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EVALUATION OF COMPUTERISED PROGRAMS FOR THE DIAGNOSIS AND TREATMENT OF BINOCULAR ANOMALIES

Lin, Wei

[Thesis]. Manchester, UK: The University of Manchester; 2016.

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Abstract

Computerised diagnostic testing and computerised vision training (VT) have been developed for the orthoptic management of binocular vision (BV) anomalies in clinical practice. Computerised measurement of BV is assumed to assist accurate diagnosis of BV anomalies because variability of testing resulting from subjective judgements of examiners is eliminated by automatic measurements. Computerised VT is thought to be effective in the treatment of BV anomalies because the computer games used for vision training will enhance the patient’s motivation. However, these assumptions were lacking scientific support. This thesis reports a range of studies to investigate the computerised programs of diagnostic testing (HTS-BVA) and vision training (HTS-iNet) in comparison with corresponding traditional approaches, respectively.The first study was to investigate inter-session repeatability of computerised testing on BV functions. The study results showed that computerised testing on measuring near horizontal fusional vergence (FV) and accommodative facility (AF) did not present higher inter-session repeatability than corresponding traditional testing.The second study was a pilot study for a future rigorous randomized clinical trial (RCT) investigating effectiveness of computerised VT as a home-based treatment for convergence insufficiency (CI). The study results showed the subjects with CI demonstrated improvement of near point of convergence (NPC), near base-out FV and symptoms associated with CI after an 8-week treatment regime. The third study, following from the first study, was to investigate whether accommodative responses (AR) are affected by the novel accommodative stimuli used in computerised AF testing. The study results showed the AR might be affected by the colours of accommodative targets and the colour filter used. Especially, the data of accommodative demand of 4 dioptres revealed that blue targets presented poorer AR than red targets, and the targets seen with colour filters presented poorer AR than those seen without colour filters. The fourth study, also following from the first study, was to investigate whether a prolonged near vision task affects measurements made relating to the near FV system, thus contributing to the variability of clinical findings. The study results showed statistically significant changes in NPC and near dissociated phoria. In further sub-group analyses, the subjects with an initially poor NPC (n = 9) presented greater changes in the NPC and near dissociated phoria than the subjects with normal poor NPC (n = 25).Overall, the computerised testing did not show more repeatable BV measurements than the traditional testing. Finally, an RCT is needed to determine if the computerised VT is more effective than placebo computerised VT as a home-based treatment for CI.