Compliance with patching for amblyopia can be an issue, for both young and older children. But a company in Israel believes it may have the answer in a new device now available in Australia that kids will find hard to put down.
Many parents will know that children can be fussy eaters. Unwanted vegetables can hit the floor with lightning speed.
But they also know that the trick is often to disguise these important dietary additions in something else the child likes.
The treatment of amblyopia, or lazy eye, in children can meet similar levels of resistance and outright rejection.
Patching is considered the gold standard treatment to help strengthen the weaker eye and bring a child’s vision to better balance, but compliance can be a problem, with many children ripping off the patch early in the process because of discomfort or stigma, mainly with older children, meaning both parents and eyecare professionals are unable to fully monitor compliance.
NovaSight, an Israeli medical device company, believes it has developed a powerful solution to not only treat children with amblyopia but also monitor that treatment – to the second.
It has created CureSight, a device with eye-tracking technology, that is distributed in Australia by BOC Instruments.
Children simply watch their favourite content on the CureSight device for 90 minutes, five days a week, while wearing dedicated anaglyph (red-blue) treatment glasses. The treatment is hidden in what, for many kids, is a popular, fun and engaging activity, which enhances their compliance.
The content on the screen is split into separate red and blue channels, one for each eye, and the eye-tracking technology within the device, that is incorporated with its treatment algorithms, blurs the central visual area of the good, dominant eye, according to the child’s momentary gaze position.
“You have to teach both eyes to work together, and we can do it by blocking only the central visual area of the non-amblyopic eye,” says NovaSight chief scientific officer Dr Oren Yehezkel, who holds a PhD in neuroscience, specialising in binocular vision, and a BSc in optometry.
“So in that way, the periphery of both eyes remains clear, allowing them to cooperate, and by that the brain is taught to use both eyes simultaneously.”
Studies in Israel, backed by research in China and the US, show that this can be an effective treatment – more on that later – but possibly even more powerful is the eye-tracking technology’s ability to monitor the child’s engagement with the content and compliance with the treatment.
Professor Tamara Wygnanski-Jaffe is a paediatric ophthalmologist, head of the paediatric ophthalmology and strabismus service at the Sheba Medical Centre in Israel and president of the International Paediatric Ophthalmology & Strabismus Council.
She also conducts clinical studies for NovaSight.
“I think the gold standard for amblyopia treatment is occlusion, where you put a patch on the eye,” she says. “In some countries that can also involve atropine drops to the dominant eye.
“We know from the studies that adherence of patching in the first six weeks is about 40% to 60%, and that the biggest improvement with patching is in the first three months of treatment, and then compliance goes down to 30%, so adherence is a big, big issue with patching.”
The other issue is monitoring of that treatment.
“When someone comes in, we don’t know if they didn’t improve because they didn’t patch, or non-compliance, or they didn’t improve because they have an earlier or deeper form of amblyopia, which is harder to treat.”
But her studies in Israel, involving 103 children aged four to nine – supported by similar research elsewhere – show a 95% compliance rate with CureSight.
The company is able to back this up because of its eye-tracking technology.
“We know, by the second, how long the child is being treated,” says Dr Yehezkel. “If they use the treatment glasses we monitor it, and if they don’t look at the screen, we know it and we notify the parents.”
By we, he means a dedicated monitoring centre that tracks the child’s usage in real time and prepares reports for both the parents and the eyecare professional, who combines that data with regular measurements of visual acuity to track progress.
“The CureSight device can have a demonstrable impact on that visual acuity and stereo acuity as well as compliance,” says Prof Wygnanski-Jaffe.
The Israel trials went for 16 weeks and showed an average improvement of 2.8 lines on a standard eye chart at distance, 1.3 lines improvement of binocular treatment, and a median improvement of stereoacuity from 200 to 60 arcseconds.
She was impressed by that improvement, but even more so that it was sustained in follow-up checks.
“We wanted to show that at one year, the improvement was sustainable, and we did.
“One of the most interesting findings was that those children that were cured of amblyopia, with less than one-line difference between the dominant eye and the amblyopic eye, had no change for the worse at one year – some actually changed for the better with getting older and visual skills being enhanced.
“I think that was a significant finding, and something that surprised me and gave me a lot of confidence in CureSight.”
As successful as the trials have been, Prof Wygnanski-Jaffe doesn’t believe the technology will be for everyone, and she doesn’t see it completely replacing patching.
“I don’t think that patching is not a good treatment, and some people prefer it, but there should also be other modes of treatment. Just like when you have a headache, you don’t have to take home the aspirin, you have other medications.
“That’s a discussion we have with the families,” she says. “What do they prefer? We tell them they can patch, and we also tell them that there are other options, like atropine drops and binocular treatment such as CureSight.”
She has seen a lot of interest from fellow eyecare professionals in prescribing CureSight as either an alternative or add on to patching, or even a complete switch to the new technology.
“We observed clinical evidence in real life, and found that children who were previously resistant to patching, demonstrated visual improvement after undergoing binocular treatment with CureSight.”
Since launching CureSight in early 2023, the company has had more than 3,000 patient referrals in the US, Italy, Portugal, Israel, Singapore and China.
In Australia, if CureSight is prescribed and the parents agree, BOC Instruments sends the device to the optometrist or ophthalmologist, including a six-month activation code.
The practitioner can provide treatment in their rooms or rent out the device for home use. When the initial six-month code expires, the practitioner has an option to continue renewing it every month, or for another six-month period, which is more cost effective.
