Recent research published in BMC Ophthalmology evaluated the impact of an application-based, multimodal visual therapy program on a real-world pediatric amblyopia patient population.
Let’s start with this program.
Developed by Smart Optometry, AmblyoPlay is a digital vision-training platform for patients (ages 3+) with amblyopia, mild strabismus, convergence insufficiency, and other binocular disorders.
Its commercial status: While the system was commercially launched to the U.S. market in 2019—and is also available in various countries—it is notably, not cleared by the FDA (nor has it received a CE mark) for amblyopia treatment.
How it works: This app-based tool (referred to as “a wellness and wellbeing tool,” to be specific) consists of a pair of binocular vision therapy training glasses and an interactive, gamified training program that offers personalized visual tasks via short, daily sessions averaging 15 to 30 minutes.
- See here for a full rundown of the process.
Explain the personalization component.
This begins with the very first few sessions. Specifically:
For 2 to 4 weeks: A patient’s eyes are tested on how they respond to different visual tasks; based on their reactions, the system adapts the difficulty level to match their current visual ability
- The intent: To ensure training is “never too easy and never too hard.”
Then for 6+ months: The system tracks how the eyes respond and gradually adjusts the difficulty to match a patient’s progress—offering a personalized training path that evolves with their visual performance.
And what outcomes are expected?
With regular (consistent; at least five times a week) training, users have reportedly experienced:
- Improved eye coordination
- Better reading comfort
- Reduced visual strain
- Improved depth perception
Even further: Patients should demonstrate measurable improvement in at least one out of three visual skills (visual acuity, stereopsis, and contrast sensitivity) after 6 to 8 months of use.
Interesting … now let’s talk about this new research.
Conducted at Istan Medipol University in Istanbul, Turkey, this non-randomized, controlled, pilot exploratory study evaluated Amblyoplay use among pediatric patients over a 6-month period.
- The participants: 29 patients (aged 7 to 13) were divided into one of two groups:
- Group 1: Diagnosed with anisometropic amblyopia (n = 14; 50% females; criteria here)
- Group 2: Controls, with normal ocular health (n = 15; 40% females; criteria here)
- The setup:
- Group 1: Performed 30-minute gamified dichoptic therapy (via AmblyoPlay), 5 days a week
- Group 2: Age- and sex-matched, typically developing controls without intervention
- The duration: 6 months
And what was evaluated?
The primary outcome: best-corrected visual acuity (BCVA; LogMAR), while secondary outcomes included:
- Stereopsis (Titmus fly)
- Oculomotor parameters (saccadic latency, smooth pursuit gain, optokinetic gain)
- Motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency [BOT]-2 subtests)
- Postural stability (sensory organization test [SOT])
How compliance was monitored: Via the app’s cloud-based tracking system, with progress reports reviewed on a weekly basis by the research team.
Now to the findings.
First, the study authors noted that—to the best of their knowledge—this research is “the first peer-reviewed clinical investigation” assessing the Amblyoplay in a pediatric anisometropic amblyopia cohort.
As for the data, let’s look at the primary outcome (BCVA):
- Group 1: The mean BCVA improved, decreasing from 0.23 ± 0.10 logMAR (at baseline) to 0.08 ± 0.05 logMAR (at 6 months; p < 0.001)
- Group 2: A stable BCVA was demonstrated across assessments (see here for those numbers)
What this means: Only Group 1 (the amblyopia group) demonstrated “statistically significant improvement in VA” over the study’s 6-month duration.
And what were the secondary outcomes?
For stereopsis: A substantial improvement was observed over the 6-month training period among Group 1 participants, indicating “enhanced binocular depth perception”
- Median stereoacuity decreased: 300 arcsec (at baseline) to 45 arcsec (at 6 months; p < 0.001)
- See how Group 2 fared.
For oculomotor assessments: Group 1 also demonstrated “significant” improvements, with:
- Saccadic latency of the amblyopic eye (AE) decreased from 235.14 ± 11.68 ms at baseline to 212.64 ± 15.06 ms at 6 months (p = 0.001)
- A similar reduction was noted in the fellow eye (FE): 235.14 ± 11.68 ms at baseline to 212.64 ± 15.06 ms at 6 months (p = 0.001)
- Meanwhile, Group 2 exhibited a “stable” performance with no significant change (p = 0.73)
- A similar reduction was noted in the fellow eye (FE): 235.14 ± 11.68 ms at baseline to 212.64 ± 15.06 ms at 6 months (p = 0.001)
And those other two oculomotor assessments?
Group 1 demonstrated similar patterns of increases in both smooth pursuit gains and optokinetic responses.
- Check them out here and here, respectively.
- Meanwhile: No statistically significant changes were observed for either assessment in Group 2.
As for the remaining secondary outcomes: This trend continued for postural and motor functions over the 6-month period (though while increases were noted for Group 1, statistical significance wasn’t reached).
How interesting … now let’s talk limitations.
The study authors identified a few drawbacks of this study, including:
- The absence of a randomized controlled design (see how this impacted the data) and the need for a parallel treatment arm for comparison purposes
- Lack of task-specific neuropsychological assessments (though this was deliberate)
- A restricted 6-month follow-up period preventing long-term evaluation of treatment effects
- Use of a Snellen chart and logMAR units conversion for VA data (see why this has limited precision for amblyopia research)
- Modest sample size and single-center study design
Noted. So how does this data compare to findings from similar studies?
In general, the findings from this research were reportedly “consistent” with previous controlled studies evaluating binocular and vision therapy-based interventions for pediatric patients with amblyopia.
- Further (and also in alignment with prior evidence, the authors noted), this data further supports the “efficacy of structured home-based and feedback-driven dichoptic interventions in pediatric amblyopia.”
And in general, for amblyopia treatment?
The results suggest that digital therapies (such as the AmblyoPlay) “may be effective and feasible, representing a promising adjunct for long-term amblyopia management.”