Serious Games Integrating Perceptual Learning and Stereopsis Training in Children With Amblyopia: Single-Arm Pre-Post Feasibility Study.

Background: Amblyopia, a leading cause of preventable childhood blindness, often remains inadequately addressed by traditional treatment methods such as refractive correction and occlusion therapy, which can be noninteractive and lead to poor adherence. Objective: This study aimed to design and evaluate the feasibility and preliminary efficacy of a serious game intervention that integrates perceptual learning and stereoscopic vision training for pediatric amblyopia and to explore its potential as a complementary or alternative approach to conventional treatments such as occlusion or atropine therapy. Methods: We evaluated visual acuity, accommodative sensitivity, binocular accommodation, stereopsis, and compliance-related data in a cohort of children with amblyopia aged 7 to 12 years before and after a 3-month intervention. Participants engaged in visual training via a serious game, attending sessions 4 times weekly for 30 minutes each. Results: Best-corrected visual acuity improved significantly from 0.42 (SD 0.16) to 0.37 (SD 0.18) logMAR, yielding a mean difference of 0.05 (95% CI 0.03-0.08; t24=4.82; Cohen d=0.96; P<.001). Accommodative sensitivity showed marked enhancement following the intervention. In the amblyopic eye, mean values increased from 1.44 (SD 2.18) to 4.96 (SD 2.91) cycles per minute, corresponding to a mean change of -3.52 (95% CI -4.59 to -2.45; t24=-6.81; Cohen d=-1.36; P<.001). Under binocular viewing, accommodative sensitivity improved from 1.52 (SD 2.49) to 5.08 (SD 2.71) cycles per minute (Δ=-3.56, representing the mean paired difference (baseline minus post), 95% CI -4.88 to -2.24; t24=-5.56; Cohen d=-1.11; P<.001). Stereoacuity also improved significantly, decreasing from 780.0 (SD 613.6) to 448.8 (SD 472.2) arc sec (Δ=331.20, 95% CI 134.20-528.20; t24=3.47; Cohen d=0.69; P=.002). The proportion of participants with normal Worth 4 dot responses increased from 76% (19/25) at baseline to 96% (24/25) after the intervention, and treatment adherence was high under supervised clinical conditions. Conclusions: The integration of gamified elements into amblyopia treatment was associated with high adherence under supervised clinical conditions and with significant short-term improvements in visual function, suggesting a promising complementary approach to conventional therapies. This interactive approach effectively combines perceptual learning with stereopsis training, presenting a potential alternative to conventional therapies.