Binocular Treatment Research Articles

High-Adherence Dichoptic Treatment Versus Patching in Anisometropic and Small Angle Strabismus Amblyopia: A Randomized Controlled Trial

PurposeTo compare the effectiveness and safety of a novel binocular eye-tracking-based-home-treatment (CureSight) to patching for the treatment of amblyopia. DesignProspective, masked, randomized controlled noninferiority trial. SettingMulticenter, multinational, home treatment. ParticipantsOne hundred forty-nine children 4 to < 9 years with anisometropic, small-angle strabismic, or mixed-mechanism amblyopia were randomized to either binocular treatment (n=75) or patching (n=74). InterventionsThe binocular treatment group used the CureSight system for 90 min/day, 5 days/week for 16 weeks (120 hours). The patching group received 2-hour patching 7 days/week (224 hours). Main outcome measuresThe primary outcome was the mean improvement from baseline in amblyopic eye visual acuity (VA) to week 16 in both study groups (non-inferiority of ≤0.10 logarithm of the minimum angle of resolution [logMAR]). Other outcomes included changes in stereoacuity and binocular VA from baseline to week 16. ResultsThe mean improvement from baseline at week 16 in the binocular treatment group was noninferior to patching group improvement in the modified intent-to-treat (mITT) dataset (LS mean difference between groups in improvement from baseline: 0.034 logMAR (95% CI -0.009 to 0.076)). In the per-protocol (PP) dataset, the mean improvement from baseline at week 16 in the binocular treatment group was superior to patching group improvement (LS mean difference between groups in improvement from baseline: 0.05 logMAR ([95% CI; 0.007 to 0.097]). At week 16, both groups showed significant median improvement in stereoacuity, with no significant between-group difference in the magnitude of improvement in both the mITT and the PP datasets. Binocular VA was also improved in both groups (p<0.0001). Median adherence in the mITT binocular treatment group (94.0%) was also significantly higher than in the patching group (83.9%; p=0.0038). ConclusionsBinocular, eye-tracking-based amblyopia home treatment is at least as effective as patching.

Flight patterns of monocularly occluded homing pigeons further reveal a left eye/right cerebral hemispheric advantage in the visual processing of familiar landscape/landmark features

Studying pigeons during homing has offered an opportunity to investigate visual–functional brain lateralization in the context of free flying and long distance navigation. In the current study we examine at a high scale of spatial resolution the flight paths of pigeons, which vary with respect to monocular and binocular treatment, as they familiarise themselves with landscape and landmark features during repeated flights home from two locations. The analysis of the flight paths of monocularly occluded pigeons revealed that pigeons using the right eye/left hemisphere visual system were more likely to display more tortuous paths over tracts of 500 m along the flight path home compared to both pigeons using the left eye/right hemisphere visual system and control birds. Accompanying this finding was the observation that pigeons using the right eye/left hemisphere system were more likely to perform flight “loops”, suggesting that, without right hemispheric visual processing, pigeons are more motivated to seek out visual input, behaviourally expanding the now monocularly reduced visual field. Taken together, the data are consistent with a more important role of the left eye/right hemisphere system in processing visual features of the landscape, which may contribute to the construction of the familiar landmark-based map used for navigation. More broadly, our data are consistent with the hypothesis that the right cerebral hemisphere of the avian brain plays a more important role in memorising and using the relational properties of visual stimuli to guide performance on spatial tasks.

A Prospective Trial to Assess the Efficacy of Eye-Tracking-Based Binocular Treatment versus Patching for Children’s Amblyopia: A Pilot Study

