{"id":5673,"date":"2025-02-06T10:22:21","date_gmt":"2025-02-06T16:22:21","guid":{"rendered":"https:\/\/blogs.und.edu\/press-releases\/?p=5673"},"modified":"2025-02-06T10:22:21","modified_gmt":"2025-02-06T16:22:21","slug":"team-focuses-on-new-vision-for-amblyopia-lazy-eye-treatment","status":"publish","type":"post","link":"https:\/\/blogs.und.edu\/press-releases\/2025\/02\/team-focuses-on-new-vision-for-amblyopia-lazy-eye-treatment\/","title":{"rendered":"Team focuses on new vision for amblyopia (lazy eye) treatment"},"content":{"rendered":"

National clinical trials will test innovative amblyopia treatment for children using virtual reality headsets<\/strong><\/p>\n

\"Carolina
Retired longtime Grand Forks optometrist Dr. David Biberdorf (right) examines Carolina Praus Poltavski in the lab. The pair, along with UND Professor Dmitri Poltavski, will head up one of 400-plus clinical testing sites for advanced pediatric amblyopia treatment. The research is administered by the renowned Pediatric Eye Disease Investigator Group. \u201cEventually, we hope to become a regional hub for specializing in novel treatments of pediatric eye disease,\u201d Poltavski said. Photo by Janelle Vonasek\/UND Today.<\/figcaption><\/figure>\n

The first mention of amblyopia, the pediatric eye disease more commonly known as lazy eye, dates back to Hippocrates and ancient Greece. And the oldest, most common way to treat the condition goes way back, too.<\/p>\n

For nearly 3,000 years, eye patch therapy<\/strong><\/a> \u2014 a daily regimen of covering the so-called \u201cgood\u201d eye to force the weaker eye to work harder to catch up \u2014 has been the go-to treatment for improving vision for millions of children worldwide.<\/p>\n

Now, UND researchers are recruiting families for a pair of Pediatric Eye Disease Investigator Group<\/strong><\/a> clinical trials that could change that standard of care for the first time in centuries. The PEDIG studies are funded through the National Eye Institute<\/strong><\/a> of the National Institutes of Health<\/strong><\/a>.<\/p>\n

One of 400-plus amblyopia treatment testing sites<\/h2>\n

\u201cA clinical trial of this scope and scale represents a huge opportunity for the University of North Dakota,\u201d said vision scientist and Psychology<\/strong><\/a> Professor Dmitri Poltavski<\/strong><\/a>, who\u2019s partnering on the research with retired longtime Grand Forks optometrist Dr. David Biberdorf<\/strong><\/a>.<\/p>\n

\u201cWe\u2019ve been doing vision research together for quite some time, and we\u2019re familiar with what type of treatments, so to speak, are hot and being tried out right now,\u201d Poltavski said. \u201cAs the only clinical site selected in the state, we\u2019re super excited to be part of this research for two reasons. No. 1, of course, is because it has the potential to change lives.<\/p>\n

\u201cJust for starters, we\u2019re going to be able to give kids in North Dakota and Minnesota treatment that may be more effective than what\u2019s currently available to them. And No. 2, we hope to boost UND\u2019s prominence as a clinical research facility.\u201d<\/p>\n

Each of the two studies will include about 250 children being treated at more than 400 pediatric eye centers throughout North America.<\/p>\n

\"Dr.
Dr. David Biberdorf (from left), optometric vision therapist Carolina Praus Poltavski and Professor Dmitri Poltavski are recruiting families to take part in two separate clinical trials that will test the effectiveness of high-tech treatments for the pediatric eye disease amblyopia. The treatment procedures will require patients to wear headsets and use binocular vision (both eyes), unlike the one-eye patching method that\u2019s been the standard of care for centuries. Photo by Janelle Vonasek\/UND Today.<\/figcaption><\/figure>\n

Meet the local amblyopia research team<\/h2>\n

Biberdorf will serve as the principal investigator for the Grand Forks clinical trials. Poltavski will be the site coordinator responsible for protocol training, equipment setup and grant management. He\u2019ll also be the liaison between UND and the Jaeb Center for Health Research<\/strong><\/a> in Tampa, Fla., which is the central data collection site.<\/p>\n

Rounding out the team is optometric vision therapist Carolina Praus Poltavski. She happens to be Poltavski\u2019s wife, and she worked alongside Biberdorf at Grand Forks\u2019 Valley Vision Clinic for more than 15 years. For the clinical trials, she\u2019ll be in charge of study-specific examinations and treatment procedures, as well as local data entry.<\/p>\n

