Binocular Game Improves Amblyopic-Eye Visual Acuity After 4 Weeks, Longer Term Efficacy Uncertain

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Age and other factors may affect treatment outcomes for young patients with amblyopia and may be lengthy in some children.

Binocular amblyopia treatment using a game on a handheld, digital device improved visual acuity (VA) in the amblyopic eye at 4 weeks, but results were inconclusive at 8 weeks in children aged 4-6 years, according to a study published in Optometry and Vision Science.

Researchers enrolled 182 children (mean age 5.7 years) across 52 centers in the study and randomly assigned them to either a home treatment regimen consisting of 8 weeks of using the binocular game and eyeglasses (n=92, 54% girls, 1 hour per day, 5 days a week) or treatment with spectacle lenses alone (n=90, 51% girls). Among the cohort, 63% had anisometropia, 16% had strabismus, and 20% had a combined-mechanism of amblyopia. The primary outcome measure was the change in visual acuity of the eye with amblyopia from baseline. 

At the conclusion of the initial follow-up at 4 weeks, mean amblyopic VA improved 0.5 more lines (95.1% CI, 0.1-0.9) among the binocular treatment group compared with eyeglasses alone (1.1 vs 0.6 logMAR lines).

However, results were inconclusive at the end of 8 weeks with a mean VA improvement of 1.3 logMAR lines in the binocular treatment group compared with 1.0 logMAR lines with spectacles alone.

Investigators question why an effect was only witnessed at the 4-week, but not 8-week follow-up and theorize, “that the nonlinear course of visual acuity improvement observed with binocular treatment, as well as traditional forms of amblyopic treatment, may differ from that seen with optical treatment. Although the time course to achieve maximal optical treatment may vary by age and other factors, it has been reported to be lengthy in some children with anisometropic, strabismic, and combined-mechanism amblyopia.”

Limitations of the study include reliance on parent reporting and a greater level of treatment adherence in the spectacle lenses group. 


Manny RE, Holmes JM, Kraker RT, et al. A randomized trial of binocular Dig Rush game treatment for amblyopia in children aged 4 to 6 years. Optom Vis Sci. 2022;99(3):213-227. doi:10.1097/OPX.0000000000001867