Children with refractive amblyopia often go undetected because their eyes are straight and they don’t have much difficulty with the “activities of daily living.” When told that they need to wear glasses full-time, this is often quite a shock. Add in the need to wear a patch for several hours a day, and not surprisingly, compliance with this treatment protocol is poor. But wearing the lenses and patching is the “backbone” of amblyopia treatment and little or no improvement can be expected if this is not done…… at least that is what “conventional wisdom” has told us to expect. What this traditional approach to amblyopia treatment fails to recognize is that amblyopia is a BRAIN problem and not an eye problem. If a child’s binocular (eye teaming) skills can be improved, this is often accompanied by an increase in visual acuity and other monocular visual skills of the amblyopic eye. In some cases, these improvements also lead to a reduction in the anisometropia (or difference in lens power between the two eyes) and an associated reduction in the lens power required in spectacles to maximize visual acuity. Press and Press have termed this treatment “reverse engineering of hyperopic anisometropic amblyopia.” Everyone is a winner if this can be accomplished. The amblyopia is successfully treated, the need for eyeglasses is reduced, the cosmesis of the eyeglass prescription is enhanced, and the patient is more compliant during the therapy process.
In the article recently published in Optometry and Vision Development, Drs. Press and Press present a case report that includes the use of Visual Evoked Potentials (VEPs) to measure the brain’s response to visual stimuli under different conditions. They were able to compare the VEPs with and without glasses, with different prescriptions, and before and after completion of an optometric vision therapy program. As the visual skills of this 4 year old girl improved and her reliance on the glasses was reduced, her brain’s responses to visual stimuli was significantly enhanced. The average increase in the amplitude of the VEPs increased by 103% post-vision therapy!! The VEPs also demonstrated that when presented with smaller, more detailed visual targets, her brain’s response was increased when she wore a minor prescription. Therefore, at the end of vision therapy, it was decided that it would be in her best interest to wear the glasses when engaged in extended reading and other near activities, but not during outdoor play or watching TV.
Kudos to Drs. Press and Press for using science to demonstrate what we know to be true in clincal practice. Not only were they able to measure changes in brain activity with optometric vision therapy, but they were also able to determine the best prescription for this young child. The reverse engineering of the hyperopic anisometropic amblyopia was a documented success!
Read more about amblyopia here.
Here is another article about approaches to amblyopia therapy.
Read Full Post »
Thank you to Dr. W.C. Maples — who quoted mama during his presentation at COVD’s annual meeting to remind us of the importance of prevention in health care. Dr. Maples was discussing infantile esotropia: an eye that turns inward that presents at a very early age, usually at about 4-6 months of age. When the eye turns in, the young child begins to make significant adaptations and changes in the way he or she processes visual information. Often the child is diagnosed with a triad of clinical conditions: esotropia (inward turning eye), anisometropia (difference in the refractive status between the eyes) and amblyopia (reduced visual acuity and visual skills in the turned eye). Treatment of this triad of visual dysfunctions is based on the development of binocularity: teaching the child to use both eyes together. The development of binocularity will create a cascade that also reduces the anisometropia and amblyopia.
But what if we could prevent the development of the esotropia and the associated amblyopia and anisometropia? Dr. Maples conducted research that reviewed the medical records of children with infantile esotropia. He and his colleagues were able to identify 26 risk factors that predispose children to develop esotropia at this early age. These risk factors include premature birth, a family history of esotropia, cardiac or other systemic disease, low birth weight and maternal high blood pressure during the pregnancy. If your baby has any of these risk factors, you can provide visual stimulation to your baby and reduce the likelihood that your baby will develop an esotropia.
What types of activities should you be doing with your baby? Engage in face-to-face activities with your baby, and make sure you do these activities in all different directions. Babies love human faces. Talk to your baby and move slowly to one side and then the other. Make a mobile to hang over the baby’s crib with black and white photographs of faces. Move the baby’s crib to different parts of the room. Find a crib bumper with checkerboard or other high contrast patterns. Movement should be a big component of playtime with baby. Even if your baby cannot yet sit up or roll, make sure the baby has plenty of room to move arms and legs. As the baby matures, be sure to provide enough room to freely move about and explore the environment. Take field trips to the mall, the park, grandma’s house and down the city streets to provide a diversity of visual stimulation from all directions: over, under, in front, behind, left and right. At home (or at the beach), place your baby on top of a beach ball and gently roll the beach ball, to get the vestibular and visual systems talking to each other. Basically, play with your baby and keep things moving! In fact, this is good advice for all parents, not just those with babies with a higher risk of developing infantile esotropia. Visual experience is a critical component of every baby’s development.
Dr. Maples pointed out that there are three components to child development: genetics, maturation, and experience. There is little that can be done to change genetics and maturation. By focusing on the experience, we can shape a child’s development and perhaps prevent the onset or lessen the impact of many dysfunctions and disorders. Mama is right – an ounce of prevention is worth a pound of cure.
Read Full Post »
Congratulations to Dr. Selwyn Super, on becoming an FCOVD-A; Academic Fellow of the College of Optometrists in Vision Development. Dr. Super began his optometric career in South Africa. He has been a key player in advancing the profession of optometry world-wide. He has traveled extensively to both learn more and share his knowledge about optometry, vision, and its interface with other disciplines and professions.
Dr. Super has a deep appreciation for the importance of collaboration and research for any profession to “develop and thrive in a world of continuous and accelerating change and demands.” For example, how do certain visual functions change with age? This clinical question has become more emergent with the aging of the “baby boomer generation” and the increasing prevalence of degenerative processes, such as Alzheimer’s Disease. By using technology, it is easier than ever for clinicians to collectively gather normative information. Only then can the clinician make well-informed decisions about treatments and their expected outcomes.
I just re-read Dr. Super’s publication on the “spiral curriculum in optometric education.” Although it was written more than 20 years ago, it still rings true today, especially as the schools and colleges of optometry are faced with an ever-expanding knowledge base, new technologies, and an unfathomable need for eye and healthcare around the world. “Optometric education should set out to integrate knowledge, skills, intentions, and attitudes from the inception and should make excellence in human relations as well as in clinical and practice skills, its major goal. The philosophy of optometry and optometric education should encompass a willingness and commitment to change so as to adapt to new knowledge, scientific discovery, technologic advances, a changing environment and changing human needs.” Well said, Selwyn.
Read Full Post »