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Eye Disorders Commonly Treated with Vision Therapy:

- Accommodative Disorders:

Accommodative disorders include Accommodative Excess/Spasm, Accommodative Infacility, Accommodative Insufficiency, and Ill-Sustained Accommodation.

(Bobier WR, Sivak JG. Orthoptic treatment of subjects showing slow accommodative responses. American Journal of Optometry & Physiological Optics, 60:678-687, 1983.) Abstract: five subjects showing slow accommodative responses were given orthoptic (vision therapy) treatment. Speed of accommodative response improved after 3 to 6 weeks. No regressions were evident 18 weeks after the cessation of training. The results of the study indicate that vision therapy is effective in improving slow accommodative responses. 

(Brodney AC, Pozil R, Mallinson K, Kehoe P. Vision Therapy in a School Setting. Journal of Behavioral Optometry,12(4):99-103, 2001.) Abstract: The purpose of the present study was to evaluate the effects of vision therapy in a school setting in which elementary school children, enrolled in a reading-mentoring program, Caring Adults Teaching Children How (CATCH), were trained as a group. The experimental goal was to improve visual-motor and visual perceptual skills, with the use of vision therapy in short sessions given weekly at school, to children with reading difficulties. Sixty students were selected after the use of  the Developmental Eye Movement test’s (DEM) exclusion criteria and were randomly assigned into one of two groups: vision therapy and non-therapy. Both groups received CATCH tutorial visits once a week for 50 minutes. In  addition, the therapy group received a weekly 30 minute activity session in which three activities were completed from the following: oculomotor, accommodation, binocularity, visual motor and visual memory.  The results revealed that vertical and horizontal eye movements and accommodative facility were significantly improved after 22 sessions of  group vision therapy. These improvements were related to attentional mechanisms leading to improved reading abilities. We believe this preliminary study gives evidence of the advantages of a program whereby vision therapy is provided in the elementary school setting to advance deficient visual skills that are related to learning and cognitive enhancement.

(Daum KM. Accommodative insufficiency. American Journal of Optometry & Physiological Optics, 60:352-359, 1983.) Abstract: A retrospective review of the records of 96 patients with accommodative insufficiency was conducted. The results of orthoptic exercises and/or a plus lens addition at near were examined. Most patients (90%) obtained some relief with treatment. About 53% had their objective and subjective problems totally solved during an average treatment period of 3.7 weeks.  

(Gruning CF. Clinical management of nearpoint stress-induced vision problems. American Journal of Optometry & Physiological Optics, June;62(6):386-391, 1985.) Abstract: Functional vision problems caused by or associated with nearpoint vision stress include: accommodative disorders (insufficiency, ill-sustained, infacility); abnormal heterophorias (esophoria, high exophoria); and vergence disorders. These vision disorders cause problems with acuity, comfort, and performance (efficiency). A combination of lens prescribing, vision therapy, and work/study visual hygiene recommendations can eliminate or greatly reduce nearpoint stress-induced vision problems.

(Hoffman L, Cohen AH, Feuer G. Effectiveness of optometric vision therapy/orthoptics in a private practice. American Journal of Optometry, 50: 813-816, 1973.) In 87 percent of the patients with accommodative anomalies eliminated their asthenopia (eyestrain) and normalized their accommodative findings after approximately 26 therapy sessions 

(Hung GK, Ciuffreda. KJ, Semmlow JL. Static vergence and accommodation and orthoptics effects. Doc Ophthalmol, 62: 165-179, 1986.) This study evaluated changes in vergence and accommodative systems in two populations: 22 visually-normal asymptomatic individuals and 21 visually-abnormal symptomatic individuals before and after conventional orthoptic therapy. Symptomatic subjects were placed into one of three training groups depending on clinical abnormalities and symptoms. The training period ranged from 8 to 16 weeks. Long term follow-up testing was performed 6 to 9 months after the training ended. Symptomatic individuals showed a shift toward the mean of visually-normal asymptomatic subjects following training. The long term results showed a maintenance of the initial post-training improvement. The efficacy of orthoptic treatment was indicated by a large reduction in overall symptom rating level.

