When it comes to modern treatment of eye disease there is a strong emphasis in the current literature and continuing education on the latest and most advanced methods for quality patient care.
Surely, are there any ocular diseases or visually impairing conditions, such as cataracts, glaucoma or dry eye disease, where a doctor’s prescribed treatment approach centers around a method developed 100+ years ago?
The answer is none, except…Amblyopia.
Amblyopia, otherwise known as Lazy Eye, is the most common form of monocular visual impairment affecting approximately 3% of the population worldwide. This condition is one that Dr. Leonard Press and I have blogged about extensively over the last 10 years on the VisionHelp Blog. Many of our posts on this topic describe, to some degree, our frustration with the persistence of many doctors to solely prescribe the conventional 100+ year old treatment approach involving occlusion (eye patching) or penalization (atropine drops) of the fellow eye, when more modern and efficacious treatments are available. The modern treatment methods for amblyopia involve binocular vision therapy which treats the etiology of amblyopia beginning with a dysfunction of binocular vision causing suppression in the amblyopic eye. This has been documented extensively by the research of Dr. Robert Hess and many others during the last 20+ years.
And now we have more new research that supports the premise that the best results for those with amblyopia is to prescribe binocular vision therapy along with traditional methods. To better explain, published on January 31, 2022 in the Open Access BMC Ophthalmology Journal, is the research paper entitled: Efficacy of vision therapy for unilateral refractive amblyopia in children aged 7-10 years.
The author’s Conclusions state: “Vision therapy combined with conventional treatment (optical correction and part-time patching) is more effective than conventional treatment alone in children aged 7-10 years with unilateral refractive amblyopia. The treatment results in not only greater vision gain, but also in shorter duration of treatment.”
One particularly impressive aspect of this research paper was the thoroughness of the Discussion Section. Here the authors did an excellent job of addressing elements of the research design, for example, why this was a retrospective study vs a prospective study and how their conclusions were valid with this treatment group.
Other examples outlined in the discussion had to do with emphasizing that their research design was not a binocular vs monocular strategy in treatment, but rather a combination of the two compared to only a monocular “patching strategy” in treatment. Once again, their research evidence clearly showed that better outcomes occur when the treatment targets the cause of amblyopia, that being a failure of binocular vision, with an emphasis to rehabilitate the binocular dysfunction as a vital component of the amblyopia patients treatment plan.
With more evidence now showing that the best method for patients with unilateral amblyopia is with binocular vision therapy as the foundation; we are long overdue in placing a priority in modern patient care on the role of incorporating binocular vision therapy as the new “gold standard” in amblyopia management. The time has come.
Dan L. Fortenbacher, O.D.,FCOVD
This is was a great article from VisionHelp Blog by Dan Fortenbacher. Thought you guys might enjoy it.
– Dr. Young
—————————— Stuart Young, OD Bowersox Vision Center 403 Washington St. Shelbyville, KY 40065 Phone: (502) 647 – 3937
I feel this article supports the Sequential Management Considerations of vision therapy treatment where not one therapy is considered, yet each therapy is considered then accepted or rejected based on the diagnosis for best patient care.
Specifically for this study, applying the sequential management considerations the following were accepted:
– Rationale for lens prescription and wearing time described – ACCEPTED – Case and Control Groups
– Added Lenses (Plus or Minus) at distance or near
– Prism (horizontal or vertical)
– Occlusion – – ACCEPTED- Case and Control Groups
– Vision therapy: AC Treatment
– Vision therapy: Active Amblyopia – ACCEPTED- Case and Control Groups
– Vision therapy: Anti-suppression – ACCEPTED – Case Group only
– Vision therapy: Sensory / Motor – ACCEPTED – Case Group only
– Maintenance / Monitor Therapy
Note, in the Study, both groups (Case and Control) each received Home Based Active Amblyopia Therapy : “Additional amblyopia training exercises at home, such as maze and connect the dots, for 30 min per day were suggested in both groups.” . Although Home-based VT would have worked better, in this study, if it was structured with rigour and tracking of effort.
Ron Gall OD
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