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A Random Dot Computer Video Game Improves Stereopsis

Portela-Camino, Juan A., PhD1*; Martín-González, Santiago, PhD2; Ruiz-Alcocer, Javier, PhD3; Illarramendi-Mendicute, Igor, OD4; Garrido-Mercado, Rafaela, PhD5

Optometry and Vision Science: June 2018 - Volume 95 - Issue 6 - p 523–535
doi: 10.1097/OPX.0000000000001222

SIGNIFICANCE Currently, treatments for amblyopia are occlusion or penalization of the stronger fellow eye. Fewer than 30% of patients improve stereoacuity using these treatments. In order to improve these outcomes, this group proposes a treatment to stimulate the stereoacuity through perceptual learning in a game format for use at home.

PURPOSE The aim of this study was to determine whether perceptual learning with random dot stimuli (RDS) in the form of a computer video game improves stereopsis in patients with a history of amblyopia.

METHODS Thirty-two stereo-deficient patients (7 to 14 years old) previously treated for amblyopia participated in a prospective, randomized, double-blind study. Participants followed a perceptual learning program at home using RDS software. In the experimental group, the demand of stereopsis was increased, until reaching the lowest detectable disparity. In the comparison group, the stimulation interval was a constant (840 to 750”). Stereoacuity was evaluated with the Randot Preschool Stereoacuity Test (RPST) and the Wirt Circles.

RESULTS Median compliance was 100% (interquartile range [IQR] = 78.50 to 100). Log10 stereoacuity outcomes were significantly different between groups (RPST, P = .041; Wirt Circles Test, P = .009). Median stereoacuity improvement with RPST was 50% (IQR = 0.00 to 75%) and 0% (IQR = 0.00 to 7.5%), respectively, for experimental and comparison groups (P = .008). Wirt Circles improvement was 46.42% (IQR = 6.25 to 73.75%) and 0% (IQR = 0.00 to 57.50%), respectively, for experimental and comparison groups (P = .089). Stereoacuity improvement was not different between groups when success was considered a 70% gain in RPST (P = .113); it was statistically different when success was considered a gain of two levels on Wirt Circles and stereoacuity 140” or less (P = .023). Stereoacuity remained stable after 6 months when measured with RPST, whereas it worsened in two subjects when measured with Wirt Circles.

CONCLUSIONS Direct stimulation of stereopsis at home using RDS in a game environment improves the stereoacuity in stereo-deficient subjects with a history of amblyopia.

1Department of Optometry, Clinic Begira, Bilbao, Spain

2Department Construction and Manufacturing Engineering, University of Oviedo, Asturias, Spain

3Health Science Department, Universidad Europea, Madrid, Spain

4Department of Optometry, Begitek Clinic, Donostia, Spain

5School of Optometry, Complutense University, Madrid, Spain *

Submitted: January 23, 2017

Accepted: April 5, 2018

Corrected: June 15, 2018

Funding/Support: European University of Madrid (2013 UEM 20; to JR-A).

Conflict of Interest Disclosure: The computer-based test itself was developed at the University of Oviedo by the IdeasCAD research team ( under the direction of SM-G, coauthor of this manuscript, and partially founded by VISUALIA visual therapy clinic (, under agreement FUO-EM-104-12. After finishing this study, a private company named VISIONARY TOOL ( has contacted both SM-G and JAP-C to participate in the development of a computerized visual training tool. This tool includes several games and tests. The one used in this article, based on random dot hidden silhouettes, is one of them.

Author Contributions and Acknowledgments: Conceptualization: JAP-C, SM-G, JR-A, RG-M; Data Curation: II-M; Formal Analysis: JAP-C, SM-G; Funding Acquisition: JR-A; Investigation: JAP-C, SM-G, JR-A; Methodology: JAP-C, SM-G, JR-A; Software: SM-G; Supervision: JR-A, RG-M; Writing – Original Draft: JAP-C; Writing – Review & Editing: JAP-C, RG-M.

The authors thank Dr. Piñeiro for his important contribution to the final version of this article.

© 2018 American Academy of Optometry