Stereoacuity and suppression also improved (all Ps < 0.05). CONCLUSIONS: None of the new protocols resulted in less improvement than the original 10% contrast increment protocol. Contrast-rebalanced binocular games yielded significant improvements in visual acuity, stereoacuity, and suppression with or without daily contrast increments.

Associations of Eye-Related Quality of Life With Vision, Visuomotor Function, and Self-Perception in Children With Strabismus and Anisometropia.

Purpose: To evaluate associations between eye-related quality of life (ER-QOL) assessed by the Child Pediatric Eye Questionnaire (Child PedEyeQ) and functional measures (vision, visuomotor function, self-perception) in children with strabismus, anisometropia, or both. Our hypothesis was that children with functional deficits would have lower ER-QOL, and if so, these associations would support the convergent construct validity of the Child PedEyeQ. Methods: We evaluated 114 children (ages 5-11 years) with strabismus, anisometropia, or both. Each child completed the Child PedEyeQ to assess four Rasch-scored domains of ER-QOL: Functional Vision, Bothered by Eyes/Vision, Social, and Frustration/Worry. In addition, children completed one or more functional tests: visual acuity (n = 114), Randot Preschool Stereoacuity (n = 92), contrast balance index (suppression; n = 91), Readalyzer reading (n = 44), vergence instability (n = 50), Movement Assessment Battery for Children-2 manual dexterity (n = 57), and Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (n = 44). Results: Child PedEyeQ Functional Vision domain scores were correlated with self-perception of physical competence (rs = 0.65; 95% confidence interval [CI], 0.35-0.96) and reading speed (rs = 0.47; 95% CI, 0.16-0.77). Bothered by Eyes/Vision domain scores were correlated with self-perception of physical competence (rs = 0.52; 95% CI, 0.21-0.83). Moderate correlations were observed between Social domain scores and vergence instability (rs = -0.46; 95% CI, -0.76 to -0.15) and self-perception of physical competence (rs = 0.43; 95% CI, 0.12-0.73) and peer acceptance (rs = 0.49; 95% CI, 0.18-0.80). Frustration/Worry domain scores were moderately correlated with self-perception of physical competence (rs = 0.41; 95% CI, 0.10-0.71) and peer acceptance (rs = 0.47; 95% CI, 0.16-0.77). Conclusions: Strong and moderate correlations were observed between functional measures and Child PedEyeQ domain scores. These associations provide supporting evidence that the Child PedEyeQ has convergent construct validity.

Binocular reading in children following extraction of a dense congenital or infantile unilateral cataract.

BACKGROUND: Reading relies on ocular motor function, requiring sequential eye movements (forward and regressive saccades). Binocularly discordant input from a dense congenital or infantile cataract is associated with ocular motor dysfunction and may affect the development of reading ability. The purpose of this study was to assess silent, binocular reading in children treated for unilateral congenital or infantile cataract. METHODS: Twenty school-age children (age range, 7-13 years) treated for unilateral congenital (n = 9) or infantile (n = 11) cataract and 49 age-similar control children silently read a grade-appropriate paragraph during binocular viewing. Reading rate (words/min) and the number of forward and regressive saccades (per 100 words) were recorded using the ReadAlyzer. RESULTS: Reading rate in children treated for a unilateral cataract did not differ significantly from controls (174 ± 59 words/min vs 195 ± 54 words/min; P = 0.1). However, they did have significantly more forward saccades (101 ± 33 saccades/100 words vs 87 ± 21 saccades/100 words; P = 0.03) but not regressive saccades (21 ± 14 saccades/100 words vs 16 ± 8 saccades/100 words; P = 0.1) compared with controls. Reading rate was not related to cataract type (congenital vs infantile), visual acuity outcome (poor vs good), or sensory fusion (fail vs pass; all P ≥ 0.1). CONCLUSIONS: Reading rate of children treated for a dense unilateral cataract did not differ from that of controls. Increased forward saccades during reading may be due to fixation instability associated with fusion maldevelopment nystagmus prevalent in children following cataract extraction.

Baseline and Clinical Factors Associated with Response to Amblyopia Treatment in a Randomized Clinical Trial.

