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      A computer-based anaglyphic system for the treatment of amblyopia

      research-article
      Clinical Ophthalmology (Auckland, N.Z.)
      Dove Medical Press
      amblyopia, computer-based, open source, virtual reality, color filters, 3-D

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          Abstract

          Purpose

          Virtual reality (VR)-based treatment has been introduced as a potential option for amblyopia management, presumably without involving the problems of occlusion and penalization, including variable and unsatisfactory outcomes, long duration of treatment, poor compliance, psychological impact, and complications. However, VR-based treatment is costly and not accessible for most children. This paper introduces a method that encompasses the advantages of VR-based treatment at a lower cost.

          Methods

          The presented system consists of a pair of glasses with two color filters and software for use on a personal computer. The software is designed such that some active graphic components can only be seen by the amblyopic eye and are filtered out for the other eye. Some components would be seen by both to encourage fusion. The result is that the patient must use both eyes, and specifically the amblyopic eye, to play the games.

          Results

          A prototype of the system, the ABG InSight, was found capable of successfully filtering out elements of a certain color and therefore, could prove to be a viable alternative to VR-based treatment for amblyopia.

          Conclusion

          The anaglyphic system maintains most of the advantages of VR-based systems, but is less costly and highly accessible. It fulfills the means that VR-based systems are designed to achieve, and warrants further investigation.

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          Most cited references16

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          A binocular approach to treating amblyopia: antisuppression therapy.

          We developed a binocular treatment for amblyopia based on antisuppression therapy. A novel procedure is outlined for measuring the extent to which the fixing eye suppresses the fellow amblyopic eye. We hypothesize that suppression renders a structurally binocular system, functionally monocular. We demonstrate using three strabismic amblyopes that information can be combined normally between their eyes under viewing conditions where suppression is reduced. Also, we show that prolonged periods of viewing (under the artificial conditions of stimuli of different contrast in each eye) during which information from the two eyes is combined leads to a strengthening of binocular vision in such cases and eventual combination of binocular information under natural viewing conditions (stimuli of the same contrast in each eye). Concomitant improvement in monocular acuity of the amblyopic eye occurs with this reduction in suppression and strengthening of binocular fusion. Furthermore, in each of the three cases, stereoscopic function is established. This provides the basis for a new treatment of amblyopia, one that is purely binocular and aimed at reducing suppression as a first step.
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            Assessment of a computer-based treatment for older amblyopes: the Glasgow Pilot Study.

            There have been few viable alternatives to patching the better eye as a treatment of amblyopia for more than two centuries. The success of patching depends on compliance, which is problematic for up to 59% of children and their families. This pilot study trialled the interactive binocular treatment (I-BiT) system as an alternative amblyopia treatment in 12 older amblyopes (6.1-11.4 years, median 8.2), who had not complied with or responded to occlusion. Virtual reality images were projected to each eye simultaneously via a headset during eight treatment sessions of 25-min duration. Outcome measures were changes in high- (HCVA) and low-contrast log MAR acuity (LCVA) at 1 week, 4 weeks and a final follow-up (3-18 months) after the final treatment. Sustained improvements in HCVA were observed in seven children (58%) and in LCVA in eight children (67%), including two for whom amblyopia was eliminated. Five children had visual acuities equivalent to 6/12 or better at least 6 months after stopping treatment, compared with one child prior to treatment. Significant improvements in HCVA occurred up to the fourth treatment; in LCVA to the seventh treatment. Sustained improvements in visual acuity were observed for 58% of this small group of children using the I-BiT system, despite prior failure with conventional treatment. This offers hope for a potential time-saving alternative to patching, in which compliance can easily be monitored, but the results need to be validated by means of a randomised controlled trial.
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              A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years.

              To determine the visual acuity outcome at age 10 years for children younger than 7 years when enrolled in a treatment trial for moderate amblyopia. In a multicenter clinical trial, 419 children with amblyopia (visual acuity, 20/40-20/100) were randomized to patching or atropine eyedrops for 6 months. Two years after enrollment, a subgroup of 188 children entered long-term follow-up. Treatment after 6 months was at the discretion of the investigator; 89% of children were treated. Visual acuity at age 10 years with the electronic Early Treatment Diabetic Retinopathy Study test. Patching and atropine eyedrops produce comparable improvement in visual acuity that is maintained through age 10 years. The mean amblyopic eye acuity, measured in 169 patients, at age 10 years was 0.17 logMAR (logarithm of the minimum angle of resolution) (approximately 20/32), and 46% of amblyopic eyes had an acuity of 20/25 or better. Age younger than 5 years at entry into the randomized trial was associated with a better visual acuity outcome (P < .001). Mean amblyopic and sound eye visual acuities at age 10 years were similar in the original treatment groups (P = .56 and P = .80, respectively). At age 10 years, the improvement of the amblyopic eye is maintained, although residual amblyopia is common after treatment initiated at age 3 years to younger than 7 years. The outcome is similar regardless of initial treatment with atropine or patching.
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                Author and article information

                Journal
                Clin Ophthalmol
                Clinical Ophthalmology
                Clinical Ophthalmology (Auckland, N.Z.)
                Dove Medical Press
                1177-5467
                1177-5483
                2011
                2011
                16 September 2011
                : 5
                : 1319-1323
                Affiliations
                Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
                Author notes
                Correspondence: Ali Rastegarpour, Ophthalmic Research Center, Shahid, Beheshti University of Medical Sciences, 23 Paidarfard St, Boostan 9 St, Pasdaran Ave, Tehran 16666, Iran, Tel +98 21 2277 0957, Fax +98 21 2259 0607, Email rstgrpr@ 123456gmail.com
                Article
                opth-5-1319
                10.2147/OPTH.S25074
                3180507
                21966210
                c10cfa6a-c0b1-45d9-96df-2f181df0291c
                © 2011 Rastegarpour, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Original Research

                Ophthalmology & Optometry
                open source,virtual reality,computer-based,color filters,3-d,amblyopia
                Ophthalmology & Optometry
                open source, virtual reality, computer-based, color filters, 3-d, amblyopia

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