Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): a protocol for a crossover randomized controlled trial.

BACKGROUND: Amblyopia is the most common developmental vision disorder in children. The initial treatment consists of refractive correction. When insufficient, occlusion therapy may further improve visual acuity. However, the challenges and compliance issues associated with occlusion therapy may result in treatment failure and residual amblyopia. Virtual reality (VR) games developed to improve visual function have shown positive preliminary results. The aim of this study is to determine the efficacy of these games to improve vision, attention, and motor skills in patients with residual amblyopia and identify brain-related changes. We hypothesize that a VR-based training with the suggested ingredients (3D cues and rich feedback), combined with increasing the difficulty level and the use of various games in a home-based environment is crucial for treatment efficacy of vision recovery, and may be particularly effective in children. METHODS: The AMBER study is a randomized, cross-over, controlled trial designed to assess the effect of binocular stimulation (VR-based stereoptic serious games) in individuals with residual amblyopia (n = 30, 6-35 years of age), compared to refractive correction on vision, selective attention and motor control skills. Additionally, they will be compared to a control group of age-matched healthy individuals (n = 30) to account for the unique benefit of VR-based serious games. All participants will play serious games 30 min per day, 5 days per week, for 8 weeks. The games are delivered with the Vivid Vision Home software. The amblyopic cohort will receive both treatments in a randomized order according to the type of amblyopia, while the control group will only receive the VR-based stereoscopic serious games. The primary outcome is visual acuity in the amblyopic eye. Secondary outcomes include stereoacuity, functional vision, cortical visual responses, selective attention, and motor control. The outcomes will be measured before and after each treatment with 8-week follow-up. DISCUSSION: The VR-based games used in this study have been conceived to deliver binocular visual stimulation tailored to the individual visual needs of the patient, which will potentially result in improved basic and functional vision skills as well as visual attention and motor control skills. TRIAL REGISTRATION: This protocol is registered on ClinicalTrials.gov (identifier: NCT05114252) and in the Swiss National Clinical Trials Portal (identifier: SNCTP000005024).

The eRDS v6 Stereotest and the Vivid Vision Stereo Test: Two New Tests of Stereoscopic Vision.

Purpose: To describe two new stereoacuity tests: the eRDS v6 stereotest, a global dynamic random dot stereogram (dRDS) test, and the Vivid Vision Stereo Test version 2 (VV), a local or "contour" stereotest for virtual reality (VR) headsets; and to evaluate the tests' reliability, validity compared to a dRDS standard, and learning effects. Methods: Sixty-four subjects passed a battery of stereotests, including perceiving depth from RDS. Validity was evaluated relative to a tablet-based dRDS reference test, ASTEROID. Reliability and learning effects were assessed over six sessions. Results: eRDS v6 was effective at measuring small thresholds (<10 arcsec) and had a moderate correlation (0.48) with ASTEROID. Across the six sessions, test-retest reliability was good, varying from 0.84 to 0.91, but learning occurred across the first three sessions. VV did not measure stereoacuities below 15 arcsec. It had a weak correlation with ASTEROID (0.27), and test-retest reliability was poor to moderate, varying from 0.35 to 0.74; however, no learning occurred between sessions. Conclusions: eRDS v6 is precise and reliable but shows learning effects. If repeated three times at baseline, this test is well suited as an outcome measure for testing interventions. VV is less precise, but it is easy and rapid and shows no learning. It may be useful for testing interventions in patients who have no global stereopsis. Translational Relevance: eRDS v6 is well suited as an outcome measure to evaluate treatments that improve adult stereodepth perception. VV can be considered for screening patient with compromised stereovision.

Personality as a Predictor of Disability in Multiple Sclerosis.

OBJECTIVE: As personality changes and personality disorders are frequently observed in multiple sclerosis (MS), personality may be a prognostic factor for this disease. The present study investigated the influence of personality on disability, progression, and treatment adherence in MS. METHOD: Personality was assessed in 41 patients with Relapsing-Remitting MS (30 females; mean age = 42.63 years) using the NEO Personality Inventory-3rd edition. Disability was measured with the Expanded Disability Status Scale, and treatment adherence information was collected from the Swiss MS Cohort. Correlation, multiple linear and partial least square regressions were performed to examine relations between personality, disability, and treatment adherence in MS. RESULTS: After accounting for age and time since disease onset, our analysis revealed that Neuroticism (ß = 0.32, p = 0.01) and its Vulnerability facet (ß = 0.28, p < 0.05) predicted greater disability, whereas Extraversion (ß = -0.25, p = 0.04) and its Activity facet (ß = -0.23, p < 0.05) predicted milder disability. Regarding disability progression, correlational analysis revealed that it was negatively correlated with Extraversion (r = -0.44, p = 0.02) and the Feelings facet of Openness (r = -0.41, p = 0.03), but regressions failed to highlight any predictive links. No significant results could be demonstrated for treatment adherence. CONCLUSIONS: Overall, our study showed that some personality traits can impact disability in MS, indicating that these should be considered in clinical practice, as they could be used to adapt and improve patients' clinical support.