Using Eye Tracking to Measure Video Game-Assisted Therapy for Improved Visual Outcomes in Pediatric Strabismus: Randomized Control Trial.

Background: Strabismus, commonly known as crossed eyes, is a condition characterized by the misalignment of the eyes, leading to impaired binocular vision and depth perception. Traditional management often involves occlusion therapy, which can be hindered by poor compliance. Video game therapy has emerged as a promising adjunct to traditional treatments, potentially improving compliance and directly stimulating visual and cognitive functions. Objective: This study compares the effectiveness of traditional occlusion therapy with and without the addition of video game therapy in improving visual outcomes among children with strabismus. Methods: This randomized, controlled clinical trial included 30 children aged 5 to 10 years diagnosed with various types of strabismus. Participants were randomly assigned to 2 groups: the control group (eye patching alone) and the treatment group (eye patching combined with video game therapy). The intervention lasted 3 months, with data collected at baseline and after the treatment. Primary outcomes included visual acuity, angle of deviation, and stereoacuity, while fixation stability was measured using the Tobii eye tracker. Data were analyzed using paired 2-tailed t tests, independent 2-tailed t tests, Mann-Whitney U tests, and multivariate analysis of variance, with a significance level set at P<.05. Results: The treatment group showed significant improvements across all measured outcomes. Visual acuity improved significantly in both the amblyopic (P<.001) and fellow or nonamblyopic eyes (P<.001). The angle of deviation decreased (P<.001), and stereoacuity improved (P<.001). Fixation stability, as measured by the eye tracker, also showed significant improvement and was higher in the treatment group (mean 2.87, SD 0.56 seconds) compared with the control group (mean 1.88, SD 0.42 seconds; P<.001). The control group, which received only eye patching, also exhibited significant improvements, though to a lesser extent. Posttreatment visual acuity in the amblyopic eye was significantly better in the treatment group compared to the control group (P<.001), with similar results for the fellow or nonamblyopic eye (P<.001). Stereoacuity also showed superior improvement in the treatment group (P=.01). Fixation stability was significantly better in the treatment group (P<.001), and multivariate analysis of variance indicated a highly significant overall difference between the 2 groups across multiple outcomes (P<.001). Conclusions: The combination of traditional eye patching with video game therapy significantly enhances treatment outcomes in children with strabismus, particularly in improving visual acuity, stereoacuity, and fixation stability. While both interventions effectively reduce the angle of deviation, video game therapy offers additional benefits by engaging in and improving the functional aspects of vision. These findings suggest that incorporating video game therapy into traditional treatment regimens could lead to more effective and engaging interventions for pediatric strabismus, potentially improving compliance and long-term outcomes. Future research should focus on understanding the underlying mechanisms and optimizing therapy for diverse patient populations.