In this project, we propose to develop and demonstrate feasibility of a head mounted smartphone?based application for in?home training and remote monitoring of progress for patients with convergence insufficiency (CI). CI develops in an estimated 13?17% of school?age children in the U.S. (3?8% overall) and causes symptoms of eye strain, blurred vision, and reduced concentration, resulting in significant educational disadvantages. If diagnosed, the disorder can be treated by a well?established training program that has been demonstrated to alleviate the symptoms. Recent studies have found that the vision therapy for CI is more successful when performed in the doctors office under monitoring and then reinforced with at?home training. However, significant barriers of cost/time of in?office treatment and poor compliance at home limit the benefits of the vision therapy and greatly hamper its success. The proposed head mounted smartphone system will consist of two components: one for binocular vision assessment and another module to broadcast remote display content wirelessly to a virtual reality headset. This novel Universal Vision Therapy and Entertainment platform will enable the patients to watch their favorite video content or play a video game of choice on a head mounted system as part of the therapy. Once the video stream is chosen by the user, the system will convert it to a dichoptic stimulus with variable induced vergence demand. During the therapy session, the system will log usage statistics and system parameters such as induced vergence demand range for post?hoc analysis and remote monitoring by the doctor. We hypothesize that an increase in compliance will be achieved due to the low invasiveness of the training protocol and a wide variety of video content that will keep the therapy engaging for prolonged duration. Through our clinical collaborations we will evaluate the compliance of the proposed therapy relative to standard methodologies in patients. At the conclusion of the Phase I project, we will have demonstrated feasibility and compliance of the novel mobile entertainment for vision therapy, showing accuracy of binocular measurements and the user acceptance of our method compared to the tests and therapies currently employed in clinics and ophthalmology practices. The wide availability of smartphones and low?cost virtual reality headsets (google cardboard), when coupled with our universal platform, have the potential to bring about a paradigm shift in cost?compliance calculations and increase awareness for binocular vision disorders, resulting in greater access to treatment for CI?affected individuals. Once the accuracy and compliance for the system meet or exceed those of current methods in a representative population, we will prepare for an in?depth evaluation of therapy efficacy in Phase II.
Public Health Relevance Statement: NARRATIVE Convergence insufficiency (CI) affects an estimated 13?17% of school?age children in the U.S. (3?8% overall) and causes symptoms of eye strain, blurred vision, and reduced concentration, resulting in significant educational disadvantages. NIH funded clinical studies have demonstrated the feasibility and effectiveness of vision therapy to restore binocular vision, but public health efforts to perform training for CI have been hampered by significant barriers of cost and time related to in?office therapy, and poor compliance in the case of in?home therapy. A significant challenge for patient compliance with in?home therapy has been the monotony of vision training tasks, limited to simple exercises or a single video game. A recent study of CI therapy reported 67% compliance for in?home computer?based therapy as opposed to 91% for in?office therapy. If patient compliance with in?home therapy can be improved, the overall success rate of CI training will likely be increased significantly. The overall goal of the proposed Phase I project is to develop a head? mounted smart phone?based vision therapy system that wirelessly converts any video entertainment from an external, user?defined source to a dichoptic training stimulus. Using such a cost?effective, widely available system, the affected population will be able to receive in?home vision therapy with automated doctor monitoring via telemedicine, all while enjoying their regular TV shows, movies or video games.
Project Terms: Affect; Awareness; base; Benchmarking; Binocular Vision; Binocular Vision Disorder; Blurred vision; Calibration; Cellular Phone; Child; Clinic; Clinical; Clinical Research; Collaborations; Compliance behavior; Computers; Convergence Insufficiency; cost; cost effective; Coupled; Data; Diagnosis; Disease; educationally disadvantaged; effective therapy; Effectiveness; Exercise; Eye; Eye Movements; Funding; Goals; Goggles; Head; Health Services Accessibility; Home environment; improved; Individual; innovation; Measurement; Measures; Methodology; Methods; Monitor; movie; Multi-Institutional Clinical Trial; Nature; novel; Office Visits; Ophthalmology; patient population; Patients; Performance; performance tests; Phase; Play; Population; preference; programs; Protocols documentation; Public Health; reduce symptoms; Reporting; School-Age Population; software development; Source; statistics; Stimulus; Strabismus; Stream; success; Surveys; Symptoms; System; Telemedicine; Testing; Therapy Evaluation; Time; tool; Training; Training Programs; treatment effect; Treatment Efficacy; United States National Institutes of Health; Video Games; virtual reality; Vision; Vision Tests; Visual; Wireless Technology
