“Cutting edge” amblyopia research just announced, April 18, 2017, in Ophthalmology Times on ModernMedicine.com: Elbow splinting increases amblyopia patching compliance.
Yes, this story is true! It is not an attempt to fabricate the news or make a joke. It is a valid research article just published in the Eye Journal, Eye (2017) 31, 406–410. A quote from the online article states, “…Elbow splints can increase children’s compliance with a patching regimen for amblyopia, researchers say.” A second quote further states, “…Adding elbow splints to the occlusion therapy regimen is an effective and parentally acceptable treatment method to ensure that all is done in order to try and improve vision in amblyopic eyes…”
The article further quotes previous research that says, “…people with uncorrected amblyopia have triple the risk of depression, double the risk of mortality and greater difficulties with day-to-day living…” This statement shows the seriousness of amblyopia. It is not just poor sight in one eye. It affects the entire quality of life of the person.
This statement confirms that the consequences of amblyopia extends much beyond reduced eye sight. But, does splinting a child’s arms to prevent them from removing an eye patch seem like a reasonable approach for treating amblyopia? Doesn’t this seem more like something right out of medieval times?
Indeed, amblyopia, often referred to as lazy eye, is a serious neuro-developmental vision problem that affects about 3% of people worldwide. The result of amblyopia is a loss of visual acuity in the affected eye due to a binocular vision dysfunction. In addition to loss of visual acuity in the amblyopic eye, the patient will have poor depth perception, poor eye hand coordination, poor visual processing and typically poor reading fluency. Historically the only treatment considered for amblyopia was occlusion therapy typically with an eye patch worn over the fellow eye. The problem with patching is that occlusion therapy has been found to be only moderately effective and riddled with negative consequences involving:
- Eye sight improves with patching, but even with good compliance will often regress when discontinued
- Patching does not treat the underlying cause of amblyopia which is due to a binocular vision problem
- Occlusion as an overall treatment can have poor or marginal results
- The child wearing an eye patch often experiences bullying, teasing, emotional upset, frustration, anger and general unhappiness
- With patching there is a need of more parent attention associated with the child’s treatment
What do we now know? There is a much better way to treat amblyopia with superior outcomes, provides the patient with the opportunity to gain binocular vision and stereopsis (3-D) and does not require a daily eye patch (or Atropine) as a part of the treatment. This treatment protocol, including supporting research, is outlined for ophthalmologists, optometrists and the public on The VisionHelp Amblyopia Project.
Indeed the use of patching in the treatment for amblyopia has been around for over 100 years and considered to be the standard of care based on multiple amblyopia research projects in the past. But now there is a much better and modern “no patch” method that does not require physical manipulation of the child to comply. Therefore, hasn’t the time come for health care of the 21st century to recognize occlusion therapy for what it is…a “dated approach”, not a modern medicine approach to a complex visual problem?
Come on!! Children with amblyopia deserve better care than elbow splints and an eye patch!
To learn more, here is a video that summarizes the modern approach to Amblyopia.
Dan L. Fortenbacher, O.D., FCOVD