Gamification to Support Adherence to a Therapeutic Ambylopia Treatment for Children: Retrospective Study Using a Focal Ambient Visual Acuity Stimulation Game

Background The gold standard treatment for amblyopia is patching the better eye. Improvement of visual acuity in the amblyopic eye is significantly impacted by the adherence to the patching therapy. It is known that the overall adherence is rather low. Objective This retrospective study evaluated whether an updated version of attention-binding digital therapeutic games based on the principle of focal ambient visual acuity stimulation (FAVAS) would result in improved patient adherence in 4- to 16-year-old patients with amblyopia associated with anisometropia or strabismus. Methods We analyzed electronically pseudonymized recorded data from patients treated with occlusion therapy and FAVAS therapeutic games. One group used an older version (2015) and the other group used a newer version (2020) that provided more attractive therapeutic games with tablet computer functionality. Objective adherence was calculated by comparing the number of minutes using the therapeutic games as monitored in the automatized logbook versus the prescribed number of minutes for using the games. Results Children in group 2015 (n=138) spent on average 2009.3 (SD 1372.1; range 36-5556) minutes using FAVAS; children in group 2020 (n=129) spent on average 2651.2 (SD 1557.1; range 38-5672) minutes using the newer version. Group 2020 spent on average 641.9 more minutes on FAVAS than group 2015 (t255.49=3.56, P<.001, d=0.45; 95% CI 0.69-0.20). Although patient adherence was very variable, compared to the 55.0% (SD 29.4%) in group 2015, it significantly improved up to 68.5% (SD 33.7%) in group 2020 (t254.38=3.48, P=.001, d=0.44; 95% CI 0.68-0.19). Conclusions FAVAS 2020, with improved gamification aspect as well as tablet computer functionality, increased adherence significantly compared to the earlier version of FAVAS 2015, indicating that FAVAS 2020 could be an effective approach to support adherence to amblyopia treatment. Trial Registration German Clinical Trials Register (DRKS) DRKS00017633; https://drks.de/search/de/trial/DRKS00017633

[1]  M. Ahadi,et al.  Distance Visual Acuity Versus Near Visual Acuity in Amblyopia. , 2021 .

[2]  Sandra Boniquet-Sanchez,et al.  Current Management of Amblyopia with New Technologies for Binocular Treatment , 2021, Vision.

[3]  S. Rychkova,et al.  Comparing the results of the application of moving and stationary sinusoidal gratings in the functionally assisted treatment of meridional amblyopia , 2021, medRxiv.

[4]  Antonio Rodán,et al.  An updated review about perceptual learning as a treatment for amblyopia , 2020, Journal of optometry.

[5]  E. Birch,et al.  A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 7 to 12 Years. , 2019, Ophthalmology.

[6]  Giulio Costantini,et al.  A Practical Primer To Power Analysis for Simple Experimental Designs , 2018 .

[7]  J. Holmes,et al.  A Randomized Trial of a Binocular iPad Game Versus Part-Time Patching in Children Aged 13 to 16 Years With Amblyopia. , 2018, American journal of ophthalmology.

[8]  R. Saxena,et al.  Evaluation of the Role of Monocular Video Game Play as an Adjuvant to Occlusion Therapy in the Management of Anisometropic Amblyopia. , 2017, Journal of pediatric ophthalmology and strabismus.

[9]  Patrick W. C. Ho,et al.  Binocular treatment of amblyopia using videogames (BRAVO): study protocol for a randomised controlled trial , 2016, Trials.

[10]  S. Dadeya,et al.  Television Video Games in the Treatment of Amblyopia in Children Aged 4–7 Years , 2016, Strabismus.

[11]  Jingyun Wang,et al.  Compliance and patching and atropine amblyopia treatments , 2015, Vision Research.

[12]  N. Pfeiffer,et al.  The prevalence of amblyopia in Germany: data from the prospective, population-based Gutenberg Health Study. , 2015, Deutsches Arzteblatt international.

