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Updated: Nov 4, 2025
The Measurement and Treatment of Suppression in Amblyopia
Published on: December 14, 2012
Barriers to successful dichoptic treatment for amblyopia in young children
Aveen Kadhum1, Emily T C Tan1, Dennis M Levi2
1Department of Ophthalmology, Erasmus Medical Center, Room Ee 1663, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Insights
Dichoptic VR video games for amblyopia treatment show limited applicability in young children due to comprehension and compliance issues. Half of the participants did not complete the treatment, primarily because of age-related challenges.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Digital Health
Background:
- Amblyopia, or "lazy eye," affects visual development in children.
- Traditional amblyopia treatments include patching and vision therapy.
- Novel dichoptic treatments using virtual reality (VR) offer a new approach.
Purpose of the Study:
- To evaluate barriers to successful dichoptic VR video game treatment for amblyopia.
- To identify factors influencing treatment completion in children.
Main Methods:
- Recruitment of newly diagnosed amblyopic children for a randomized clinical trial.
- Dichoptic VR video game treatment administered for 1 hour weekly under supervision.
- Documentation and categorization of treatment difficulties and influencing factors.
Main Results:
- Out of 17 children who started dichoptic treatment, 10 did not complete it.
- Younger children (under 5.5 years) struggled with game comprehension.
- Older children showed reduced willingness to comply, and loss of interest was a common issue.
Conclusions:
- Approximately half of the children failed to complete dichoptic VR treatment, mainly due to young age.
- The applicability of this VR treatment is limited in settings where amblyopia is detected before age 6.
Purpose:
In an ongoing randomised clinical trial comparing dichoptic VR video games with patching for amblyopia, we evaluated any potential barriers to successful use of this novel amblyopia treatment method.
Methods:
From December 2017, all newly diagnosed amblyopic children were recruited. Excluded were children under age 4 and patients with strabismus exceeding 30PD. The video game was played for 1 h per week at the outpatient clinic under direct supervision. Records were kept of difficulties encountered during treatment and categorised into domains. Factors influencing the successful completion of this treatment were identified and related to patient characteristics.
Results:
Ninety-one children were recruited for the trial, 20 parents refused participation before randomisation, because of the logistical challenges the outpatient dichoptic treatment would cause them. Of the 17 children who commenced dichoptic treatment (median age 6.2 years; IQR 4.9-8.4 years), 10 did not complete treatment. Children under age 5.5 years were unable to comprehend the game settings or the game itself. Older children (N = 7; 41%) were less willing to comply with the video game. Loss of interest in the game (N = 8; 47%) was found to be a limiting factor at all ages.
Conclusion:
Half of the children failed to complete VR dichoptic treatment, mainly due to young age. In countries with nationwide screening where amblyopia is detected before age 6, the applicability of such dichoptic treatment is limited.
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