Most adults can remember a time from their childhoods where they observed another child wearing a pirate-like eye patch – and not at Halloween. In fact, maybe they were the child wearing the eye patch.
Whether the child was the observer or the wearer, the chances are that the eye patch was worn to treat what is colloquially called “lazy eye,” a condition known to medical specialists as amblyopia where one eye is weaker than the other.
Amblyopia occurs in about 3 percent of children and has traditionally been treated by “patching,” or covering the stronger eye with a patch in order to encourage the weaker eye to work harder and thus to gain greater eye-brain connection.
Though patching is an effective treatment, compliance can be a major issue. And even if children are perfectly compliant, in the process of treating a visual problem, patching may bring with it emotional and social problems; namely, through self-consciousness a child may feel or bullying the child may receive for wearing the patch.
But it appears researchers have found a way to effectively treat amblyopia without patching, and in a truly win-win proposition, to make treatment fun.
The treatment, in the form of an iPad based game called Captain Lazy Eye, suggests that it may not only substitute for patching but work better than this traditional treatment.
As recounted in the JAMA Ophthalmology, 28 children aged 4 to 10 with a lazy eye participated in either an iPad game treatment group or an eye patch treatment group.
As explained by study author Krista Kelly, a postdoctoral fellow with the Crystal Charity Ball Pediatric Vision Evaluation Center at the Retina Foundation of the Southwest, “ The game required the kids to wear special glasses with red and green lenses, similar to 3D glasses, that separate game elements seen by each eye. For example, the stronger, healthy eye could see reduced-contrast elements, the amblyopic eye could see high-contrast elements, and both eyes could pick up high-contrast background images. The weaker eye is forced to work harder to keep up.”
Those in the game-treatment group played the game one hour per day, five days per week for two weeks, totalling 10 hours of treatment.
Those in the patch-treatment group wore the eye patch for two hours per day, seven days per week for two weeks, totalling 28 hours of treatment.
Not only did the game-treatment stack up to traditional path-treatment, it markedly outperformed it: after just two weeks of treatment, significantly more improvement was seen in the game-treated children than in the path-treated children.
“We found that the game was better than patching and children in that group improved twice as much,” Kelly confirmed.
Researchers were encouraged to discover that the game-treated group showed this significantly greater improvement with less than half as many hours of treatment as did the patch-treated group. (10 vs 28 hours).
Specifically, the authors reported that: “39 percent of the children in the iPad game group achieved 20/32 vision or better, compared with only 7 percent of the kids in the eye patch group.”
In their next move, researchers transferred patch-treated children to the game-treatment group, assigning them the same treatment protocols as the game-treated children.
Over the next two weeks, all study participants played the iPad game, with the former patch-treated group achieving the same improvements as seen in the original game-treated group.
Says Kelly about the findings: “The preliminary studies so far show promise but are only short term. We want to try adding new games, and we definitely want them to play it more than four weeks.”
Because early visual input plays a powerful in mapping the brain, it’s critical to catch amblyopia as early as possible. “If one of your eyes doesn’t have visual input, you map more monocular vision. Or if one muscle is really weak, you’ll map the brain really differently for the rest of your life,” Wendy Sue Swanson, executive director of Digital Health at Seattle Children’s Hospital and a pediatrician at The Everett Clinic in Mill Creek, Washington.
Swanson, who was not involved in the study, explained that the study was small but strong because it was populated with children presenting with muscle-related lazy eye and well as other lazy eye characterized by other visual conditions.
One of the things that struck Swanson about the study was the beneficial use of “screen time,” something that parents are often cautioned regulating on behalf of their children.
Swanson also affirmed the basic orientation of the study in its aim to achieve treatment efficacy in a way that proved to be enjoyable to the children, thus enhancing compliance and potentially solving for the emotional and social problems that patch-treatment can generate.
“I like the beautiful overlay of thinking in this study — about knowing what a standard of care is for an intervention and then using a tool to make it more engaging and child centered,” said Swanson.
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