This innovative, home-based therapy have been proven effective in restoring steroacuity in children. Compliance with the protocol is monitored online, while the random-dot stimuli make cheating impossible during training. This technique is designed for young patients with a history of anisometropic or a strabismic amblyopia.
With no ocular deviation, this small visual acuity value of at least dot eight and gross stereopsis. The protocol is part of the vast body of research into perceptual learning as applied to a treatment of amblyopia. Before beginning the training, perform a baseline optometric evaluation to ensure that all of the appropriate inclusion and exclusion criteria have been met.
Measure the best corrected distance logarithmic visual acuity with a digital screen. To check for the absence of strabismus, use a monocular cover/uncover test and stimulate accommodation with the letter acuity score of 20/30, to ensure that the patient looks at the letter with the fovea when performing the fixing movement. Measure the global stereo acuity with a random dot stereogram conducted according to the manufacturer's instructions.
Measure the local stereo acuity using a contour test with a word circles test conducted according to the manufacturer's instructions. Then measure the refractive error by cycloplegic refraction following the Pediatric Eye Disease Investigator Group guidelines. Use a slit lamp to rule out any ocular pathology in the anterior and posterior poles, respectively.
At the patient's first optometric center visit, create a patient profile in the game surface application and set the patient's interpupillary distance. Then, install the video game in the patient's personal laptop. Click on the configuration panel to configure the game and set the physical dimensions of the patient's computer screen.
Then have the patient put on the anaglyph glasses with the red filter over the left eye. To measure the patient's stereopsis basal acuity using the computerized stereoscopic game, have the patient sit at an 80-centimeter distance from the computer screen and instruct the patient not to try to cheat the program by moving closer to the screen. Parents should make sure that children don't move closer to the screen and inadvertently make the stereoacuity task easier.
Dim the lights in the room to avoid any reflections on the computer screen, and explain that the program takes the form of a video game, in which a random dot image conceals a hidden silhouette that can only be seen in three dimensions while wearing the anaglyph glasses. Instruct the patient to use the mouse to indicate when the silhouette appears, by selecting one figure from the four options shown at the bottom of the screen. If the correct corresponding figure has been selected, the software will emit a high pitched sound, and the correct image will appear in the form of a full color picture as a reward.
If the answer is incorrect, the software will emit a deep sound, And the patient will still have two more attempts to find the right answer. If there are three consecutive wrong answers, the software will show the correct answer. After each trial, the software will generate a new screen with a random dot image concealing a new hidden silhouette.
When the patient has finished the practice trial, show the patient how to access the exercises for performing the trials at home. Explain that the patient must follow a course of training using the computerized stereoscopic game at home five days a week for a total of 60 eight-minute sessions, and that the research team will have access to their compliance and results data in the cloud. Perform checkup visits with the patient upon the completion of every 15 therapy sessions within three weeks of the initial visit.
And check both the compliance and stereopsis results data in the patient's profile in the game service application. Remind the parents of the patients and the patients about the importance of respecting the working distance from the screen and remind the parents of the patients and the patients about the importance of compliance. Then use the computerized stereoscopic game to measure the patient's stereopsis.
Upon the completion of the required 60 therapy sessions, perform the first post-treatment optometric evaluation, and schedule and perform a follow-up evaluation six months after the completion of the study to confirm the stability of the results. While visual acuity among the subjects remained stable during and post-therapy, in this representative analysis, the stereoacuity improved in a significant number of subjects. When the means, medians, and minimum and maximum values of the test scores were analyzed using the Mann-Whitney U test, the stereo acuity was further determined to have improved significantly after treatment.
To obtain high compliance, it is important to explain to patients that the activity is recorded in real-time in the cloud, and that the optometrist can track their activity. This procedure represents the last phase of amblyopia treatment. Our main challenge, especially with children, is compliance.
Because we can track the participant activity remotely, we can detect non-compliance and correct the behavior early on. The application of the underlying mechanisms of perceptual learning from amblyopia treatment is still controversial. Our innovative procedure employs random dot stimuli to use stereopsis.
