Our resident, Dr. Melissa Kendall and I were reviewing a current vision therapy patient’s record before quittin’ time last night, and she asked me something about an “anti-suppression” procedure. Which prompted me to realize that I hadn’t used that term in quite some time, though I couldn’t quite put a finger on why.
Then it dawned on me. I really don’t care for treatment language that is couched in the negative. For example, the patient is “non-compliant”. Or we’re going to use occlusion during therapy to “force” the patient to use the “bad eye”. Or “penalization” therapy, which punishes the good eye. Perhaps even worse there’s the notion of giving a “lazy” eye a better work ethic, an outmoded negative as reviewed in a previous blog by Dr. Fortenbacher. And then we have “anti-suppression”, which makes it sounds like we’re going to butt heads with the patient’s adaptation.
So, Dr.Kendall and I agreed, let’s forget about “anti-suppression”, and focus instead on building binocular vision. So when we’re doing MFBF for example (Monocular Fixation in a Binocular Field), it’s a totally positive venture in which the patient is learning how to let the amblyopic eye take the lead and guide what both eyes are doing. As you begin to give this more thought, you’ll naturally come up with more procedures that tap into what both eyes can do together – even if the targets have to be very large or binocularly locked or enhanced at the outset (think large luster fields; large quoits — and as you work your way smaller, the binocular synchronicity factors of Press Lites — another shameless plug.) Accentuating the positive, and looking at ways to build binocular vision to a higher level is both a mindset, and one that leads to emphasis on progressively and optimally integrating both eyes instead pitting one eye against the other. Paralleling the move away from occlusion in amblyopia should be the move away from anti-suppression in binocular vision therapy.