ABSTRACT Purpose To assess visual acuity (VA) and stereoacuity (SA) improvements in children with amblyopia treated with either binocular dichoptic treatment or patching treatment. Methods In this pilot prospective coherent study, 34 participants between 4 and 9 years of age with unilateral anisometropic amblyopia and without history of prior amblyopia treatment were enrolled into three groups. Full treatment group (FTG; n = 12): participants were prescribed the binocular dichoptic treatment to watch for 90 minutes per day, 5 days a week. Part-time treatment group (PTTG; n = 8): participants were prescribed the same binocular treatment as FTG, 90 minutes per day, 3 days per week. Patching treatment group (PTG; n = 14): participants wore an adhesive patch over the dominant eye for 2 hours per day, 7 days per week. Amblyopic-eye distance visual acuity (DVA), near visual acuity (NVA) and SA were evaluated at baseline, 4, 8, and 12 weeks. Results At 12 weeks, mean amblyopic-eye DVA improved 1.8 lines (95% CI, 1.1–2.5) in FTG, 1.5 lines (95% CI, 0.4–2.7) in PTTG and 3.0 lines (95% CI, 2.0–4.0) in PTG. The amblyopic-eye NVA improved 2.9 lines (95% CI, 2.4–3.5) in FTG, 1.7 lines (95% CI, 0.5–3.0) in PTTG and 2.8 lines (95% CI, 1.8–3.9) in PTG. The SA improved 0.38 log-arcseconds (95% CI, 0.24–0.53) in FTG, 0.59 log-arcseconds (95% CI, 0.36–0.82) in PTTG and 0.40 log-arcseconds (95% CI, 0.13–0.67) in PTG. No significant differences were found in DVA, NVA or SA improvement between FTG and PTG at 12 weeks. Conclusions VA and SA after binocular dichoptic treatment produced a similar therapeutic outcome to patching, suggesting a potential value for binocular therapy when treating anisometropic moderate degree of Children’s amblyopia.

Binocular treatment for amblyopic children: a review.

The narrative review was planned to investigate the efficiency of binocular treatment for amblyopic children, and to compare it with the standard methods. Literature search was conducted for articles in English language available on PubMed, Cochrane Library, Embase, Medline and PsycInfo databases as well as through bibliographies of peer-reviewed studies. Studies in the field of binocular treatment for amblyopia were included. Visual outcomes considered were visual acuity, types of amblyopia and stereoacuity. Studies on deprivation amblyopia, animal studies, literature review of amblyopia treatment, case reports, and trials targeting participants in whom previous amblyopia treatment had failed were excluded. Of the 40 studies found, 21(52.5%) met the inclusion criteria. Visual acuity and binocular function improved with binocular treatment for treating amblyopia in children by decreasing suppression depth extent and increasing stereopsis. Binocular treatment for amblyopic children was found to be an effective and fast process for the recovery of visual functions, especially in the critical time of visual development.

Binocular amblyopia treatment improves manual dexterity

To determine whether deficits in manual dexterity in children with amblyopia improve after binocular amblyopia treatment and whether improvements are related to age at treatment, baseline sensory status, or amount of improvement in sensory status with treatment. Manual dexterity (Movement Assessment Battery for Children-2), visual acuity, fusion, suppression, and stereoacuity were measured at baseline and after 4-8 weeks of binocular amblyopia in 134 children with amblyopia, including 75 children in the "younger group" (aged 3 to <7 years) and 59 in the "older group" (aged 7-10 years), and in 40 age-similar control children. Baseline manual dexterity standard scores of amblyopic children were significantly below those of controls in both the younger (8.81 ± 0.33 vs 11.80 ± 0.60 [P < 0.0001]) and older groups (7.19 ± 0.34 vs 9.75 ± 0.57 [P = 0.00013]). After 4-8 weeks of binocular amblyopia treatment, the younger group standard score improved to 9.85 ± 0.35 and the older group improved to 8.08 ± 0.39, but both groups remained significantly lower than controls (P = 0.03 and P = 0.01, resp.). Improvement in manual dexterity standard score was not associated with any baseline factors but was weakly correlated with the amount of visual acuity improvement (rs = 0.26; 95% CI, 0.09-0.41) CONCLUSIONS: Manual dexterity impairments are common among children with amblyopia. In our study cohort, binocular amblyopia treatment improved visual acuity and manual dexterity.

