Amblyopia, or ‘lazy eye’, is reduced corrected visual acuity which exists in the absence of any detectable organic disease. Typically amblyopia is present in only one eye and is usually as a result of a squint (turn) or unequal lenses in the prescription spectacles. This condition affects 2-3% of the population, which equates to conservatively around 10 million people under the age of 8 years worldwide. It is currently treated by wearing an adhesive patch over the non-amblyopic eye for several hours per day, over a period of many months. Non-compliance with patch wearing is a problem that can result in unsuccessful treatment. Moreover, it is generally considered that patching does not work in patients above the age of 8 years. Patients often re-present to clinic as adults hoping for treatment to allow them to enter a profession with specific visual requirements. In the UK the visually impaired register consists of large numbers of people who are amblyopic, but have lost their remaining ‘good’eye through injury or disease.
The aim of our research was to provide a new way to treat amblyopia, that young children would find interesting and so comply with treatment. Working as a unique collaboration our multi-displinary team involved orthoptists and ophthalmologists from the hospital and IT technologists from the university. Together we devised a novel virtual-reality based system, the I-BiT™ system, in which children play interactive computer games. The innovation here is that the game is played with both eyes open and the amblyopic eye is given additional visual stimuli to encourage the eye to be used and hence the vision to improve. Amblyopia treatment with both eyes open is a world first.

Early clinical trials showed encouraging results, with rapid increases in vision in some children after only two hours of treatment. These results have been observed consistently in patients both under 8 and up to 12 years of age. The treatment worked in newly diagnosed children and those in whom previous occlusion therapy had failed. This means that, for the first time, it is now possible to provide treatment for older patients with amblyopia.

This new technology has been internationally patented and licensed to a commercial partner, specialising in manufacturing ophthalmic equipment. Development of the first manufactured prototype was achieved through joint research involving parents, children, clinicians and human factors specialists to evaluate and provide feedback informing iterative prototype development. A pre-production prototype is now available for clinical trial and six other hospital clinics have requested to test a system.

This project has allowed integration of research into clinical practice and is now linked into our departmental action plan. Change in service provision has been supported by full co-operation of orthoptic colleagues. This project has provided opportunities for personal development of orthoptists and one is registered for a higher degree.
Orthoptists can utilise their clinical expertise to work on innovative research to the level of PhD, and clinical orthoptists have a valid place in improving patient care through innovative IT.

http://www.virart.nottingham.ac.uk/ibit/