Watching Movies Helped Improve Vision in Children with Amblyopia

Popular animated films can be modified so that viewing strengthen the weak eye while holding children’s attention, reports new study in the Journal of AAPOS

San Francisco, CA, October 15, 2015

Amblyopia, commonly known as “lazy-eye,” has been classically treated by patching the strong eye to force the weaker eye to be used. However, the concept of binocular dysfunction, in which the brain suppresses the image from the weaker eye in favor of the stronger eye, has motivated new approaches to amblyopia treatment. In a new report published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), researchers describe how the use of dichoptic therapy, which presents different images to each eye separately, combined with popular children’s movies, has produced improved visual acuity in young children.

Dichoptic techniques combined with perceptual-learning tasks or simple games have been shown to improve visual acuity significantly in amblyopia. However, children find these tasks intensive and repetitive, and up to 40% of unsupervised patients are noncompliant. A multicenter team of researchers investigated a potentially more engaging method by using popular animated movies with complementary dichoptic stimulation to hold children’s interest.

“If the feature film approach has efficacy similar to the contrast-balanced perceptual learning tasks and games in this proof-of-concept study, it may lead to home-based binocular amblyopia therapy with greater compliance,” noted lead investigator Eileen E. Birch, PhD, of the Retina Foundation of the Southwest, and the UT Southwestern Medical Center, Dallas, TX.

In the study eight amblyopic children 4-10 years of age watched three dichoptic movies per week for two weeks. Each eye was presented with an image with irregularly shaped blobs that masked different portions of the film. The blobs seen by one eye were the inverse of the blobs seen by the other, so that the entire screen could only be perceived with binocular vision. In order to overcome suppression and allow binocular vision to form a complete picture, the image presented to the stronger eye was reduced in contrast.

Watching movies with Amblyopia

A girl with amblyopia watching one of the dichoptic movies on a passive 3D display while the child wore 3D cinema glasses.

Movie scenes were separated into irregular blob-shaped areas that were complementary for the amblyopic and fellow eyes so that the entire scene could only be perceived if binocular vision was used to merge the parts of the picture shown to each eye. Images were presented at high contrast to the amblyopic eye and low-contrast image to the fellow eye. The contrast-imbalance overcomes suppression of the amblyopic eye and reveals binocular vision. Photograph courtesy of the Retina Foundation of the Southwest.

Visual acuity improved in the eye with amblyopia in this study. ”Children achieved 1-4 lines of improvement in visual acuity with just six sessions (nine hours) of dichoptic (both eyes looking at target at same time) movie viewing over two weeks,” explained Dr. Birch. “Patching, by comparison, requires 120 hours of treatment to achieve 1 line of improvement in amblyopic children who have already been treated with spectacles for 12-16 weeks.”

While the maximum improvement or the persistence of the improvement remains to be determined, Dr. Birch added, “If these preliminary results are confirmed in a controlled clinical trial, passive viewing of dichoptic feature films could be useful as a primary, supplemental, or maintenance treatment for amblyopia.”

Researchers contributing to this study are affiliated with the Retina Foundation of the Southwest, Dallas, Texas; McGill Vision Research, Department of Ophthalmology, McGill University, Montréal, Québec, Canada; Ophthalmology, UT Southwestern Medical Center, Dallas, Texas; and Pediatric Ophthalmology & Adult Strabismus, Plano, Texas.

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Notes for Editors
“Dichoptic movie viewing treats childhood amblyopia,” bySimone Li, PhD; Alexandre Reynaud, PhD; Robert F. Hess, PhD; Yi-Zhong Wang, PhD; Reed M. Jost, MS; Sarah E. Morale, BS; Angie De La Cruz, BS; Lori Dao, MD; David Stager Jr., MD; and Eileen E. Birch, PhD, DOI: http://dx.doi.org/10.1016/j.jaapos.2015.08.003. It appears in the Journal of AAPOS, Volume 19, Issue 5 (October 2015) published by Elsevier.

Full text of the article is available at to credentialed journalists upon request; contact Eileen Leahy at +1 732 238 3628 or hmsmedia@elsevier.com to obtain a copy. Journalists wishing to interview the authors should contact Eileen E. Birch at 214-363 -3911, ext 111 or ebirch@retinafoundation.org.

About the Journal of AAPOS
Journal of AAPOS presents expert information on children's eye diseases and on strabismus as it impacts all age groups. Major articles by leading experts in the field cover clinical and investigative studies, treatments, case reports, surgical techniques, descriptions of instrumentation, current concept reviews, and new diagnostic techniques. The Journal is the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

About the American Association for Pediatric Ophthalmology and Strabismus
The goals of the AAPOS, the American Association for Pediatric Ophthalmology and Strabismus, are to advance the quality of children's eye care, support the training of pediatric ophthalmologists, support research activities in pediatric ophthalmology, and advance the care of adults with strabismus.

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

Media contact
Eileen Leahy
Elsevier
+1 732 238 3628
hmsmedia@elsevier.com  

Jennifer Hull
AAPOS
+1 415 561 8505
jhull@aao.org