App usage to improve compliance with amblyopia therapy
Reviewed by Fiona Rowe

In this study, the authors report the development of the software ‘Magical patching’ for iOS and Android (for smartphones and tablets) as the first version of the amblyopia treatment Chulalongkoru university (ATCU) app. In this randomised controlled trial, they aimed to determine the effectiveness of the ATCU app in increasing compliance with occlusion therapy for amblyopia. Children with unilateral strabismic and anisometropic amblyopia were recruited to group 1, occlusion with the app, and group 2, standard care occlusion. The app contains four sections of education, patching calendar, mini games and notifications. Forty-five children were recruited with one lost to follow-up at three months. Of 44 remaining, 50% were male, 22 were recruited to group 1 and 22 to group 2, and mean age was seven years (SD 2). All but one child had had previous amblyopia therapy but with no significant change in visual acuity. Moderate amblyopia was in 30 and severe in 14 children. Mean occlusion period was 7.2 hours (SD 2.9). Compliance significantly improved in group 1 at one month but with no significant compliance difference between groups by three months. There were no significant differences for moderate vs severe amblyopia. Best corrected visual acuity improved significantly in both groups but with significantly greater improvement for group 1 at one and three months. The difference in visual acuity equated to one line of Snellen acuity which was acknowledged as likely not clinically significant. Whilst feasibility and acceptability were shown for use of the app, a potential drop in app compliance after one month was explained as possibly due to the initial novelty wearing off with boredom due to lack of diversity of the mini games. Both groups used the app logbook so this could have impacted on overall results. This pilot trial has provided useful information but requires a larger trial with robust outcome measures.

Effectiveness of the smartphone application in increasing compliance with occlusion therapy in children with amblyopia: a randomised controlled trial.
Uttamapinan S, Pukrushpan P, Honglertnapakul W.
STRABISMUS
2024;32(2):73–80.