https://orcid.org/0000-0002-5061-7717
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Abstract
Background
To be successful, amblyopia therapeutic techniques must respond when ingenious (shrewd) amblyopic children sabotage treatment effect by discovering ways(1) to alter those therapy aspects they find frustrating.
Methods
Her guardian consented to IRB-approved study outside typical FDA enrollment guidelines for CureSight dichoptic therapy. Acuity (EVA) and stereopsis was by PEDIG protocols.
Results
A 6-year-old rural Alaska native girl in foster care had previously been diagnosed with anisometropic amblyopia and treated with spectacles and patching but had poor compliance with BCVA 0.9–1.0 logMAR. She demonstrated exceptional creativity and hyperactivity but had no other medical issues. Atropine was prescribed in addition to her spectacles +5.50+1.00x90 and +0.50+1.00x90, but the patient discovered the rare “Spectacle Flip” method that sabotaged therapeutic impact. She had EVA enrollment acuities of logMAR 0.9 right and −0.1 left with stereo 400 seconds of arc. After just one month dichoptic therapy 1.5 hours 6 days per week, acuity improved to logMAR 0.7 and −0.1 with stereo up to 140 second of arc. Four months later acuity was 0.6 right and −0.2 left. Stereoacuity improved from 400 to 200 arc seconds.
Conclusion
Even when conventional compliance methods fail, dichoptic therapy with eye-tracking has the novel and unique potential to improve amblyopia treatment compliance with real-time monitored fixation compliance and confirmation of correct spectacle wear.
Clinical Trial Registration
NCT06165705.
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© 2024 Arnold. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
Plain Language Summary
Dichoptic therapy with eye-tracking improved compliance and achieved de novo acuity and stereo gains in a girl with severe refractory anisometropic amblyopia compounded by the rare complication of topical atropine therapy called “spectacle-flip sabotage”
Ethics and Consent
The parent and legal guardian provided signed informed consent for the study. The legal guardian provided signed consent for sharing and publishing of patient images/video for educational purposes. Approval for this study was given by the Alaska Blind Child Discovery department of the Alaska Children’s EYE & Strabismus institution.
Disclosure
Dr. Arnold coordinates the Alaska Blind Child Discovery which has received discounted vision screening technology from several vendors. He was an investigator for the USA Curesight multi-center clinical trial and received Curesight dichoptic devices one of which was modified and used free-of-charge in this separate study. He is a board member for PDI check; In addition, Dr Robert Arnold has a patent Systems and Methods for Eye Evaluation and Treatment issued to Robert W. Arnold and Alex Damarjian.