Are We Patching The Wrong Eye In Amblyopia?

ARVOThanks to our colleague, Dr. Curt Baxtrom, for pointing out an interesting abstract from this year’s ARVO meeting.  It’s co-authored by our colleague from Canada, Professor Robert Hess.  First take a look at the abstract here.  You’ll note the stated purpose as follows:

Patching therapy has been commonly used clinically to improve visual functions in the amblyopic eye by occluding the fellow eye under the assumption that amblyopia is a purely monocular deficit. However, there is emerging evidence that amblyopia is the result of binocular sensory imbalance resulting in suppression. Here we show that the binocular imbalance that characterizes amblyopia can be reduced by occluding the amblyopic eye, the opposite to what has been done for the last 200 years.

ACiVT Book CoverTwo things I’d like to highlight here:

1) Regarding emerging evidence that amblyopia is the result of binocular sensory imbalance resulting in suppression, we’re pleased to see research catching up with the clinical approach that is a mainstay of optometric vision therapy.  As you’ll note in my textbook (original edition in 1997, OEP edition 2008), p. 83: “Abnormal binocular integration is a common feature of amblyopia.  Competition between the two eyes, and inhibition exerted through the nonamblyopic eye, play a strong role in the development of amblyopia and the recovery of function during treatment.”  You can also see this approach on p. 22 of the AOA’s Clinical Practice Guideline on Care of the Patient With Amblyopia, originally authored in 1994.

2) Regarding patching the amblyopic eye instead of the fellow eye, this is known as inverse or nonconventional occlusion.  As you can see here, the idea has been tried before.  We applaud Professor Hess for revisiting it and look forward to vision science research shedding more light on why what we do in optometric vision therapy works as well as it does when the patient is guided by the optometrist through supervised MFBF, bi-ocular and binocular activities.






One thought on “Are We Patching The Wrong Eye In Amblyopia?

  1. Thanks Dr. Press,
    What works for me is MFBF, Monocular and Binocular VT and you can do this with a cheap filter, scotch tape to match the VEP for the amblyopic eye but you probably use a different patch. Maybe patching the wrong eye is for anomalous fixation?
    Otherwise, as for patching the wrong eye….I just don’t get it……maybe I am too old to change, but I like the success I am getting already.

    Just received a patient from an OMD who patched the bully eye completely, not with VEP controls, and no success.
    Well at least he did not do muscle surgery. Maybe they are moving away from surgery to old malpractice complete patching
    as that is what he did. August

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