An Eye-Tracking–Based Dichoptic Home Treatment for Amblyopia: A Multicenter Randomized Clinical Trial

Comparing visual outcomes after use of a novel binocular eye-tracking-based home treatment (CureSight; NovaSight, Ltd) with patching. Prospective, multicenter, randomized, masked, controlled, noninferiority pivotal trial. One hundred three children 4 to < 9 years with anisometropic, small-angle strabismic or mixed-mechanism amblyopia were randomized 1:1 to either CureSight treatment or patching. The CureSight treatment uses combined anaglyph glasses and an eye tracker to induce real-time blur around the fellow eye fovea in dichoptic streamed video content.Participants used the device for 90 minutes/day, 5 days/week for 16 weeks (120 hours). The patching group received 2 hours of patching 7 days/week (224 hours). The prespecified noninferiority margin was 1 line. The primary outcome was the improvement in the amblyopic eye visual acuity (VA), modeled with a repeated measures analysis of covariance. Secondary outcomes included stereoacuity, binocular VA, and treatment adherence rates, analyzed by a 1-sample Wilcoxon test within each group and a 2-sample Wilcoxon test comparing groups. Safety outcomes included the frequency and severity of study-related adverse events (AEs). CureSight group VA improvement was found to be noninferior to patching group improvement (0.28 ± 0.13 logarithm of the minimum angle of resolution [logMAR] [P < 0.0001] and 0.23 ± 0.14 logMAR [P < 0.0001], respectively; 90% confidence interval [CI] of difference, -0.008 to 0.076). Stereoacuity improvement of 0.40 log arcseconds (P < 0.0001) and improved binocular VA (0.13 logMAR; P < 0.0001) were observed in the binocular treatment group, with similar improvements in the patching group in stereoacuity (0.40 log arcseconds; P<0.0001) and binocular VA (0.09 logMAR; P < 0.0001), with no significant difference between improvements in the 2 groups in either stereoacuity (difference, 0; 95% CI, -0.27 to -0.27; P= 0.76) or binocular VA (difference, 0.041; 95% CI, -0.002 to 0.085; P= 0.07). The binocular treatment group had a significantly higher adherence than the patching group (91% vs. 83%; 95% CI, -4.0% to 21%; P= 0.011). No serious AEs were found. Binocular treatment was well tolerated and noninferior to patching in amblyopic children 4 to <9 years of age. High adherence may provide an alternative treatment option for amblyopia. Proprietary or commercial disclosure may be found after the references.

Binocular treatment for individual with amblyopia: A systematic review and meta-analysis.

Objective:To assess the efficacy of binocular treatment for individual with amblyopia.Methods:In this meta-analysis, a comprehensive search of literatures was performed from PubMed, Embase, Cochrane Library and Web of Science databases up to December 21, 2020. Sensitivity analysis was performed for all outcomes. The Begg’s test was used to assess the publication bias. Heterogeneity test was conducted for each effect indicator. Indicators were analyzed by random-effects model when the heterogeneity statistic I2 ≥ 50%, on the contrary, indicators were analyzed by fixed-effect model. Standard mean difference (SMD) or weighted mean difference (WMD) was adopted as effect indicators, and the effect amount was expressed as 95% confidence intervals (CIs).Results:A total of 13 literatures including 1146 participants were finally enrolled, with 595 in the intervention group and 551 in the control group. The results indicated that the improvement of amblyopic eye visual acuity [SMD: 0.882, 95%CI: (0.152, 1.613), P = 0.018] in binocular treatment group was better than that in control group. And binocular treatment could improve stereo acuity in individual with amblyopia [WMD: 0.138, 95%CI: (0.068, 0.208), P < 0.001].Conclusion:Binocular treatment may be beneficial to visual acuity, stereo acuity and binocular function improvement for individual with amblyopia. In clinical practice, binocular treatment can be used as one of the treatments for individual with amblyopia.

Randomized clinical trial of streaming dichoptic movies versus patching for treatment of amblyopia in children aged 3 to 7\xa0years

Contrast-rebalanced dichoptic movies have been shown to be an effective binocular treatment for amblyopia in the laboratory. Yet, at-home therapy is a more practical approach. In a randomized clinical trial, we compared dichoptic movies, streamed at-home on a handheld 3D-enabled game console, versus patching as amblyopia treatment. Sixty-five amblyopic children (3–7 years; 20/32–125) were randomly assigned to one of two parallel arms, binocular treatment (3 movies/week) or patching (14 h/week). The primary outcome, change in best corrected visual acuity (BCVA) at the 2-week visit was completed by 28 and 30, respectively. After the primary outcome, both groups of children had the option to complete up to 6 weeks of binocular treatment. At the 2-week primary outcome visit, BCVA had improved in the movie (0.07 ± 0.02 logMAR; p < .001) and patching (0.06 ± 0.01 logMAR; p < 0.001) groups. There was no significant difference between groups (CI95%: − 0.02 to 0.04; p = .48). Visual acuity improved in both groups with binocular treatment up to 6 weeks (0.15 and 0.18 logMAR improvement, respectively). This novel, at-home, binocular movie treatment improved amblyopic eye BCVA after 2 weeks (similar to patching), with additional improvement up to 6 weeks. Repeated binocular visual experience with contrast-rebalanced binocular movies provides an additional treatment option for amblyopia.Clincaltrials.gov identifier: NCT03825107 (31/01/2019).

Evaluation of interactive binocular treatment in amblyopia

Evaluation of interactive binocular treatment in amblyopia

Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years.

Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years.

Jumping spiders do not seem fooled by texture gradient illusions

Jumping spiders (Salticidae) use exceptional vision, largely mediated by their forward-facing anterior lateral (AL) and anterior medial (AM) eyes, to pounce on prey from a distance. We evaluated depth perception through the use of ‘texture density’ (depth estimation through surface texture comparisons, with greater distances having higher textural density) in the salticid Trite planiceps. In visual cliff experiments, spiders tended to choose an area with a false ‘low drop’ over a false ‘high drop’ with the same texture densities, but showed no preference for either area when presented with substrates with different texture densities at a constant height. This was corroborated when T. planiceps did not avoid jumping over an illusion resembling a trench compared to a no-illusion control pattern. We then selectively occluded both AL and 1 AM eye (monocular treatment), both AL eyes (ALE-occluded binocular treatment) or no eyes (control), and induced spiders to jump across a gap at different heights. Neither control spiders, spiders with binocular cues from the AM eyes or monocular treatment spiders exhibited a height preference. These results suggest that while T. planiceps accurately perceives depth, it does not appear to rely on texture gradients as a depth cue.

A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years.

Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.

Efficacy of long-term orthokeratology treatment in children with anisometropic myopia.

To explore the efficacy of the orthokeratology lens for anisometropic myopia progression. A retrospective study was performed. Cycloplegic refraction and axial length (AL) were collected from 50 children (10.52±1.72y) who visited Peking University Third Hospital from July 2015 to August 2020. These children's one eyes (Group A) received monocular orthokeratology lenses at first, after different durations (12.20±6.94mo), their contralateral eyes (Group B) developed myopia and receive orthokeratology as well. The data in 1-year of binocular period were recorded. AL growth rate (difference of follow-up and baseline per month) were compared between two groups by paired t test. Interocular differences of AL were compared by Wilcoxon test. During monocular period, the AL growth rate of the Group A (0.008±0.022 mm/mo) was significantly slower than that of the Group B (0.038±0.018 mm/mo; P<0.0001). However, during binocular period, the AL growth rate of the Group A (0.026±0.014 mm/mo) was significantly faster than that of the Group B (0.016±0.015 mm/mo; P<0.0001). The AL difference between both eyes was 0.6 (0.46) mm, then significantly decreased to 0.22 (0.39) mm when started binocular treatment (P<0.0001). However, it was significantly increased to 0.30 (0.32) mm after a year (P<0.0001), but still significantly lower than baseline (P<0.0001). The orthokeratology lens is efficient for control the AL elongation of monocular myopia eyes and reduce anisometropia. For the condition that the contralateral eyes develop myopia and receive orthokeratology lens later, there is no efficiency observed on control interocular difference of AL during binocular treatment.

New treatment for amblyopia based on rules of synaptic plasticity: a randomized clinical trial.

Amblyopia resulting from early deprivation of vision or defocus in one eye reflects an imbalance of input from the eyes to the visual cortex. We tested the hypothesis that asynchronous stimulation of the two eyes might induce synaptic plasticity and rebalance input. Experiments on normal adults showed that repetitive brief exposure of grating stimuli, with the onset of each stimulus delayed by 8.3 ms in one eye, results in a shift in perceptual eye dominance. Clinical studies (Clinical trial registration number: ChiCTR2100049130), using popular 3D movies with similar asynchrony between the two eyes (amblyopic eye stimulated first) to treat anisometropic amblyopia, established that just 10.5 h of conditioning over <3 weeks produced improvement that met criteria for successful treatment. The benefits of asynchronous conditioning accumulate over 20-30 45 min sessions, and are maintained for at least 2 years. Finally, we demonstrate that asynchronous binocular treatment alone is more effective than patching only. This novel treatment is popular with children and is some 50 times more efficient than patching alone.

POSC154 Cost-Effectiveness of Binocular Treatment for Amblyopia: A Markov Model Framework

A novel binocular digital therapeutic for the treatment of amblyopia has the potential to improve binocular function, such as visual acuity (VA) and stereopsis. This research aims to develop a cost-effectiveness model that captures the natural history of amblyopia and the treatment effects on binocular vision.

Binocular treatment for amblyopia: A meta-analysis of randomized clinical trials.

To date, there is still no consensus regarding the effect of binocular treatment for amblyopia. The purpose of this systematic review and meta-analysis was to summarize the available evidence to determine whether binocular treatment is more effective than patching in children with amblyopia. Four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) were searched for studies that compared binocular treatment and patching in children with amblyopia. The outcome measures were visual acuity and stereopsis. Pooled effects sizes were calculated with a random-effect model. The standardized difference in means (SDM) with 95% confidence intervals (CI) was calculated. Sensitivity analysis and assessment of publication bias were performed. Five randomized clinical trials were included. No significant difference in visual acuity between patients treated with binocular treatment and patching was observed (SDM = -0.12; 95% CI: -0.45-0.20; P = 0.464). No significant difference in stereopsis between patients treated with binocular treatment and patching was observed (SDM = -0.07; 95% CI: -0.61-0.48; P = 0.809). For both variables, the between-study heterogeneity was high (respectively, I2 = 61% and I2 = 57%). This meta-analysis found no convincing evidence supporting the efficacy of binocular treatment as an alternative to conventional patching. Therefore, the binocular treatment cannot fully replace traditional treatment but, to date, it can be considered a valid complementary therapy in peculiar cases. Further studies are required to determine whether more engaging therapies and new treatment protocols are more effective.

Virtual reality prototype for binocular therapy in older children and adults with amblyopia

To evaluate the best-corrected visual acuity and stereoacuity gains in children >7years of age and adults with unilateral amblyopia treated with a prototype virtual reality-based binocular amblyopia therapy. In this randomized, double masked, cross-in clinical trial, patients at Boston Children's Hospital with unilateral anisometropic and/or strabismic amblyopia and history of prior amblyopia treatment failure were randomized to either a full-treatment group (8weeks of binocular treatment using therapeutic software application in virtual reality headset) or a sham-crossover group (4weeks of sham treatment followed by 4weeks of binocular treatment). Amblyopic eye visual acuity and stereoacuity were evaluated at 4, 8, and 16weeks' follow-up. The study cohort included 20 participants (10 females), with a median age of 9years (range, 7-38years). In the full-treatment group (11 patients), the mean amblyopic eye logMAR visual acuity at 16weeks was 0.49±0.26, compared with 0.47±0.20 at baseline. In the sham-crossover group, it was 0.51±0.18 at 16weeks, compared with 0.53±0.21 at baseline. Stereoacuity (log arcsec) was significantly improved, from 7.3±2 at baseline to 6.6±2.3 at 8weeks (P<0.001) and 6.7±2.6 at 16weeks (P<0.001). No significant adverse events (diplopia, asthenopia, or worsening strabismus) were noted in either group. Although the virtual reality-based prototype for binocular amblyopia therapy did not significantly improve visual acuity in the amblyopic eyes of older children and adults, stereoacuity did significantly improve compared with baseline; improvements were clinically minute. However, larger studies are required to confirm the results.

