The patient then trained for another 10 h, without any further additional change. Nonetheless, the role, origin, and nature of suppression in amblyopia have not always been viewed this way (Barrett et al. As our work is a series of cases, the small sample size appears as the main limitation. Pediatra Integral XVII(7):489506, Mitchell D, Kind P, Sengpiel F, Murphy K (2003) Brief daily periods of binocular vision prevent deprivation-induced acuity loss. volume27,pages 385396 (2023)Cite this article. Another dichoptic strategy has been employed by Gambacorta et al. It can be argued that the video game also produces a certain training effect on the non-amblyopic eye. Consequently, dichoptic stimulation would also improve CS of the fellow eye. Introduction. As criterion for amblyopia a minimum visual acuity difference of 0.2 logMAR (ETDRS Sloan Optotypes) between the two eyes was considered. Likewise, the impact of these findings in the refractive surgery field should be assessed further, considering the potential synergistic effect of the surgical procedure that leads to a change in the retinal image and an optimization of ocular optics [14,15], as well as the cortical activation induced by the virtual reality-based visual training. Sixteen months later, his BCDVA was stable around a value of 0.4 (Sloan), with positive Lang I and II tests (Figure 2). https://doi.org/10.1016/j.cub.2003.09.026, Moret B, Camilleri R, Pavan A, LoGiudice G, Veronese A, Rizzo R, Campana G (2018) Differential effects of high-frequency transcranial random noise stimulation (hf-tRNS) on contrast sensitivity and visual acuity when combined with a short perceptual training in adults with amblyopia. Thompson B., Maehara G., Goddard E., Farivar R., Mansouri B., Hess R.F. Conventional amblyopia therapy in adults is associated with poor results due to lack of plasticity. 2014; Antonini et al. It can be worthy to understand which game characteristics are linked to particular outcomes. There could be a generalization of the response as shown by various studies (Casco et al. New advances in amblyopia therapy I: binocular therapies and 2006, 2007; Spolidoro et al. 2017). (2017) point out, the high level of motivation associated with RV videogames results in better outcomes and could contribute to the beginning of neuronal plasticity. Stereopsis scores remained stable during the whole study and comparable to normal vision (Fig. https://doi.org/10.1016/j.jaapos.2011.09.016, Vedamurthy I, Knill DC, Huang SJ, Yung A, Ding J, Kwon OS, Bavelier D, Levi DM (2016) Recovering stereo vision by squashing virtual bugs in a virtual reality environment. El Mallah M.K., Chakravarthy U., Hart P.M. Amblyopia: Is visual loss permanent? Rehabilitation of visual functions in adult amblyopic patients with a virtual reality videogame: a case series. In contrast to monocular patching, binocular vision is In such case a life was lost. Methods Front Neural Circ 8:82. https://doi.org/10.3389/fncir.2014.00082, Capetillo OB, Triana-Casado I, Martnez-Legn Z, Roche-Caso S, Broche-Hernndez A (2011) Frequency of amblyopia in school children. CS improved progressively during the training and one month later, showing even better scores for higher frequencies (Fig. Dichoptic Virtual Reality Therapy for Amblyopia in Adults May 1, 2017 updated by: Marc Levin, University of California, San Francisco This was a randomized, masked, controlled study of the effect of a virtual reality, binocular, 3-dimensional video game on visual acuity and stereopsis in adult patients with amblyopia. https://doi.org/10.1016/S0166-2236(03)00168-1, Bonaccorsi J, Berardi N, Sale A (2014) Treatment of amblyopia in the adult: insights from a new rodent model of visual perceptual learning. The paradigm involved changing the Titmus 2D test and fixation image. This procedure was repeated a total of six times, with randomized swapping of individual areas while scanning brain activity. Thus, while the fundamental element of the game is to track the trajectory and movement of the ball (only presented to the amblyopic eye), the fellow eye was also exposed to the rest of the scene and to the movement of the pad that the player moved to intercept the ball. The first draft of the manuscript was written by Carmen Jimenez-Rodriguez and Lourdes Yelamos-Capel, and all authors commented on previous versions of the manuscript. ; data collection, J.H., M.B., S.S. and P.Z. Although research has mainly focused on children, there are some studies with adults showing that the age of treatment is not a barrier for visual rehabilitation. https://doi.org/10.1016/j.neuron.2004.12.001, Paudel N (2018) Smartphone applications for amblyopia treatment: a review of current apps and professional involvement. Future studies should confirm in significant samples of adult amblyopic patients the potential benefit of using virtual reality environments over other modalities of vision training. (2017), who only completed the medium-term follow-up for 3 patients, we have not yet done a