[13]  F. Proudlock,et al.  An educational intervention to improve adherence to high-dosage patching regimen for amblyopia: a randomised controlled trial , 2014, British Journal of Ophthalmology.

[14]  K. Bartz-Schmidt,et al.  Measuring wearing times of glasses and ocular patches using a thermosensor device from orthodontics , 2013, Acta ophthalmologica.

[15]  David B. Petersen,et al.  A randomized trial of increasing patching for amblyopia. , 2013, Ophthalmology.

[16]  H. D. de Koning,et al.  An educational cartoon accelerates amblyopia therapy and improves compliance, especially among children of immigrants. , 2012, Ophthalmology.

[17]  J. Holmes,et al.  Distance versus near visual acuity in amblyopia. , 2011, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[18]  A. Ganesh,et al.  Compliance of amblyopic patients with occlusion therapy: A pilot study , 2009, Oman journal of ophthalmology.

[19]  L. Pillunat,et al.  Long-Term Application of Computer-Based Pleoptics in Home Therapy: Selected Results of a Prospective Multicenter Study , 2008, Strabismus.

[20]  M. B. Wheeler Amblyopia therapy. , 2007, Ophthalmology.

[21]  M. Moseley,et al.  Objectively monitored patching regimens for treatment of amblyopia: randomised trial , 2007, BMJ : British Medical Journal.

[22]  S. Loudon,et al.  Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor. , 2006, Investigative ophthalmology & visual science.

[23]  J. Felius,et al.  A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic amblyopia in children. , 2006, Ophthalmology.

[24]  F. Proudlock,et al.  A randomized controlled trial of unilateral strabismic and mixed amblyopia using occlusion dose monitors to record compliance. , 2005, Investigative ophthalmology & visual science.

[25]  E. Birch,et al.  Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children. , 2005, Archives of ophthalmology.

[26]  S. Loudon,et al.  The History of the Treatment of Amblyopia , 2005, Strabismus.

[27]  D. Stager,et al.  A randomized trial of atropine regimens for treatment of moderate amblyopia in children. , 2004, Ophthalmology.

[28]  M. Moseley,et al.  Treatment dose-response in amblyopia therapy: the Monitored Occlusion Treatment of Amblyopia Study (MOTAS). , 2004, Investigative ophthalmology & visual science.

[29]  Richard W Hertle,et al.  A randomized trial of patching regimens for treatment of moderate amblyopia in children. , 2003, Archives of ophthalmology.

[30]  G Lennerstrand,et al.  Amblyopia in 4-year-old children treated with grating stimulation and full-time occlusion; a comparative study. , 1983, British Journal of Ophthalmology.

[31]  R F Hess,et al.  Preliminary results of a physiologically based treatment of amblyopia. , 1978, The British journal of ophthalmology.

[32]  D. Hubel,et al.  The period of susceptibility to the physiological effects of unilateral eye closure in kittens , 1970, The Journal of physiology.

[33]  J. Otto,et al.  [PLEOPTIC TRAINING AND THE APPEARANCE OF THE "VERSION PHENOMENON"]. , 1963, Klinische Monatsblatter fur Augenheilkunde.

[34]  S. McKee,et al.  Classification and diversity of amblyopia , 2018, Visual Neuroscience.

[35]  S. Loudon,et al.  Randomised comparison of three tools for improving compliance with occlusion therapy: an educational cartoon story, a reward calendar, and an information leaflet for parents , 2012, Graefe's Archive for Clinical and Experimental Ophthalmology.

[36]  L. Nelson Two-Year Follow-up of a 6-Month Randomized Trial of Atropine Vs Patching for Treatment of Moderate Amblyopia in Children , 2006 .

[37]  T. Seiler,et al.  [Supportive amblyopia treatment by means of computer games with background stimulation; a placebo controlled pilot study of 10 days]. , 2001, Klinische Monatsblatter fur Augenheilkunde.

[38]  J. Otto,et al.  [Effect of optomotor stimulation on the kind of fixation and correction of amblyopic eyes with excentric fixation]. , 1969, Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde.