An action video game for the treatment of amblyopia in children: A feasibility study.

The gold-standard treatment for childhood amblyopia remains patching or penalizing the fellow eye, resulting in an average of about a one line (0.1 logMAR) improvement in visual acuity following ≈120 h of patching in children 3-8 years old. However, compliance with patching and other treatment options is often poor. In contrast, fast-paced action video games can be highly engaging, and have been shown to yield broad-based improvements in vision and attention in adult amblyopia. Here, we pilot-tested a custom-made action video game to treat children with amblyopia. Twenty-one (n = 21) children (mean age 9.95 ±â€¯3.14 [se]) with unilateral amblyopia (n = 12 anisometropic and n = 9 strabismic) completed 20 h of game play either monocularly, with the fellow eye patched (n = 11), or dichoptically, with reduced contrast to the fellow eye (n = 10). Participants were assessed for visual acuity (VA), stereo acuity and reading speed at baseline, and following 10 and 20 h of play. Additional exploratory analyses examined improvements after 6-10 weeks of completion of training (follow-up). Following 20 h of training, VA improved, on average, by 0.14 logMAR (≈38%) for the dichoptic group and by 0.06 logMAR (≈15%) for the monocular group. Similarly, stereoacuity improved by 0.07 log arcsec (≈17%) following dichoptic training, and by 0.06 log arcsec (≈15%) following monocular training. Across both treatment groups, 7 of the 12 individuals with anisometropic amblyopia showed improvement in stereoacuity, whereas only 1 of the 9 strabismic individuals improved. Most improvements were largely retained at follow-up. Our feasibility study therefore suggests that the action video game approach may be used as an effective adjunct treatment for amblyopia in children, achieving results similar to those of the gold-standard treatment in shorter duration.

A dichoptic custom-made action video game as a treatment for adult amblyopia.

Previous studies have employed different experimental approaches to enhance visual function in adults with amblyopia including perceptual learning, videogame play, and dichoptic training. Here, we evaluated the efficacy of a novel dichoptic action videogame combining all three approaches. This experimental intervention was compared to a conventional, yet unstudied method of supervised occlusion while watching movies. Adults with unilateral amblyopia were assigned to either play the dichoptic action game (n=23; 'game' group), or to watch movies monocularly while the fellow eye was patched (n=15; 'movies' group) for a total of 40hours. Following training, visual acuity (VA) improved on average by ≈0.14logMAR (≈28%) in the game group, with improvements noted in both anisometropic and strabismic patients. This improvement is similar to that obtained following perceptual learning, video game play or dichoptic training. Surprisingly, patients with anisometropic amblyopia in the movies group showed similar improvement, revealing a greater impact of supervised occlusion in adults than typically thought. Stereoacuity, reading speed, and contrast sensitivity improved more for game group participants compared with movies group participants. Most improvements were largely retained following a 2-month no-contact period. This novel video game, which combines action gaming, perceptual learning and dichoptic presentation, results in VA improvements equivalent to those previously documented with each of these techniques alone. Our game intervention led to greater improvement than control training in a variety of visual functions, thus suggesting that this approach has promise for the treatment of adult amblyopia.

Changing the P300 brain computer interface.

Brain-computer interfaces (BCIs) are now feasible for use as an alternative control option for those with severe motor impairments. The P300 component of the evoked potential has proven useful as a control signal. Individuals do not need to be trained to produce the signal, and it is fairly stable and has a large evoked potential. Even with recent signal classification advances, on-line experiments with P300-based BCIs remain far from perfect. We present two potential methods for improving control accuracy. Experimental results in an evoked potential BCI, used to control items in a virtual apartment, show a reduced response exists when items are accidentally controlled. The presence of a P300-like signal in response to goal items means that it can be used for automatic error correction. Preliminary results from an interface experiment using three different button configurations for a yes/no BCI task show that the configuration of buttons may affect on-line signal classification. These results will be discussed in light of the special considerations needed when working with an amyotrophic lateral sclerosis (ALS) patient.

Use of the evoked potential P3 component for control in a virtual apartment.

Virtual reality (VR) may prove useful for training individuals to use a brain-computer interface (BCI). It could provide complex and controllable experimental environments during BCI research and development as well as increase user motivation. In the study reported here, we examined the robustness of the evoked potential P3 component in virtual and nonvirtual environments. We asked subjects to control several objects or commands in a virtual apartment. Our results indicate that there are no significant differences in the P3 signal between subjects performing a task while immersed in VR versus subjects looking at a computer monitor. This indicates the robustness of the P3 signal over different environments. For an online control task, the performance in a VR environment was not significantly different from performance when looking at a computer monitor. There was, however, a more significant result when the subject's head view of the virtual world was fixed (p < 0.05) when compared with looking at a computer monitor. We also found that subjects' self-reported qualitative experiences did not necessarily match their objective performance. Six out of nine subjects liked the VR environment better, but only one of these subjects performed the best in this environment. The possible ramifications of this, as well as plans for future work, are discussed.