Dichoptic Gaming Shows Viability for Treating Amblyopia

Dichoptic gaming may provide visual and stereoacuity improvements that are comparable to occlusion therapy in less time per week.

Dichoptic gaming, performed 1 hour per week, may improve visual acuity and stereoacuity in pediatric patients with amblyopia, according to a study published in Acta Ophthalmologica. Children older than 5.5 years may derive the greatest benefit from this therapy, as they are more likely to comprehend the game’s tasks and have the attention span to complete it compared with children younger than 5.5 years, the report suggests.

Researchers included data from 33 children (49% girls; median age, 5.4 years) with refractive amblyopia in the investigation and randomly assigned them to treatment with occlusion therapy (2 hours/ day; n=17) or clinically-monitored dichoptic action gaming (1 hour/ week; n=16). Overall, 14 participants in the occlusion group and 7 children in the dichoptic gaming group completed the study. The team obtained visual acuity, stereoacuity, and contrast sensitivity measurements at baseline and every 6 weeks after during the 24-week study duration and conducted both per protocol and intention to treat analyses.

It is possible that occlusion and gaming influence plasticity at different anatomical locations.

Both the dichoptic gaming and occlusion therapy groups demonstrated significant visual acuity improvements compared with baseline (0.30 vs 0.20 logarithm of the minimum angle of resolution [logMAR]; P <.001 for both), but demonstrated no statistically significant differences when compared with each other (P =.823). Likewise, the gaming and occlusion therapies significantly improved stereoacuity at the 24-week study conclusion compared with baseline (1.70 vs 1.40 log arc sec and 2.00 vs 1.40 log arc sec, respectively; P <.001 for both) with no statistically significant differences between the groups (P =.609). The team did not observe any statistically significant changes for contrast sensitivity from baseline in either group.

Overall treatment efficiency was 1.25 logMAR per 100 hours (range, 0.42–2.08) with dichoptic gaming compared with 0.08 logMAR per 100 hours (range, −0.19–0.68) with occlusion (P <.001). A decrease in treatment efficiency occurred over time in both groups, with the most rapid decrease noted during the first 12 weeks, according to the report.

“More rapid [visual acuity] improvement may reflect greater plasticity in the visual cortex,” according to the researchers. “Could this difference in efficiency be explained by different modes of action of occlusion therapy compared to that of dichoptic game therapy? It is possible that occlusion and gaming influence plasticity at different anatomical locations. Attention may increase cortical plasticity and ‘speed up the treatment of amblyopia’.”

Study limitations include a small sample size and high loss to follow up.


Kadhum A, Tan ETC, Fronius M, et al. Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: effectiveness and efficiency. Acta Ophthalmol. Published online April 20,2023. doi:10.1111/aos.15674