Visual acuity increase in meridional amblyopia by exercises with moving gratings as compared to stationary gratings. 2022

Uwe Kämpf, and Svetlana Rychkova, and Ron Lehnert, and Evelyn Heim, and Felix Muchamedjarow
Amblyocation GmbH, Dresden.

The aim of the present work was to investigate the effect of a novel therapy based on pleoptic exercises combined with standard occlusion in patients with meridional amblyopia. The exercising system itself, termed focal ambient visual acuity stimulation (FAVAS), consists of sinusoidally modulated circular gratings, which were implemented as a background pattern in computer games binding the children's attention. For the assessment of therapeutic effects, we tested for the development of best-corrected visual acuity (BCVA) in patients trained with a gaming field background of moving gratings (Moving) compared to patients treated with stationary gratings (Stationary). Patients with amblyopia (caused by strabismus, refraction, or both) and astigmatism were randomly allocated to two groups, all of whom received a standard occlusion regimen. In combination with occlusion, using a crossover design, the first group (Moving-Stationary group) was alternately exercised for 10 days with a series of Moving followed by 10 days with Stationary and the second group (Stationary-Moving group) vice versa. The treatment-dependent training effect on BCVA was measured with respect to the alignment of the least vs. the most ametropic meridian in both groups. BCVA was examined using a meridionally direction-sensitive visual test inventory, and we estimated the monocular BCVA in all patients along four meridians: 0°, 45°, 90°, and 135° before and after Moving as compared to Stationary treatments. The Moving-Stationary group consisted of 17 children (34 eyes) aged 10 to 13 (average 11.6 ± 0.3) years. The Stationary-Moving group consisted of 20 children (40 eyes) aged 9 to 14 (average 12.5 ± 0.4). In both groups, visual acuity increased significantly only with Moving combined with occlusion. Thereby, the visual acuity (logMAR) along different meridians showed a statistically significant improvement induced by Moving if testing was coincident with alignment of the directional optical characters close to the most ametropic meridian in the Moving-Stationary group (0.73 ± 0.32 to 0.41 ± 0.22, p < 0.01) and also in the Stationary-Moving group (0.48 ± 0.27 to 0.33 ± 0.18, p < 0.01). Significant improvement was also induced by Moving if tested in alignment with the perpendicular orientation close to the least ametropic meridian, although with a smaller amount, in the Moving-Stationary group (0.49 ± 0.23 to 0.37 ± 0.21, p < 0.01) as well as in the Stationary-Moving group (0.33 ± 0.18 to 0.28 ± 0.16, p < 0.01). After Stationary combined with occlusion, however, there was no statistically significant improvement, regardless of the meridian. Visual training of patients with meridional amblyopia by a series of online exercises using attention-binding computer games which contained moving gratings as a background stimulus (Moving) resulted in a statistically significant improvement in visual acuity in the most refractive meridian, and to a lesser extent, in the least refractive meridian. No statistically significant improvement was achieved after the respective exercising series in the sham condition with stationary gratings (Stationary).

UI MeSH Term Description Entries
D012029 Refraction, Ocular Refraction of LIGHT effected by the media of the EYE. Ocular Refraction,Ocular Refractions,Refractions, Ocular
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000550 Amblyopia A nonspecific term referring to impaired vision. Major subcategories include stimulus deprivation-induced amblyopia and toxic amblyopia. Stimulus deprivation-induced amblyopia is a developmental disorder of the visual cortex. A discrepancy between visual information received by the visual cortex from each eye results in abnormal cortical development. STRABISMUS and REFRACTIVE ERRORS may cause this condition. Toxic amblyopia is a disorder of the OPTIC NERVE which is associated with ALCOHOLISM, tobacco SMOKING, and other toxins and as an adverse effect of the use of some medications. Anisometropic Amblyopia,Lazy Eye,Amblyopia, Developmental,Amblyopia, Stimulus Deprivation-Induced,Amblyopia, Suppression,Stimulus Deprivation-Induced Amblyopia,Amblyopia, Anisometropic,Amblyopia, Stimulus Deprivation Induced,Amblyopias,Amblyopias, Anisometropic,Amblyopias, Developmental,Amblyopias, Stimulus Deprivation-Induced,Amblyopias, Suppression,Anisometropic Amblyopias,Deprivation-Induced Amblyopia, Stimulus,Deprivation-Induced Amblyopias, Stimulus,Developmental Amblyopia,Developmental Amblyopias,Eye, Lazy,Eyes, Lazy,Lazy Eyes,Stimulus Deprivation Induced Amblyopia,Stimulus Deprivation-Induced Amblyopias,Suppression Amblyopia,Suppression Amblyopias
D001251 Astigmatism Unequal or irregular curvature of the CORNEA (Corneal astigmatism) and/or the EYE LENS (Lenticular astigmatism) resulting in REFRACTIVE ERROR. Corneal Astigmatism,Hyperopic Astigmatism,Lenticular Astigmatism,Mixed Astigmatism,Myopic Astigmatism,Oblique Astigmatism,Astigmatism, Corneal,Astigmatism, Hyperopic,Astigmatism, Lenticular,Astigmatism, Mixed,Astigmatism, Myopic,Astigmatism, Oblique,Hyperopic Astigmatisms,Mixed Astigmatisms,Myopic Astigmatisms,Oblique Astigmatisms
D014787 Vision Tests A series of tests used to assess various functions of the eyes. Test, Vision,Tests, Vision,Vision Test
D014792 Visual Acuity Clarity or sharpness of OCULAR VISION or the ability of the eye to see fine details. Visual acuity depends on the functions of RETINA, neuronal transmission, and the interpretative ability of the brain. Normal visual acuity is expressed as 20/20 indicating that one can see at 20 feet what should normally be seen at that distance. Visual acuity can also be influenced by brightness, color, and contrast. Acuities, Visual,Acuity, Visual,Visual Acuities

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