Video Game-Based Interventions for Visual Rehabilitation in Childhood Amblyopia: A Systematic Review and Meta-Analysis

Background: Novel approaches such as video games represent a promising tool in increasing visual acuity (VA) in children with amblyopia. The aim was to determine the effectiveness of video game-based interventions (VGBIs) in increasing VA in children with amblyopia. Secondarily, to estimate safety, satisfaction, and compliance with VGBIs. Methods: According to the PRISMA guidelines, a systematic review with meta-analysis (SRMA) was conducted, including studies retrieved from PubMed Medline, SCOPUS, WOS, CINAHL, and PEDro without publication date and language restrictions. We included randomized controlled trials (RCTs) and pilot RCTs, comprising children with amblyopia, that compared the effectiveness of VBGI vs. others in improving VA. Pooled effect was estimated with the Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95%CI). Results: Twenty-one RCTs, providing data from 1515 children, were included. VGBIs are effective (SMD = 0.38; 95%CI 0.08 to 0.68; p = 0.013) in increasing VA. Subgroup analyses suggested that non-immersive video games are the most appropriate for improving VA (SMD = 0.35; 95%CI 0.02 to 0.68; p = 0.039) and that VGBI is more effective than patching therapy, especially in combination with patching therapy (SMD = 0.63; 95%CI 0.29 to 0.97; p < 0.001). Conclusion: This SRMA, including a large number of RCTs to date, demonstrates that VGBI is effective in improving VA in children with amblyopia.