Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency

Aveen Kadhum*, Emily T.C. Tan, Maria Fronius, S. J. Baart, Dennis M. Levi, Maurits V. Joosse, Huibert J. Simonsz, Sjoukje E. Loudon

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
12 Downloads (Pure)


Purpose: To compare the effectiveness and efficiency of supervised dichoptic action-videogame play to occlusion therapy in children with amblyopia. Methods: Newly diagnosed children with amblyopia aged 4–12 years were recruited, excluding strabismus >30PD. After 16 weeks of refractive adaptation children were randomized to gaming 1 h/week supervised by the researcher, or electronically monitored occlusion 2 h/day. The gaming group played a dichoptic action-videogame using virtual reality goggles, which included the task of catching a snowflake presented intermittently to the amblyopic eye. Contrast for the fellow eye was self-adjusted until 2 identical images were perceived. The primary outcome was visual acuity (VA) change from baseline to 24 weeks. Results: We recruited 96 children, 29 declined and 2 were excluded for language or legal issues. After refractive adaptation, 24 of the remaining 65 no longer met the inclusion criteria for amblyopia, and 8 dropped out. Of 16 children treated with gaming, 7 (6.7 years) completed treatment, whereas 9 younger children (5.3 years) did not. Of 17 treated with occlusion, 14 (5.1 years) completed treatment and 3 (4.5 years) did not. Of 5 children with small-angle strabismus, 3 treated with occlusion completed treatment and 2 treated with gaming did not. Median VA improved by 0.30 logMAR (IQR 0.20–0.40) after gaming, 0.20 logMAR (0.00–0.30) after occlusion (p = 0.823). Treatment efficiency was 1.25 logMAR/100 h (range 0.42–2.08) with gaming, 0.08 (−0.19–0.68) with occlusion (p < 0.001). Conclusion: Dichoptic gaming seems a viable alternative for older children with refractive amblyopia after glasses adaptation. Treatment efficiency with gaming under continuous supervision was 15 times higher than with occlusion at home.

Original languageEnglish
Pages (from-to)38-48
Number of pages11
JournalActa Ophthalmologica
Issue number1
Early online date20 Apr 2023
Publication statusPublished - Feb 2024

Bibliographical note

Funding information:
ODAS Stichting, Grant/Award Number:
2016-4; Stichting Lijf en Leven, Grant/
Award Number: 36; Uitzicht, Grant/Award
Number: 2016-25

Publisher Copyright:
© 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.


Dive into the research topics of 'Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency'. Together they form a unique fingerprint.

Cite this