Monday, July 1, 2013

Alternatives to patching for treating amblyopia

The oldest treatment for amblyopia is patching. An eye patch is placed over the good eye in the hopes that the weak eye will be forced to "work" and improve its function.  

There are two basic problems with patching.  The first, is that kids hate to wear a patch. It affects their self-esteem and negatively impacts their psychological and social development. Many doctors still require children to go to school wearing a patch and to wear a patch all day long. Those unfortunate children are often subject to bullying and teasing at school.

The second problem with patching is that it is not as effective as treatment that incorporates some form of eye-brain rehabilitation using targeted visual tasks that stimulate the brain and speed up the healing of the eye-brain connection that is at the root of amblyopia. The best approach is to combine a limited amount of patching with doctor prescribed visual tasks. Vision therapy is a common and effective solution.  As pointed out recently by the VisionHelp Blog:

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. 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.

Treatment with patching alone is based on an out-of-date understanding of amblyopia. By focusing on one eye, it ignores the fact that amblyopia is a binocular vision problem and a treatment approach such as vision therapy that focuses on how both eyes work together is much more effective. A study published in the September 2010 issue of the journal Optometry & Vision Science should be required reading for every amblyopia patient (or their parents):

amblyopia is an intrinsically binocular problem and not the monocular problem on which current patching treatment is predicated. Thought of in this way, the binocular problem involving suppression should be tackled at the very outset if one is to achieve a good binocular outcome as opposed to hoping binocular vision will be regained simply as a consequence of acuity recovery in the amblyopic eye, which is the current approach and which is often not found to be the case.

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