\u201cBetween the three of us, we had all the credentials for a complete team, so it was a no-brainer for us to apply to become a clinical trial site,\u201d Poltavski said. \u201cFor us, it\u2019s a win-win because not only can we provide this free service to our community \u2014 no insurance is involved, the grant pays for all of it \u2014 we\u2019re also opening a new avenue for external research funding.\u201d<\/p>\n

And being a PEDIG site positions UND for possible future research funding, he said.<\/p>\n

\u201cAs a study site, we can introduce new advances that we may have discovered here,\u201d Biberdorf added. \u201cWe can approach the rest of the group and say, \u2018Hey, we have an idea for a study we think needs exploring.\u2019 We can come up with our own innovative ideas to pitch.\u201d<\/p>\n

Biberdorf called PEDIG a pioneer in pediatric eye disease research. Formed by NEI in 1997 as a collaborative network dedicated to clinical research in amblyopia, strabismus (misaligned, or crossed, eyes) and other pediatric eye disorders, PEDIG receives millions of dollars in NIH funding each year, he said, and typically manages several ongoing projects.<\/p>\n

\"Dr.
Dr. David Biberdorf and optometric vision therapist Carolina Praus Poltavski worked side by side for more than a decade at Valley Vision Clinic in Grand Forks. Photo by Janelle Vonasek\/UND Today.<\/figcaption><\/figure>\n

What is the cause, impact of amblyopia?<\/h2>\n

The researchers described amblyopia as a neurodevelopmental disorder that results from inadequate visual stimulation to one eye during the first years of life. When the eyes are not properly aligned \u2014 for example, if one eye turns outward or inward \u2014 they cannot work together, and critical visual development is thrown off course.<\/p>\n

Using an analogy to help explain, Biberdorf said: \u201cI like to think of amblyopia as having an underdeveloped eye. It\u2019s like you have a 6-year-old eye and a 3-month-old eye. And what we need to do is get that 3-month-old eye to catch up to the 6-year-old level.\u201d<\/p>\n

Added Poltavski: \u201cIt\u2019s almost like visual neglect because the brain will suppress the low-quality information from the eye with poor visual acuity and begin to rely more on the information coming from the \u2018good\u2019 eye.\u201d<\/p>\n

If treated early, prescription eyeglasses sometimes can be enough to correct the condition. But if left untreated, the brain can begin to ignore visual signals from the poor eye altogether.<\/p>\n

The disorder affects 2 percent to 5 percent of the pediatric population, and it\u2019s the leading cause of monocular vision loss in children. Biberdorf says it also can cause \u201csubstantial variations in brain activity patterns and cortical thickness, changes in gray and white matter and functional brain activity.\u201d<\/p>\n

Further, amblyopia often reduces hand-eye coordination and can lower a child\u2019s reading performance and self-perception. Because it impacts binocular (two-eyed) vision, it also diminishes 3D depth perception and visually guided skills such as the speed and accuracy of reaching and grasping.<\/p>\n

Poltavski and Biberdorf say it\u2019s important to begin treating amblyopia early because the success rate with current treatment standards drops significantly after age 8 \u2014 a statistic largely attributed to a coinciding decrease in patch compliance rates as children get older.<\/p>\n

\u201cThey get to age 8, and they just don\u2019t want to do it,\u201d Poltavski said. \u201cThey don\u2019t want to be different. They don\u2019t want to be teased for wearing the patch.\u201d<\/p>\n

\"Dr.
Dr. David Biberdorf says visual acuity and the ability to distinguish black-on-white letters is not the only vision that can be distorted by amblyopia. Patients also can experience difficulties with spatial properties such as 3D depth perception and motion detection. \u201cThe diagnosis can affect career choices. It can be devastating if you have a child who wants to serve in the military, be a pilot or a police officer, for example,\u201d he said. Photo by Janelle Vonasek\/UND Today.<\/figcaption><\/figure>\n

How does the advanced amblyopia treatment work?<\/h2>\n

And that\u2019s just one reason the high-tech treatment using virtual reality headsets may have an advantage.<\/p>\n

\u201cThe science is complex, but when we\u2019re talking about improving vision, what we\u2019re really talking about is neuroplasticity and training the brain to overcome the poor circuitry that\u2019s feeding reduced information to the visual cortex,\u201d Biberdorf said.<\/p>\n

Added Poltavski: \u201cOnce you can tap into that mechanism of cerebral plasticity, the eyes will start to work as a team, and the visual cortex will incorporate input from both eyes. Once the process gets started, it\u2019s almost self-healing.\u201d<\/p>\n

So how do these advanced treatments differ from the age-old patching method?<\/p>\n

