Amblyopia Therapy: A Resurrection

‘Tis the season of Passover and Easter, but the resurrection I have in mind is of a non-theologic nature: the springing to life of old principles that have become new in amblyopia therapy.

It’ll be worth your time to take a look at the comments in an exchange between Dr. Sherman and Dr. Fortenbacher, in regard to Dr. Fortenbacher’s blog post last month.  Here’s a link to one of the papers that Dr. Sherman references, and he has been an influential proponent of the binocular approach to amblyopia therapy.

Sherman CardsI like the fact that Keystone View refers to the Sherman Playing Cards as Visionary.  Here are the two visionary principles for which Dr. Sherman has been a staunch advocate:  for amblyopia therapy to improve visual performance it has to integrate the two eyes, and for the patient to be compliant or cooperative the treatment approach should be fun.   There have been many anaglyphic and polarized variations of the themes that Dr. Sherman introduced, and they all have in common some component of engaging the child in an activity that doesn’t feel punitive.  We all know of the challenges of trying to gain a child’s cooperation for eye patching, which Dr. Fortenbacher reviews.  And let’s face it – while atropine penalization is a step in the right direction as pharmacologic MFBF therapy, getting drops in at home can be very challenging!

… which brings us to the recent work from the Hess lab on the use of video game technology as an updated approach to binocular vision therapy.  In the paper that the Hess group published in the online journal Optometry last year, he referenced a paper that I authored in 1981 that was published in Optometry and Vision Development on electronic games and strabismus therapy.  I introduced the concept through then available anaglyphic hand-held video games, and elaborated this in a series of OEP papers around the same time that were subsequently published as a monograph on Computers and Vision Therapy Programs.  One of the chapters in the monograph was authored by Dr. William Ludlam, and his application of computerized therapy for the Amiga program was the first its kind specifically for amblyopia therapy.  Dr. Jeffrey Cooper would subsequently extend this to computerized MFBF therapy with AmbiNet, as reviewed in this paper in the Journal of Behavioral Optometry.

As you’ll see in their paper published last year the Journal of Visualized Experiments, Hess and colleagues have extended the concept of MFBF and made the therapy more of a binocular method of limits in balancing the contrasts sensitivity function of the right and left eye through a coherent motion paradigm.  The video that accompanies the paper is very informative, and the training paradigm essentially converts the principles of an amblyoscope into a Tetris video game format.

Microsoft PowerPoint - finalfigures1807_BT.pptx

Microsoft PowerPoint - finalfigures1807_BT.pptx

4 thoughts on “Amblyopia Therapy: A Resurrection

  1. Binocular therapy is essential in the treatment of Amblyopia. For may years I would measure the PVEP amplitudes and latencies. When the latencies were different, which occurred quite often, I would place a neutral density filter before the eye with the shorter latency and measure the the binocular amplitudes. Filterers of increasing density were used until the binocular amplitude changed by 20%. That filter was prescribed and worn while the patient was receiving binocular therapy and full time otherwise. Success was good.

  2. Pingback: Tetris therapy for amblyopia? Yes, please. by Bright Eyes Tampa

  3. Dr. Margaretten,
    Hi. This is August. I work with AD/HD kids and have had success with visual attention training, but lately am seeing about two amblyopia kids each day. I note the OMD’s still patch, but I use scotch tape, one or two layers.
    My question here concerns Amblyopia and as stated by Dr. Fortenbacher, a binocular approach for this lazy brain condition works. Would your approach work using scotch tape over the “Bully Eye” rather than a neutral density filter?
    If you feel your approach works better, what filter percent seems to be the most used?
    Thanks, August

    • Yes, if measured with VEPs. The key is to get binocular enhancement with the filter over the non-amblyopic eye.

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