From Amblyopia to 20/20

There is one question that I love to ask, and hate to ask, when I lecture to others regarding vision and child development: ‘How is amblyopia treated’? The generally accepted treatment for amblyopia is “full-time patching.” This is one of the most pervasive and enduring myths regarding vision care. You would think that living in the 21st century we would have opened our eyes by now, to see through this veil of visual mythology. Neuroscientists and clinicians have confirmed, over and over again, that the treatment for amblyopia no longer needs to be so cruel.

Wonderful research by Stewart, Stephens and Fielder has shown that covering the non-amblyopic eye for three to six hours per day, while at home and engaging in specific fine-motor activities is more effective than patching for six hours or more.1  Earlier Blogs in VisionHelp regarding amblyopia have discussed how Bangerter Occluders and the use of binocular fusion therapy further augment the therapeutic result of part time, directed patching.

When will we stop sending children to school, covering their only well-functioning eye, and expecting them to perform academically, socially and athletically? IMG_0057Remember, when you patch an eye, you are really “patching the brain!”  If a child is patched full time they may develop an “amblyopia  for academic, social and athletic endeavors.”  Developmental Optometrists understand this, and have long discarded outdated full-time patching and implemented 21st century treatments based on current research in neuroscience.

Carl G. Hillier, OD, FCOVD

1Objectively monitored patching regimens for treatment of amblyopia: randomised trial. 
Stewart C.E., Stephens D.A., Fielder A.R. & Moseley M.J. ( 2007) British Medical Journal, 335, 707– 711.

5 thoughts on “From Amblyopia to 20/20

  1. Well, I just attended a session at a college of optometry (June this year) concerning amblyopia. The lecture continued to recommend full time patching because the thought was that the patient would look around a bangerter foil. We might be able to come up with a transparent patch to match the acuity of the amblyopic brain. I try to do that with VEP. And I do the transparent patch only FRI, SAT and SUN.
    I have had good luck with Atropine to the bully eye also on FRI, SAT and SUN, but now I learn that we need to keep the accommodation the same on each eye?
    What I am looking at now is what Dr. Dan Fortenbacher does; MFBF..and the Review of Optometry (May 15, 2013) reviewed a study in Current Biology indicating dramatic visual improvement in the weaker eye-brain side using dichoptically the game of Tetris. What should we be doing? What do you do and what results do you get? August

  2. There must be different approaches to patching, as all of our patients come to the situation at different ages, temperments, goals and support systems. If I have a parent that can monitor their child, then that child can be patched 3 to 6 hours a day without much peeking. The key in the research above is Directed and Monitored; if it can’t be directed or monitored, you are left with a second-best treatment modality, which may have to be full time patching.

    If you can arrange for dichoptic activities, great! Otherwise engage in fine-motor, three dimensional manipulatives.

    PS: I make my own sticky-patch Bangerters and they work some of the time. You can also create a side-shield around a frame which holds a lens that the Bangerter is applied to – much easier

    • Putting a Bangerter in the form of a sticky-patch was my intention, and tried cutting out the center of a patch, and placing a tanslucent piece of Bangerter in its place. Over time, it didn’t prove to be reliable just due to the mechanics of keeping those two pieces together. I’m still trying to figure out a way to have it be a reliable therapuetic device. Instead of using plastic as the variable density occlusion material, I am considering various densities of woven material that would provide the same effect, and it also would “breath” and not collect moisture like the plastic tends to do. Let me know if you have any ideas!

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