Adherence to home-based videogame treatment for amblyopia in children and adults

Objective: Home-based videogame treatments are increasingly being used for various sensory conditions, including amblyopia (lazy eye), but adherence continues to limit success. To examine detailed behavioral patterns associated with home-based videogame treatment, we analyzed in detail the videogame adherence data from the Binocular treatment of amblyopia with videogames (BRAVO) clinical trial (ACTRN12613001004752). Methods: Children (7-12 years), Teenagers (13-17 years) and Adults (≥18 years) with unilateral amblyopia were loaned iPod Touch devices with either an active treatment or placebo videogame and instructed to play for 1-2 hours/day for six weeks at home. Objectively-recorded adherence data from device software were used to analyze adherence patterns such as session length, daily distribution of gameplay, use of the pause function, and differences between age groups. Objectively-recorded adherence was also compared to subjectively-reported adherence from paper-based diaries. Results: 105 of the 115 randomized participants completed six weeks of videogame training. Average adherence was 65% (SD 37%) of the minimum hours prescribed. Game training was generally performed in short sessions (mean 21.5, SD 11.2 minutes), mostly in the evening, with frequent pauses (median every 4.1 minutes, IQR 6.1). Children played in significantly shorter sessions and paused more frequently than older age groups (p<0.0001). Participants tended to over-report adherence in subjective diaries compared to objectively-recorded gameplay time. Conclusion: Adherence to home-based videogame treatment was characterized by short sessions interspersed with frequent pauses, suggesting regular disengagement. This complicates dose-response calculations and may interfere with the effectiveness of treatments like binocular treatments for amblyopia, which require sustained visual stimulation.