Well, that\u2019s complicated, too, but Biberdorf sums it up this way:<\/p>\n

The virtual reality headsets incorporate dichoptic\/binocular technology, whereby the child watches shows or plays interactive video games as each eye views a separate and independent screen. Different stimuli are presented to each eye simultaneously.<\/p>\n

\u201cEmploying the science of perceptual learning and brain plasticity, the object is to degrade the image quality or reduce the luminance to the dominant eye to provide the amblyopic eye with a visual advantage of a computer-generated scene,\u201d Biberdorf said. \u201cThe manipulated stimuli are such that many of the important details of the scene will be perceived only by the amblyopic eye.\u00a0In this way, the visual system can achieve a more balanced binocular view of a scene.<\/p>\n

\u201cIn contrast to patching \u2014 in which the object is to penalize the dominant eye and to stimulate the amblyopic eye passively \u2014 the binocular treatment has the objective of progressively balancing both eyes to involve a more attentional interaction on the part of the patient. This\u00a0simultaneous vision approach is thought to lead to improved binocularity.\u201d<\/p>\n

Evidence has shown that some of the high-tech digital devices may improve visual acuity more quickly than patching \u2014 with patients showing significantly improved acuity after one to two months compared with the four to six months required to achieve similar improvement through typical patching.<\/p>\n

\u201cThis could improve patient compliance as well as reduce the cost of visits, travel to appointments and time off work for parents,\u201d Biberdorf said.<\/p>\n

The technology also is promising for patients whose progress has plateaued with traditional therapy.<\/p>\n

\u201cThe clinical trials are so new, but the beauty of an NIH-funded study is that it can be systematized in such a way that the results could change the standard of care,\u201d Biberdorf said.<\/p>\n

Imagine that. Research that could change the treatment of a disease as old as Hippocrates \u2014 the father of medicine himself \u2014 is happening right here at UND.<\/p>\n

What are the details for the amblyopia treatment studies?<\/h2>\n

In one clinical trial, children ages 4 to 7 will be randomly selected via computer to begin the 26-week study either by wearing an eye patch two hours a day, seven days a week or watching children\u2019s shows using a Luminopia<\/strong><\/a> virtual reality headset for one hour a day, six days a week.<\/p>\n

They also will begin by answering some initial questions and have their vision tested while wearing their regular prescription glasses. Follow-up vision tests and questions come at Weeks 13 and 26.<\/p>\n

Children who begin with patching will have the chance to try the Luminopia headset if they still show signs of amblyopia at the end of 26 weeks. They then return for follow-ups at Weeks 39 and 52.<\/p>\n

The eye patches and headsets will be provided. If new glasses are needed during the study, they will be provided at no charge.<\/p>\n

A second study for children ages 8 to 12 is designed to test whether watching shows wearing the Luminopia headset (one hour per day, six days a week) or playing games using a Vivid Vision<\/strong><\/a> headset (25 minutes per day, six days a week) improve vision better than glasses alone.<\/p>\n

Again, the testing is random for the 18-week study, and the children begin with initial questions and vision tests while wearing their regular glasses. Follow-up visits come at Weeks 9 and 18.<\/p>\n

Children selected for the glasses-alone group will have the opportunity to try one of the headsets for 18 weeks if they still have amblyopia at the end of the first round. In that case, two more follow-ups come at Weeks 27 and 36.<\/p>\n

In both studies, parents or guardians will record daily treatment time on a calendar and be asked questions about their child\u2019s eyes.<\/p>\n

All headsets must be returned at the completion of the study, but families will get to take something home. To cover travel and other visit-related expenses, families will receive $100 Amazon gift cards (up to a total of $500) after each exam is completed.<\/p>\n

>> How do I learn more about the studies or find out if my child is eligible?<\/strong> Leave a voicemail at 701.777.6843 or email UND.eyeclinictrials@UND.edu.<\/p>\n

>> Read about more amblyopia research <\/strong>conducted by Poltavski and Biberdorf. \u201cEffectiveness of a Novel Video Game Platform in the Treatment of Pediatric Amblyopia\u201d<\/strong><\/a> originally was published in April 2023 in the Journal of Pediatric Ophthalmology & Strabismus.<\/p>\n

>><\/strong>\u00a0Do you want to read more UND Today stories?\u00a0<\/strong>Just\u00a0hit the link<\/strong><\/a>\u00a0or go to our home page to subscribe to our twice-weekly newsletter.<\/p>\n

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The pair, along with UND Professor Dmitri Poltavski, will head up one of 400-plus clinical testing sites for advanced pediatric amblyopia treatment. The research is administered by the renowned Pediatric Eye Disease Investigator Group. \u201cEventually, we hope to become a regional hub for specializing in novel treatments of pediatric eye disease,\u201d Poltavski said. 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