Mobile Graphic Device Vision Screening for Unilateral Amblyopia in Pediatric Patients.

Abstract

Purpose: To determine whether inter-ocular brightness disparity during a self-directed video game on a mobile graphic device can effectively detect unilateral amblyopia.

Methods: Forty-nine children of ages 3 to 17 years participated in this prospective, non-interventional study. A series of sample image pairs were presented on an iPad (Apple, Inc) to illustrate the concept of relative brightness. Participants subsequently wore spectacles with orthogonally polarized lenses to dissociate image pairs between eyes. The video game employed a forced-choice algorithm that varied relative brightness disparity between image pairs in a stepwise manner. Participants chose the brighter of each pair of images until the end point of equal brightness was detected. The game was repeated to assess consistency. Eye examination records with acuities measured in logarithm of the minimum angle of resolution units were subsequently reviewed to compare with the video game results.

Results: The study had a mean game time of 108 seconds. Inter-ocular brightness disparity greater than 0.3 log units indicated a relative afferent brightness sense defect. The video game detected unilateral amblyopia with 88% sensitivity and 95% specificity. The positive predictive value was 78% and the negative predictive value was 98%.

Conclusions: This iPad video game can be played by children at least as young as 3 years of age. Inter-ocular brightness disparity is a sensitive and specific sign of unilateral amblyopia in a general pediatric population. The non-threatening nature and engaging format of this video game make it a promising and accessible method for early amblyopia screening. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].