{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:06:53Z","timestamp":1788890813110,"version":"build-2803163510"},"reference-count":35,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Amblyopia, a unilateral or bilateral visual disorder, affects up to 5% of the general population and is a leading cause of childhood visual impairment. Current treatments, such as patching therapy, aim to improve amblyopia by temporarily occluding the unaffected eye, thereby promoting the use of the amblyopic eye. However, adherence to patch therapy can be challenging, as the forced use of the amblyopic eye can be stressful for children. Moreover, despite improvements in visual acuity by patch therapy, children with amblyopia often face difficulties with hand-eye coordination; therefore, a treatment that reduces stress for them while simultaneously improving hand-eye coordination could address the limitations of existing amblyopia therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study investigated the safety of our motion-based virtual reality (VR) dichoptic training app using Japanese Kendama in healthy adult participants, which was designed to improve hand-eye coordination in pediatric patients with amblyopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective intervention study involved 20 healthy young adults (median age 21, IQR 21\u201028.3 y), including 16 women. The participants played the motion-based VR dichoptic training app for 30 minutes and then completed a subjective symptom questionnaire, which comprised 9 questions (Q1-Q9) with each item scored on a 4-point scale, except Q9, which was assessed on a binary scale. Q1-Q3 focused on subjective eye symptoms, Q4-Q7 evaluated physical and mental discomfort, Q8 assessed the degree of VR session\u2013induced arm fatigue, and Q9 assessed the severity of visually induced motion sickness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No significant differences were observed in the reported ocular symptoms before and after the VR session, including eye fatigue (mean before vs after: 1.25, SD 0.94 points vs 1.35, SD 0.85 points), blurred vision (0.55, SD 0.50 points vs 0.80, SD 0.40 points), eye dryness (0.95, SD 0.74 points vs 1.25, SD 0.83 points), and visually induced motion sickness (0.00, SD 0.00 points vs 0.05, SD 0.22 points). These results suggested that the motion-based VR dichoptic training did not induce significant adverse ocular effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The motion-based VR dichoptic training app demonstrated minimal adverse ocular effects in healthy adult participants, suggesting that it is safe for use in this population. These findings demonstrate the feasibility and good tolerability of this VR-based intervention in healthy adults. Further studies, including clinical studies in adult and pediatric patients with amblyopia, are warranted to evaluate its applicability and therapeutic effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/69801","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T16:17:07Z","timestamp":1750177027000},"page":"e69801-e69801","source":"Crossref","is-referenced-by-count":4,"title":["Safety Evaluation in Healthy Adults of Motion-Based Virtual Reality Dichoptic Training for Pediatric Patients With Amblyopia: Prospective Intervention Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1420-9844","authenticated-orcid":false,"given":"Masakazu","family":"Hirota","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-5469","authenticated-orcid":false,"given":"Yuichi","family":"Okumura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0317-6074","authenticated-orcid":false,"given":"Ken","family":"Nagino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9992-9198","authenticated-orcid":false,"given":"Takao","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8812-8011","authenticated-orcid":false,"given":"Takashi","family":"Negishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4200-0052","authenticated-orcid":false,"given":"Shintaro","family":"Nakao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9643-0747","authenticated-orcid":false,"given":"Hitoshi","family":"Kawasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3435-1055","authenticated-orcid":false,"given":"Takenori","family":"Inomata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/s0161-6420(98)91862-0","article-title":"Prevalence and causes of amblyopia in an adult population","volume":"105","author":"Attebo","journal-title":"Ophthalmology"},{"issue":"4","key":"R2","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1080\/09273972.2017.1391849","article-title":"The prevalence of amblyopia and its determinants in a population-based study","volume":"25","author":"Faghihi","journal-title":"Strabismus"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.ajo.2005.07.060","article-title":"Amblyopia: diagnostic and therapeutic options","volume":"141","author":"Wu","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"R4","doi-asserted-by":"publisher","first-page":"1965","DOI":"10.1016\/j.ophtha.2008.05.030","article-title":"Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study","volume":"115","author":"Liang","journal-title":"Ophthalmology"},{"issue":"4","key":"R5","first-page":"403","volume":"1","author":"de Z\u00e1rate","journal-title":"Clin Ophthalmol"},{"issue":"3","key":"R6","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1136\/bjo.87.3.291","article-title":"Differences in the management of amblyopia between European countries","volume":"87","author":"Tan","journal-title":"Br J Ophthalmol"},{"issue":"11","key":"R7","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1136\/bjo.81.11.956","article-title":"Effectiveness of occlusion therapy in ametropic amblyopia: a pilot study","volume":"81","author":"Moseley","journal-title":"Br J Ophthalmol"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1001\/archopht.123.4.437","article-title":"Randomized trial of treatment of amblyopia in children aged 7 to 17 years","volume":"123","author":"Scheiman","journal-title":"Arch Ophthalmol"},{"issue":"9","key":"R9","doi-asserted-by":"publisher","first-page":"6158","DOI":"10.1167\/iovs.13-11861","article-title":"Compliance with occlusion therapy for childhood amblyopia","volume":"54","author":"Wallace","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1038\/sj.eye.6700086","article-title":"Psychosocial and clinical determinants of compliance with occlusion therapy for amblyopic children","volume":"16","author":"Searle","journal-title":"Eye (Lond)"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2012.11.001","article-title":"Amblyopia and binocular vision","volume":"33","author":"Birch","journal-title":"Prog Retin Eye