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Assessment and Treatment of patients with Amblyopia using interactive binocular computer games Alexander Foss Interactive Technologies and Games (ITAG) Conference 2014 Health, Disability and Education Dates: Thursday 16 October 2014 - Friday 17 October 2014 Location: The Council House, NG1 2DT, Nottingham, UK
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Assessment and Treatment of patients
with Amblyopia using interactive
binocular computer games
Alexander Foss Nottingham University Hospital
Anthony Vivian Addenbrooke’s Hospital
Jon Purdy University of Bradford
Richard Eastgate and Sue Cobb University of Nottingham
Roy Harris Nottingham University Hospital
Daisy MacKeith and Niki Herbison Nottingham University Hospital
Steve Haworth and Richard Gregson
CURRENT TREATMENT
Amblyopia
Suppression
Displaced/blurred image
Patching and Penalisation do not address
suppression. Simultaneous perception is
the first step towards depth perception
Unpopular with patients
70 - 80% have
residual amblyopia
Disadvantages with
conventional treatment
Patching:
Prolonged treatment
Unpopular
Poor compliance resulting in treatment failure
Negative impact on school and family life
Atropine:
Prolonged treatment
Local side effects common
Systemic side effects rare but serious
Visual acuity in non-amblyopic eye penalised
throughout treatment
What would be the perfect
amblyopia therapy?
Effective
Good compliance
Acceptable to young children
Quick
Safe
Easy to administer
Cost effective
Well maintained
I-BiT™
Interactive Binocular Treatment for Amblyopia
3 Year project funded by the Wellcome Trust
Chief Investigators - Mr Richard Gregson/ Mr Alex Foss. Consultant
Ophthalmologists
Patented technology
Collaboration between:
Nottingham University Hospitals
University of Nottingham
University of Hull
Cambridge University Hospitals
The current I-BiT system
Concept:
Present separate images to each eye
Dynamic visual scene
Preferentially stimulating amblyopic eye
Patient motivation:
Interactive games and videos
Encourage patient compliance
Motor response:
Treatment can be adjusted in real time
Shutter glasses technology
Shutter glasses
High definition screens
Faster processing speeds
Adaptations for use with
the I-BiT system
The adaptation by combining shutter glasses
with I-BiT software is to change the ratio of
information presented to each eye in order to
stimulate one eye more than the other
This creates a 2D view rather than the
intended 3D stereoscopic view
Project employs software technicians from
the University of Hull to make these
adaptations
DVD Player
Border with controls
common to both eyes
Only amblyopic eye
sees the DVD
For patients with
dense suppression,
option to adjust the
transparency settings
in the non-amblyopic
eye
NUX Game
Inclusion Criteria
Diagnosis of Anisometropic, Strabismic or
Mixed Amblyopia as made by an orthoptist
Male or Female
Aged 4 – 8 years inclusive.
Participant’s parent or guardian is willing and
able to give informed consent for participation
in the study
Evidence
Six children treated with prototype and gained 2 lines of vision (Waddingham et al Eye 2006)
10 treated with I-BiT and improvement of 0.189 logMAR. Almost two lines. (Herbison et al Eye 2013)
Trial data being analysed. An improvement of one line. 49 children, treated with I-BiT but higher proportion of residual amblyopia. Two treated with I-BiT got double vision.
Other groups have similar encouraging results e.g. Hess’s group with the game Tetris in adults (required a minimum of 6 hours play before any effect was discernible)
The treatment times were very short
Total time of 3 hours
Consistent effect
Results
Visual acuity in LogMAR units for all patients from baseline to week 10 .
Phase 2 Trial
Eligible patients randomised to one of the following
Week 1 I-BiT Game Non-I-BiT Game I-BiT DVD
Week 3 Interim assessment
Week 6 End of treatment periodEnd of treatment assessment
Week 10End of follow-up period
End of follow-up assessmentFull orthoptic assessment
All patients followed up for 4 weeks
Patients receive 30 minstreatment weekly
Patients receive 30 minstreatment weekly
RESULTS
Previous treatment 75%
Occlusion 75%
Penalisation 19%
Average Age 6 years
Range 4 – 8 years
Compliance 90%
RESULTS
CONCLUSIONS
Well accepted
Three hours treatment gives about 0.1
logMAR improvement
Games alone gave similar effect
More work needed to see if this is an
effective modality of treatment
INTERESTS
EU Patent 03722819.4
Date of filing 4.5.2002
CONTACT DETAILS
WEBSITE: www.lazy-i-bit.com
Contact details:
Catherine Knipe – Research Orthoptist
0115 9709750
Alexander Foss