Current Management of Amblyopia with New Technologies for Binocular Treatment.

Amblyopia is the most common cause of monocular poor vision affecting up to 3.7% of the global population. Classically, the first step in treatment has been optical correction, followed by patching and/or pharmacological treatment. However, this is an evolving scenario, since researchers and clinicians are interested in new binocular treatments due to the increasing development of new technologies. In this article main, current binocular treatments as Dig Rush, falling blocks, I-BiT, Occlu-tab, Vivid Vision, and movies are reviewed for binocular amblyopia management.

Adherence to home-based videogame treatment for amblyopia in children and adults

ABSTRACT Clinical relevance: Home-based videogame treatments are increasingly popular for amblyopia treatment. However, at-home treatments tend to be done in short sessions and with frequent disruptions, which may reduce the effectiveness of binocular visual stimulation. These treatment adherence patterns need to be accounted for when considering dose-response relationships and treatment effectiveness. Background: Home-based videogame treatments are increasingly being used for various sensory conditions, including amblyopia (‘lazy eye’), but treatment adherence continues to limit success. To examine detailed behavioural patterns associated with home-based videogame treatment, we analysed in detail the videogame adherence data from the Binocular tReatment of Amblyopia with VideOgames (BRAVO) clinical trial (ACTRN12613001004752). Methods: Children (7-12 years), teenagers (13-17 years) and adults (≥ 18 years) with unilateral amblyopia were loaned iPod Touch devices with either an active treatment or placebo videogame and instructed to play for a total of 1-2 hours/day for six weeks at home. Objectively-recorded adherence data from device software were used to analyse adherence patterns such as session length, daily distribution of gameplay, use of the pause function, and differences between age groups. Objectively-recorded adherence was also compared to subjectively-reported adherence from paper-based diaries. Results: One hundred and five of the 115 randomised participants completed six weeks of videogame training. Average adherence was 65% (SD 37%) of the minimum hours prescribed. Game training was generally performed in short sessions (mean 21.5, SD 11.2 minutes), mostly in the evening, with frequent pauses (median every 4.1 minutes, IQR 6.1). Children played in significantly shorter sessions and paused more frequently than older age groups (p < 0.0001). Participants tended to over-report adherence in subjective diaries compared to objectively-recorded gameplay time. Conclusion: Adherence to home-based videogame treatment was characterised by short sessions interspersed with frequent pauses, suggesting regular disengagement. This complicates dose-response calculations and may interfere with the effectiveness of treatments like binocular treatments for amblyopia, which require sustained visual stimulation.

A pilot randomized trial of contrast-rebalanced binocular treatment for deprivation amblyopia

Binocular neural architecture may be preserved in children with deprivation amblyopia dueto unilateral cataract. The purpose of this study was to investigate whether a contrast-rebalanced binocular treatment, recently used with success to treat the interocular suppression and amblyopia in strabismic and anisometropic children, can contribute to rehabilitation of visual acuity in children with deprivation amblyopia secondary to monocular cataract. In a pilot randomized trial, 15 children (4-13years of age) were enrolled and randomized to continue with their current treatment only (n=7) or to continue with their current treatment and add contrast-rebalanced binocular iPad game play 5hours/week for 4weeks (n=8). The primary outcome was change in visual acuity at 4weeks. Although 10 of 15 participants were patching, there was little change in visual acuity during the 3months prior to enrollment. At the 4-week primary outcome visit, the mean improvement in visual acuity for the binocular game group was significantly greater than that for the current-treatment group (0.08±0.10 logMAR vs -0.03±0.05 logMAR [t10.2=2.53, P=0.03]). None of the children who had dense congenital cataract achieved improved visual acuity with binocular treatment. In this study cohort, visual acuity improved over 8weeks in children with unilateral deprivation amblyopia who played a binocular contrast-rebalanced binocular iPad game.