New Treatment
Many ECPs are not familiar with the
new forms of treatment for Amblyopia. It is recommended that they
consult with an expert in the industry
to ensure proper treatment.
“The best thing an ECP who is untrained in managing these conditions
can do is to search for a developmental
optometrist whose practice emphasizes
this type of work. Patients need to
know that there is something that can
be done, and that these are less medical
conditions than functional ones, and
the best trained to deal with theses
are developmental optometrists,”
said Boulet.
“These are not permanent conditions,
necessarily, and in most cases great
improvements can be made within 6
months or less. These cases should be
monitored more closely and require
active therapies. ECPs can certainly
use prism and lenses to assist unaffected
clients and parents to understand to
some degree how these conditions feel.”
He added ECPs should also remind
people that these conditions are not a
simple matter of seeing blur, but that
vision is multifaceted and that these
conditions will consequently impact
on motor skills, cognitive skills, and
emotional state.
It is often difficult to keep kids engaged
in Vision Therapy. It can require many
hours of work on the part of the child
and the parent. Boulet said a team
effort is required on the part of all
involved to see success.
“First, ensure there is an appropriate Rx
in place. OD’s and MD’s all too often will
prescribe the cycloplegic refraction as
the baseline/habitual Rx. This is almost
always contraindicated in children as
they will most often choose to disregard
the Rx by looking over
the top of the frame,”
he said.
“Strabismus treatment,
in particular, requires
ongoing work at home,
and the treating facility
needs to work with the
family to ensure they are
on task and motivated.
The referring ECP
should ensure they check
up with the family to also
encourage adherence to
the treatment program.”
He noted traditional eye
patch treatments can
still be useful, however,
the variety of alternatives
means kids should no
longer have to wear them
for extended periods
of time.
“Patching was traditionally used as
the sole primary treatment tool, with
children wearing them full time for up
to several years. We know that this
approach often loosens binocular
function and leads to increased time
strabismic. Because vision is designed
to be binocular, treatment is best
approached as a binocular system, or
at the outset at least as a bi-ocular system
(each eye viewing different targets
but in the same visual field),” he said.
“We also know that aniseikonic/
isophoric lens designs can also be more
effective than patching in cases of
refractive amblyopia and that this approach is often more agreeable to
patients as it serves to boost binocular
vision, not suppress it.”
He noted ECPs should do their research
before recommending a surgical option.
He noted surgery will have no impact
on amblyopia if there is no strabismus.
He said surgery can be helpful in
some cases of immovable strabismus,
but most often, these cases are not assessed by developmental optometry.
“The best approach in terms of safety,
cost, and outcomes is to turn to OVT
first , then surgery, if it’s still indicated,
followed again by OVT to reduce the need
for repeat surgeries. Surgery approaches
the visual system as a mechanical
entity, so very much like an automobile
or computer where if a part is out of
alignment or no longer working, it
simply needs to be ‘fixed’ or replaced,”
he said.
“Human physiology is not at all like
this and therefore, treatments by surgery
often require repeat procedures
because the brain still has not learned
operate both visual channels as a team.”
>>> RESOURCES
> www.shawlens.com
> www.aboutkidshealth.ca
> www.eyeresearch.ca