Adherence to home-based videogame treatment for amblyopia in children and adults

ABSTRACT

Clinical relevance: Home-based videogame treatments are increasingly popular for amblyopia treatment. However, at-home treatments tend to be done in short sessions and with frequent disruptions, which may reduce the effectiveness of binocular visual stimulation. These treatment adherence patterns need to be accounted for when considering dose-response relationships and treatment effectiveness.

Background: Home-based videogame treatments are increasingly being used for various sensory conditions, including amblyopia (‘lazy eye’), but treatment adherence continues to limit success. To examine detailed behavioural patterns associated with home-based videogame treatment, we analysed in detail the videogame adherence data from the Binocular tReatment of Amblyopia with VideOgames (BRAVO) clinical trial (ACTRN12613001004752).

Methods: Children (7-12 years), teenagers (13-17 years) and adults (≥ 18 years) with unilateral amblyopia were loaned iPod Touch devices with either an active treatment or placebo videogame and instructed to play for a total of 1-2 hours/day for six weeks at home. Objectively-recorded adherence data from device software were used to analyse adherence patterns such as session length, daily distribution of gameplay, use of the pause function, and differences between age groups. Objectively-recorded adherence was also compared to subjectively-reported adherence from paper-based diaries.

Results: One hundred and five of the 115 randomised participants completed six weeks of videogame training. Average adherence was 65% (SD 37%) of the minimum hours prescribed. Game training was generally performed in short sessions (mean 21.5, SD 11.2 minutes), mostly in the evening, with frequent pauses (median every 4.1 minutes, IQR 6.1). Children played in significantly shorter sessions and paused more frequently than older age groups (p < 0.0001). Participants tended to over-report adherence in subjective diaries compared to objectively-recorded gameplay time.

Conclusion: Adherence to home-based videogame treatment was characterised by short sessions interspersed with frequent pauses, suggesting regular disengagement. This complicates dose-response calculations and may interfere with the effectiveness of treatments like binocular treatments for amblyopia, which require sustained visual stimulation.

KEYWORDS:

• Amblyopia
• children’s vision

Disclosure statement

Authors Benjamin Thompson and Robert F Hess are named inventors on two patents (US 12528934 and US 8006372 B2) related to the contrast-balancing binocular videogame treatment used in the BRAVO clinical trial. Robert F Hess is a scientific advisor to Amblyotech, a company that licenses the patents. All other authors do not have conflicts of interest or competing financial interests.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The BRAVO clinical trial was supported by research project grants from the Health Research Council of New Zealand [reference 13/169] and the Hong Kong Health and Medical Research Fund [reference 11122991]. The Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian Government. The funding bodies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.