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    Researchers make strides in amblyopia

     

    Another study suggested that children end up wearing their eye patches for less than half the prescribed time, calling into question the importance of prescribing a precise time period for occlusion.

    Conversely, some researchers have found that prescribing tasks requiring near vision can speed the results of occlusion therapy. And others have found that providing educational cartoons, decorating the patches, and providing rewards resulted in children wearing the patches longer.

    But therapists have other alternatives for treating amblyopia. Some research suggests that fully correcting the patient’s refraction can significantly improve amblyopia, and is sometimes the only therapy needed.  And surveys show that many orthoptists begin treatment of amblyopia with refractive correction before trying other methods.

    Related: Stressing the need for child vision screenings

    However, children often don’t want to wear glasses, and studies suggest a wide variation in adherence. Questions also remain about whether some patients are more likely to benefit from refractive correction than others, and how long this treatment should be tried before moving on to other therapies. Some concerns have also been raised that refractive therapy can delay emmetropisation.

    Because of the challenges of getting children to wear patches or glasses, some therapists have used atropine to temporarily blur vision in the dominant eye by paralysing the ciliary muscles that control accommodation and constriction of the pupil.

    Comparisons between atropine and occlusion therapy have shown similar outcomes, regardless of the type of amblyopia. Still, practitioners seem to use it as a fall-back method for patients who don’t adhere to occlusion therapy.

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    A fourth alternative gaining attention is perceptual learning. In this therapy, patients practice perceptual tasks. The approach dates back at least to 1963 and the Cambridge Visual Stimulator (CAM), which used high-contrast rotating sine-wave gratings. The CAM fell out of favour when it could not demonstrate superior outcomes to occlusion.

    But the advent of computer programs for perceptual learning has reawakened interest. Often patients work on contrast sensitivity tasks while the non-amblyopic eye is occluded. Game play formats may increase simulation of the amblyopic eye. In one example, patients play a game such as Tetris with only half the blocks visible to each eye. Transcranial direct current stimulation may hasten the benefits.

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