full long-term follow-up (after one year) for all patients. Amblyopia treatment of adults with dichoptic training using the virtual The patient evaluated in the current report was diagnosed of amblyopia at 8 years of age, when occlusion therapy was no longer effective due to limited tolerance to and compliance with this type of treatment. The aim of our work is to retrospectively analyze the results of treatment of anisometropic amblyopia using dichoptical training in virtual reality in adult amblyopic patients. Through the visual training, the patient gradually developed stereopsis. Thus, some patients improved their VA, others their CS, others their stereopsis or a combination of different variables. Copyright 2023 Association for Research in Vision and Ophthalmology. Materials and methods: Our group consisted of 84 amblyopic patients with anisometropic amblyopia with an average age of 33.8 9.4 years. Effectiveness of combined dichoptic therapy, binocular visio - LWW Early studies provided solid epidemiological data on patients with amblyopia. 4-6 Concern that cessation of treatment would lead to a relapse in amblyopia was widely touted, but 15-year follow-up data confirmed that the amblyopia trea. Stereopsis also improved notably from 800 in the baseline to 100 after two weeks of training. As a library, NLM provides access to scientific literature. See decreased activity in frontal, parietal, and occipital lobes after treatment. During the four weeks of treatment the four levels were used (Fig. Telemed J E Health 24(10):797802. This disappeared after 3weeks of training and it was maintained one month later. The exercise provided not only visual acuity improvement in the amblyopic eye but also improved stereopsis. Dichoptic training is a promising new therapeutic approach to amblyopia, which employs simultaneous and separate stimulation of both eyes (thus dichoptic). The Oculus DK2 headset employed in the present study, as well as by Ziak et al. In summary, after 44 h of training, the left eye BCDVA improved to 0.5 (Sloan). We are conducting a single-center, masked, placebo-controlled study of the effect of 3-dimensional, VR gameplay on visual acuity (VA) and stereopsis in subjects with amblyopia. No improvements were observed for higher frequencies. Use of virtual reality training in amblyopia - Ophthalmology Times Strabismus 19(3):110118. Two years after the initial examination, the patient came to our consultation to check if the visual gain he had obtained was maintained. Specifically, the patient did not wear the eyeglass correction required and was not compliant with occlusion therapy. The chart was placed 160cm from the floor and the participants were set at 250cm from the chart. https://doi.org/10.1038/nn1965, Herbison N, Cobb S, Gregson R et al (2013) Interactive binocular treatment (I-BiT) for amblyopia: results of a pilot study of 3D shutter glasses system. AmbliOK is based on the classic videogame Arkanoid, with a Halloween inspired aesthetic. Can lazy eye be treated in adults? The answer is, Yes! - Bynocs https://doi.org/10.1523/JNEUROSCI.19-11-04388.1999, Article (2017). https://doi.org/10.3233/rnn-170731, Barrett B, Panesar G, Scally A, Pacey I (2012) A Limited Role for suppression in the central field of individuals with strabismic amblyopia. Each time all the pumpkins were destroyed a new screen filled with pumpkins was automatically displayed and the participant got an extra life. ; visualization, J.H., M.B., S.S., D.P.P. Amblyopia or lazy eye has a prevalence of 15% (Bonaccorsi et al. Material preparation, data collection and analysis were performed by Carmen Jimenez-Rodriguez, Lourdes Yelamos-Capel and Patrizia Salvestrini. Consequently, previous interventions could have positive or negative effects on a subsequent binocular treatment. https://doi.org/10.1016/s0042-6989(00)00025-0, McKee S, Levi D, Movshon J (2003) The pattern of visual deficits in amblyopia. 2004). AVR 2017. During the first month, the therapeutic procedure consisted of visual training using the Oculus Rift virtual reality helmet two times a week using the Diplopia Game beta version (VividVision, San Francisco, CA, USA), with a total duration of 8 h. Results were very encouraging and, after the first month of training, an improvement in the BCDVA of the amblyopic eye to 0.2 was observed (Sloan chart). Such improvement remained one month and one year after the intervention (Fig. The study revealed significant improvements in visual acuity after only 8 sessions (of 40 minutes each.) Worths four dot examination confirmed the presence of fusion. Singh B., Sharma S., Bharti N., Singh A., Dadia S., Bharti S. Visual outcomes after refractive laser corneal surgery and phakic IOL in amblyopic eyes. Approximately 50 participants between the ages of 15 and 45 with moderate vision loss from anisometropic and/or strabismic amblyopia are being enrolled. Thus, the brain inhibits the image coming from the turned eye (Gil-Gibernau 1997; Merchante 2013; Kanski 2016). ; funding