SIGNIFICANCE: We sought to identify baseline and clinical factors that were predictive of the response to amblyopia treatment. We report that binocular amblyopia treatment may be especially effective for moderate amblyopia in orthotropic children. PURPOSE: We previously reported results from the primary cohort (n = 28) enrolled in a randomized clinical trial (NCT02365090), which found that binocular amblyopia treatment was more effective than patching. Enrollment of an additional 20 children was pre-planned to provide the opportunity to examine factors that may be predictive of response to amblyopia treatment. METHODS: Forty-eight children (4 to 10 years old) were enrolled, with 24 randomized to contrast-rebalanced binocular game treatment (1 hour a day, 5 days a week) and 24 to patching treatment (2 hours a day, 7 days a week). The primary outcome was change in amblyopic eye best-corrected visual acuity at the 2-week visit. Baseline factors examined were age at enrollment, visual acuity, stereoacuity, and suppression. Clinical factors were etiology, age at diagnosis, prior treatment, and ocular alignment. RESULTS: At 2 weeks, visual acuity improvement was significantly greater with the binocular game than patching. Children with moderate amblyopia and orthotropia had more visual acuity improvement with binocular game play than did those with severe amblyopia. In addition, children who spent more time playing the binocular game had more improvement. We were not able to confidently identify any baseline or clinical factors that were associated with response to patching treatment. CONCLUSIONS: Binocular amblyopia treatment was more effective among orthotropic children with moderate amblyopia than among children with microtropia or severe amblyopia.

Improved monitoring of adherence with patching treatment using a microsensor and Eye Patch Assistant.

BACKGROUND: Use of a microsensor has been suggested to monitor patching adherence. Application has been limited because the microsensor's small size makes it easy to lose and a swallowing risk. We designed the Eye Patch Assistant (EPA) to hold the small microsensor in place and reduce the risk of loss or swallowing. This study reports the accuracy, precision, ease of use, and comfort for patching with EPA (patch+EPA) to monitor adherence. METHODS: Adults (N = 13) wore an adhesive patch alone or a patch+EPA for 2 hours each, recorded wear time, and completed an ease of use/comfort questionnaire; 30 children wore a patch or patch+EPA and completed the questionnaire. Sensor sampling interval was every 5 minutes or every 1 minute. Sensor accuracy and precision were evaluated by Bland-Altman analysis and 95% limits of agreement, and questionnaire scores compared by Wilcoxon tests. RESULTS: With 5-minute sampling, we found excellent accuracy for adults (mean actual vs recorded time difference, 1.4 minutes) and children (mean difference, -0.9 min). We found high precision for both adults and children (95% limits of agreement half widths of 6.4 minutes and 1.9 minutes, respectively). In adults, the ease of use score for the patch+EPA was lower than the patch (P < 0.01), but the comfort score for the patch+EPA was higher (P < 0.01). For children, scores did not differ significantly. The patch+EPA functioned well between 45° and 82°F. CONCLUSIONS: The patch+EPA was well accepted and monitored adherence accurately and precisely.

Impaired Fellow Eye Motion Perception and Abnormal Binocular Function.

Purpose: Binocular discordance due to strabismus, anisometropia, or both may result in not only monocular visual acuity deficits, but also in motion perception deficits. We determined the prevalence of fellow-eye deficits in motion-defined form (MDF) perception, the ability to identify a two-dimensional (2D) shape defined by motion rather than luminance contrast. We also examined the following: the causative role of reduced visual acuity and binocularity, associations with clinical and sensory factors, and effectiveness of binocular amblyopia treatment in alleviating deficits. Methods: Participants included 91 children with residual amblyopia (strabismic, anisometropic, or both; age, 9.0 ± 1.7 years), 79 nonamblyopic children with treated strabismus or anisometropia (age, 8.5 ± 2.1 years), and 20 controls (age, 8.6 ± 1.5 years). MDF coherence thresholds, visual acuity, stereoacuity, and interocular suppression were measured. Results: MDF deficits, relative to controls, were present in the fellow eye of 23% of children with residual amblyopia and 20% of nonamblyopic children. Stereoacuity and age first patched were correlated with MDF threshold (r = 0.29, 95% CI: 0.09-0.47; r = -0.33, 95% CI: -0.13 to -0.50, respectively). MDF deficits were more common in children treated with patching alone than in those receiving contrast-rebalanced binocular treatment with games or movies (t89 = 3.46; P = 0.0008). The latter was associated with a reduction in mean fellow eye MDF threshold (t26 = 6.32, P < 0.0001). Conclusions: Fellow eye MDF deficits are common and likely reflect abnormalities in binocular cortical mechanisms that result from early discordant visual experience. Binocular amblyopia treatment, which is effective in improving amblyopic eye visual acuity, appears to provide a benefit for the fellow eye.

Binocular amblyopia treatment with contrast-rebalanced movies.

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 (t26 = 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; t25 = 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; t25 = 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.