Res"},{"issue":"6","key":"R12","doi-asserted-by":"publisher","first-page":"793","DOI":"10.3233\/RNN-2010-0550","article-title":"A new binocular approach to the treatment of amblyopia in adults well beyond the critical period of visual development","volume":"28","author":"Hess","journal-title":"Restor Neurol Neurosci"},{"issue":"9","key":"R13","doi-asserted-by":"publisher","first-page":"37854740","DOI":"10.7759\/cureus.45395","article-title":"Dichoptic game training in strabismic amblyopia improves the visual evoked response","volume":"15","author":"Emmanouil","journal-title":"Cureus"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.visres.2015.04.008","article-title":"A dichoptic custom-made action video game as a treatment for adult amblyopia","volume":"114","author":"Vedamurthy","journal-title":"Vision Res"},{"issue":"4","key":"R15","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1111\/j.1475-1313.1993.tb00496.x","article-title":"Binocular vision in a virtual world: visual deficits following the wearing of a head-mounted display","volume":"13","author":"Mon-Williams","journal-title":"Ophthalmic Physiol Opt"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12886-017-0501-8","article-title":"Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: preliminary results","volume":"17","author":"\u017diak","journal-title":"BMC Ophthalmol"},{"issue":"4","key":"R17","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.jaapos.2021.03.008","article-title":"Virtual reality prototype for binocular therapy in older children and adults with amblyopia","volume":"25","author":"Elhusseiny","journal-title":"J AAPOS"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.ophtha.2021.09.001","article-title":"Randomized controlled trial of a dichoptic digital therapeutic for amblyopia","volume":"129","author":"Xiao","journal-title":"Ophthalmology"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"154","DOI":"10.3928\/01913913-20210108-02","article-title":"Virtual reality game playing in amblyopia therapy: a randomized clinical trial","volume":"58","author":"Rajavi","journal-title":"J Pediatr Ophthalmol Strabismus"},{"issue":"2","key":"R20","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1080\/02713683.2023.2275531","article-title":"Randomized controlled trial of patching versus dichoptic stimulation using virtual reality for amblyopia therapy","volume":"49","author":"Meqdad","journal-title":"Curr Eye Res"},{"issue":"3","key":"R21","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1167\/iovs.10-6341","article-title":"Eye-hand coordination skills in children with and without amblyopia","volume":"52","author":"Suttle","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"9","key":"R22","doi-asserted-by":"publisher","first-page":"5687","DOI":"10.1167\/iovs.14-14745","article-title":"Age- and stereovision-dependent eye-hand coordination deficits in children with amblyopia and abnormal binocularity","volume":"55","author":"Grant","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"5","key":"R23","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1002\/ajim.10133","article-title":"Association between duration of daily VDT use and subjective symptoms","volume":"42","author":"Nakazawa","journal-title":"Am J Ind Med"},{"issue":"5","key":"R24","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1097\/00006324-200205000-00010","article-title":"Performance and comfort on near-eye computer displays","volume":"79","author":"Sheedy","journal-title":"Optom Vis Sci"},{"issue":"3","key":"R25","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1167\/8.3.33","article-title":"Vergence-accommodation conflicts hinder visual performance and cause visual fatigue","volume":"8","author":"Hoffman","journal-title":"J Vis"},{"issue":"3","key":"R26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230788","article-title":"Objective evaluation of visual fatigue in patients with intermittent exotropia","volume":"15","author":"Hirota","journal-title":"PLoS ONE"},{"issue":"6","key":"R27","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1080\/00140139.2019.1582805","article-title":"Comparison of visual fatigue caused by head-mounted display for virtual reality and two-dimensional display using objective and subjective evaluation","volume":"62","author":"Hirota","journal-title":"Ergonomics"},{"issue":"2","key":"R28","doi-asserted-by":"publisher","DOI":"10.1167\/tvst.7.2.9","article-title":"Objective evaluation of visual fatigue using binocular fusion maintenance","volume":"7","author":"Hirota","journal-title":"Transl Vis Sci Technol"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-79565-y","article-title":"NEIVATECH pilot study: immersive virtual reality training in older amblyopic children with non-compliance or non-response to patching","volume":"14","author":"Leal-Vega","journal-title":"Sci Rep"},{"issue":"8","key":"R30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199302253280817","article-title":"Dry eyes and video display terminals","volume":"328","author":"Tsubota","journal-title":"N Engl J Med"},{"issue":"17","key":"R31","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1080\/10447318.2020.1778351","article-title":"Virtual reality sickness: a review of causes and measurements","volume":"36","author":"Chang","journal-title":"Int J Hum-Comput Interact"},{"issue":"1","key":"R32","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3109\/09273972.2011.650813","article-title":"Vertical heterophoria and susceptibility to visually induced motion sickness","volume":"20","author":"Jackson","journal-title":"Strabismus"},{"issue":"1","key":"R33","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-10-77","article-title":"Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review","volume":"10","author":"Briggs","journal-title":"BMC Musculoskelet Disord"},{"issue":"8","key":"R34","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1136\/archdischild-2011-301253","article-title":"School children\u2019s backpacks, back pain and back pathologies","volume":"97","author":"Rodr\u00edguez-Oviedo","journal-title":"Arch Dis Child"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00236","article-title":"Virtual reality enhances gait in cerebral palsy: a training dose-response meta-analysis","volume":"10","author":"Ghai","journal-title":"Front Neurol"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e69801","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:57:57Z","timestamp":1782842277000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2025\/1\/e69801"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":35,"URL":"https:\/\/doi.org\/10.2196\/69801","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,17]]},"article-number":"v9i1e69801"}}