Lab Study: A binocular iPad treatment for amblyopic children



Monocular amblyopia treatment (patching or penalization) does not always result in 6/6 vision and amblyopia often recurs. As amblyopia arises from abnormal binocular visual experience, we evaluated the effectiveness of a novel home-based binocular amblyopia treatment.


Children (4–12 y) wore anaglyphic glasses to play binocular games on an iPad platform for 4h/w for 4 weeks. The first 25 children were assigned to sham games and then 50 children to binocular games. Children in the binocular group had the option of participating for an additional 4 weeks. Compliance was monitored with calendars and tracking fellow eye contrast settings. About half of the children in each group were also treated with patching at a different time of day. Best-corrected visual acuity, suppression, and stereoacuity were measured at baseline, at the 4- and 8-week outcome visits, and 3 months after cessation of treatment.


Mean (±SE) visual acuity improved in the binocular group from 0.47±0.03 logMAR at baseline to 0.39±0.03 logMAR at 4 weeks (P<0.001); there was no significant change for the sham group. The effect of binocular games on visual acuity did not differ for children who were patched vs those who were not. The median stereoacuity remained unchanged in both groups. An additional 4 weeks of treatment did not yield additional visual acuity improvement. Visual acuity improvements were maintained for 3 months after the cessation of treatment.


Binocular iPad treatment rapidly improved visual acuity, and visual acuity was stable for at least 3 months following the cessation of treatment.

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S L Li1, R M Jost1, S E Morale1, D R Stager2, L Dao3, D Stager3 and E E Birch1,4

  1. 1Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, Dallas, TX, USA
  2. 2Pediatric Ophthalmology and Center for Adult Strabismus, Dallas, TX, USA
  3. 3Pediatric Ophthalmology and Adult Strabismus, Plano, TX, USA
  4. 4Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA

Correspondence: EE Birch, Crystal Charity Ball Pediatric Vision Evaluation Center, Retina Foundation of the Southwest, 9600 North Central Expressway, Suite 200, Dallas, 75231, TX, USA Tel: +1 214 363 3911; Fax: +1 214 363 4538. E-mail:

Received: 20 December 2013; Accepted in Revised form: 13 June 2014
Advance online publication 25 July 2014

The data presented in this manuscript were presented, in part, at the 2013 Annual Meeting of the Association for Research in Vision and Ophthalmology in Seattle, WA, USA.

Posted in Research.