acquisition, P.Z. A study on Amblyopia treatment of adults with dichoptic training using a VR-based procedurewas conducted on adults, with anisometropic amblyopia, ranging between the ages 17-69 years. https://doi.org/10.1007/s00221-008-1509-3, Varadharajan S, Hussaindeen J (2012) Visual acuity deficits in the fellow eyes of children with unilateral amblyopia. Regarding VA, it improved notably, overcoming the criterion for amblyopia at the end of training. Results: Thus, traditional therapies like eye occlusion are not prescribed beyond 89years old. J Opthalmol. The remaining authors declare no conflict of interest. Restor Neurol Neurosci 35(5):483496. (2018) argue that its improvement is due to a weakening of inhibitory lateral interactions between V1 neurons for specific spatial orientations and frequencies (Polat 1999; Polat et al. BL: base line; PM: 1month follow-up; PY: 1year follow-up; AE: amblyopic eye; FE: fellow eye; BIN: binocular; P1P4: participants, Evolution of sensibility evolution (scores from all the frequencies have been aggregated) along the training, 1month and 1year after for the amblyopic eye (a) and the fellow eye (b). Purpose: Results from this pilot study suggest that visual training based on perceptual learning through an immersive VR environment could be a viable treatment for improving CS, VA, and stereopsis in some children with anisometropic amblyopia. Participant 1 showed a VA difference of 0.22 logMAR between the fellow eye (left) and amblyopic eye (right) in her baseline assessment. Neuron 44(6):10311041. The preliminary results of this case show the potential of using virtual reality-based visual training as a treatment for adult amblyopia. Abnormal intra-network architecture in extra-striate cortices in amblyopia: A resting state fMRI study. (2011) on the strengthening interaction between binocular neurons would be also applicable to the case of CS. Binocular dichoptic visual therapy in virtual reality was the only patients treatment option applied in this case after appropriate refractive correction. 2018). CS was poor as she only could discriminate 2 out of 8 items in the lower frequency range. More than 300 users have trialed this system without reporting persistent diplopia or other bothersome side effects. Thereby, the possibility of treating amblyopia in adulthood has become a reality. The ETDRS Optotype (Precision Vision, Woodstock, Illinois, USA) is the most used instrument to determine static visual acuity. As some objects were seen with the amblyopic eye and others were seen with the fellow eye, the game forced the brain to use both eyes together to play. Materials. Amblyopia treatment of adults with dichoptic training using the virtual Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: preliminary results. Nevertheless, as Ziak et al. Several studies have found that after monocular deprivation (a model of amblyopia), binocular activity was recovered with appropriate stimulation in adulthood (Berardi et al. Google Scholar, Arlati S, Zangiacomi A, Greci L, Di Santo SG, Franchini F, Sacco M (2017) Virtual enviroments for cognitive and physical training in ederly with mild cognitive impairment: a pilot study. 2003; Smith and Trachtenberg, 2007). https://doi.org/10.3109/09273972.2013.877945, Mataga N, Mizuguchi Y, Hensch TK (2004) Experience-dependent pruning of dendritic spines in visual cortex by tissue plasminogen activator. The patient was a 22 year old man on baseline examination that never previously wore correction for his anisometropia. The fellow eye also showed a progressive improvement in all the frequencies. (2017), we do not know other studies using VR for stereopsis treatment in amblyopic patients. Our randomized-controlled study will formally test the effects of dichoptic VR therapy on VA and stereopsis. However, these works rely on the assessment of a reduced number of visual variables, usually no more than two. Conclusions Dichoptic training using a virtual reality head mounted display seems to be an effective option of treatment in adults with anisometropic amblyopia. https://doi.org/10.1089/tmj.2017.0220, Polat U (1999) Functional architecture of long-range perceptual interactions. Conclusions: Dichoptic training using a virtual reality head mounted display seems to be an effective option of treatment in adults with anisometropic amblyopia. 2011). Overall, although there is a significant variability across patients, an improvement in some variables has been observed during the training phase with the videogame, in the subsequent evaluations one month after the end of the training, and even one year later (in the only case where the participant could be evaluated). The advantage of a dichoptic treatment is the possibility of stimulating both monocular and binocular processes at the same time. The authors suggested that a reduced adaptation may be a consequence of the reduced response to different stimuli reported for amblyopic eyes. See Figs. 2017; 17:105. doi: 10.1186/s12886-017-0501-8. However, in the case described, peak activity did not seem to decrease, with the activity located in specific brain sites. Lecture Notes in Computer Science, vol 10325. Methods: From December 2017, all newly diagnosed amblyopic children were recruited. Perception 4(2):125143. It has been done according with the Spanish Law 14/2007 for Biomedical Research and has been conducted according to the tenets of the Helsinkis Declaration (2013). Future clinical trials are needed to confirm this preliminary evidence. Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: Preliminary results. This participant did not show suppression. One month later, amblyopic and fellow eyes and binocular VA improved over the last evaluation score at the end of the last training week (Fig. Tommila V., Tarkkanen A. Likewise, Thompson et al. Stereopsis improvement is in line with the results of Ziak et al. Therefore, as shown by Barollo et al. Long-Range Interocular Suppression in Adults with Strabismic Amblyopia: A Pilot fMRI Study. Accordingly, the visual therapy was continued. 2020). 2014). HHS Vulnerability Disclosure, Help All authors read and approved the final manuscript. Patient has to pick circles from the highest disparity continually to the lowest disparity. 3). The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the Jessenius Faculty of Medicine in Martin, Commenius University in Bratislava (protocol code EK 1795/2016, date of approval: 08/03/2016). Am J Ophthalmol 92(3):416421. Regarding CS, this participant was unable to discriminate any item at any frequency, and showed extremely poor stereopsis (800) in the baseline assessment. The precise mechanism by which anisometropia causes a decrease in stereopsis is not clear. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. https://doi.org/10.1016/j.jaapos.2006.11.111, Saraiva AA, Barros MP, Nogueira AT, Fonseca-Ferreira NM, Valente A (2018) Virtual interactive environment for low-cost treatment of mechanical strabismus and amblyopia. Informed consent was obtained from the subject involved in this case report. Fawcett and Birch (2003) point out that binocularity can be experienced with low levels of anisometropia, and Robaei et al. https://doi.org/10.1016/j.neuron.2004.11.028, McColl S, Ziegler L, Hess R (2000) Stereodeficient subjects demonstrate non-linear stereopsis. With regard to the physiological bases of the fellow eye improvement, it could be associated with changes in the functioning of binocular neurons that might influence vision in an up-down way. Subjectively, he began perceiving 3D vision; in his own words, when I put on contact lenses, I felt the world become plastic. Objectively, he began to see all 3D objects on Lang cards 1 year after finishing the visual therapy. Licensee MDPI, Basel, Switzerland. and P.Z. 2). Future clinical trials are needed . Dichoptic Virtual Reality Therapy for Amblyopia in Adults In control subjects with varied levels of vision, measures of acuity and stereopsis from clinical examinations correlate with in-game testing metrics. Clinic of Almera. Different game difficulty levels are used. The patient was asked to wear polarized glasses to be examined with the Titmus 3D test when placed in the MRI device. 2017;17:105. (2013) hypothesized that alleviating suppression through the presentation of dichoptic stimuli results in a higher level of plasticity than forcing the use of the amblyopic eye. According to Meier and Giaschi (2017), although the fellow eye shows better performance than the amblyopic eye, its performance is not equivalent to a control healthy eye. Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: Preliminary results. https://doi.org/10.1016/0002-9394(81)90534-1, von Noorden GK Campos EC (2002) Binocular Vision and Ocular Motility, Theory and Management of Strabismus. J vis 3(5):380405. Furthermore, previous studies (Julesz and Miller 1975; Ogle and Wakefield 1967) have informed conditions in which interocular suppression and stereopsis can be dissociated. 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. [9] found that dichoptic viewing slightly reduced the BOLD response magnitude in amblyopic eye retinotopic regions in V1 and reduced the time to peak response. After an initial three-week period of patching or gameplay at home, all subjects receive the dichoptic intervention for an additional three weeks. https://doi.org/10.1155/2020/7067846, Ding J, Levi D (2011) Recovery of stereopsis through perceptual learning in human adults with abnormal binocular vision. Conclusions Dichoptic training using a virtual reality head mounted display seems to be an effective option of treatment in adults with anisometropic amblyopia. In clinical practice, there exist two classical treatments for amblyopia: refractive correction and occlusion of the fellow eye, and penalization treatment with atropine of the fellow eye. Amblyopia or lazy eye is a dysfunction of the visual system that appears during childhood and traditionally has been considered untreatable in adults.