by Dr. Marsha Sorenson, FCOVD


Optometry students + residents–earn $500 to attend the 2018 Annual Meeting by writing something just like this!

Last year, Kathryn Werner OD received a Travel Grant for the 2017 Annual Meeting with her summary of an article on a tablet-based amblyopia treatment. We’ve shared it with you here, combined with new practice-relevant insights, as inspiration for this year’s applicants!

Amblyopia is a developmental disorder of the visual cortex, the hallmark of which is reduced visual acuity.  Amblyopia is typically caused by strabismus (an eye turn) or anisometropia (a high prescription in one eye).  Visual acuity is not the only problem in an amblyopic patient’s visual system.  Amblyopes tend to have reduced stereopsis, or 3-D vision.  Reduced 3-D vision can lead to difficulty with motor skills, as the visual system guides the motor system in early development.  A vision therapy-based approach to treating amblyopia uses therapy to improve visual acuity, reduce suppression (inhibition of the amblyopic eye by the dominant eye), improve 3-D vision, and improve visual-motor skills.  A new research study gives evidence that this type of treatment is beneficial, as motor skills can be improved by improving 3-D vision!

The purpose of this study was  to determine if reduced fine motor skills in amblyopic children improve after binocular  treatment provided by an anti-suppression variable-contrast tablet game.

The study had a total of twenty-eight participants aged 7-12 years.  Twenty children had amblyopia and ten children had normal vision.    All of the children diagnosed with amblyopia received the appropriate glasses prior to the study.  83% of amblyopic patients had a history of  prior patching or atropine treatment.

Home-based binocular tablet game therapy was prescribed for one hour per day for five weeks. The treatment was designed to reduce suppression of the amblyopic eye.  Each participant wore red/green filters over their glasses while playing a colored block-matching game on a tablet device. During the therapy game, 100%-contrast red blocks were presented to the amblyopic eye, while reduced-contrast green blocks were presented to the dominant eye. The contrast of the blocks was modified depending on the child’s performance score. The tablet recorded the time spent playing to monitor compliance.

Each participant’s fine motor skills, visual acuity, and level of binocular function were assessed at the baseline visit, the conclusion of the five-week treatment, and seventeen weeks after the baseline visit.  Fine motor skills were evaluated using the Bruininks-Oseretsky Test of Motor Proficiency, which assesses upper limb speed and dexterity, two skills that prior research has found were reduced in amblyopic children.  Binocular function was assessed using the Randot Preschool Stereoacuity Test and Worth 4 Dot test.

Prior to any treatment, fine motor skills scores in the amblyopic group were reduced compared to the normal children.   After five weeks of treatment, the amblyopic children had improved fine motor skills scores.  Greater improvement in fine motor  skills was associated with better baseline visual acuity in the amblyopic eye and better stereopsis.  Anisometropic amblyopes had greater fine motor skill improvement than strabismic amblyopes.  The improvements in fine motor skills remained stable after 17 weeks.  Several children were suppressing their amblyopic eye at the start of the study, and after treatment suppression was reduced and stereopsis improved.

This exciting new study shows that vision and the motor system are closely linked, and improving 3-D vision can improve fine motor skills.   A vision therapy program that treats all aspects of the amblyopia is important to help patients reach their full potential!

 Webber AL, Wood JM, Thompson B.  Fine Motor skills of Children With Amblyopia Improve Following Binocular Treatment.  Invest Opthal and Vis Sci.  2016; 57:4713-4720.