(Rouse MW. Management of binocular anomalies: efficacy of vision therapy in the treatment of accommodative deficiencies. American Journal of Optometry & Physiological Optics, Jun;64(6): 415-420, 1987.) Abstract: This paper is a review of the literature supporting vision therapy as an effective treatment mode for accommodative deficiencies. Vision therapy procedures have been shown to improve accommodative function effectively and eliminate or reduce associated symptoms. In addition, the actual physiological accommodative response variables modified by the therapy have been identified, eliminating the possibility of Hawthorne or placebo effects accounting for treatment success. Finally, the improved accommodative function appears to be fairly durable after treatment.

(Sterner B, Abrahamsson M, Sjostrom A. Accommodative facility training with a long term follow up in a sample of school aged children showing accommodative dysfunction. Doc Ophthalmol 99:93-101, 1999.)   Abstract: The purpose of this study was to evaluate the effect of accommodative training in a group of children with accommodative dysfunction and subjective symptoms. A total of 38 symptomatic children (ages nine to thirteen) and 24 controls, participated in the study. The length of training varied from 3 to 25 weeks. A follow-up examination was performed two years after the end of training. The study showed that it is possible to increase relative accommodative by accommodative facility training and minimize subjective symptoms. In the follow-up evaluation, none of the children had regained any subjective symptoms.

(Wold RM, Pierce JR, Keddington J. Effectiveness of optometric vision therapy. Journal of the American Optometric Association, 49: 1047-1059, 1978.)  The study reported on 100 children who had undergone accommodative vision therapy procedures. These clinically selected cases showed an 80% rate of improvement in accommodative amplitude (the eye’s ability to focus clearly on objects at near distances) and 76% in accommodative facility (the eye's ability to adjust focus on objects with various distances). 

- Binocular Dysfunctions  

Binocular dysfunctions include Convergence Insufficiency, Convergence Excess, Fusional Vergence Dysfunction, Esophoria, and Exophoria. For more information,

 

(Atzmon D, Nemet P, et al. A randomized prospective masked and matched comparative study of orthoptic treatment versus conventional reading tutoring treatment for reading disabilities in 62 children. Binocular Vision & Eye Muscle Surgery Quartrly, 8(2):p. 91-106, 1993.)   Abstract: Controversies remain whether orthoptics and/or “visual training” can remedy reading disabilities. Therefore, and to extend our prior studies, we under took a comparative and controlled study. One hundred and twenty children with reading disability were tested extensively, matched and randomly divided into three groups: orthoptic, conventional (reading tutoring), and no-treatment control. Unfortunately, participants in the control group were unable to adhere to no-treatment and were deleted. Each of the 40 children in the first two groups had 40 sessions, 20 minutes da.

Orthoptic treatment was directed to markedly increasing fusional convergence amplitudes for both near and distance to 60 D. The two treatments were also carefully matched in time and effort. Sixty-two children in 31 matched pairs completed the course of treatment and testing. The results were equal and statistically significant (P< .05) marked improvement in reading performance in both treatment groups on essentially all tests.

Orthoptic treatment, to increase convergence amplitudes to 60 D, is as effective as conventional in-school reading tutoring treatment of reading disabilities. An advantage of orthoptic treatment was that subjective reading and asthenopic symptoms (excessive tearing, itching, burning, visual fatigue, and headache) virtually disappeared after orthoptics. We recommend orthoptic treatment as: 1) an effective alternate primary treatment; 2) adjunctive treatment for those who do not respond well to standard treatment; and 3) as primary treatment in any case with asthenopic symptoms of /or convergence inadequacy.

(Birnbaum MH, Soden R, Cohen AH. Efficacy of vision therapy for convergence insufficiency in an adult male population. Journal of the American Optometric Association, April; 70(4): 225-232, 1999.) BACKGROUND: Although vision therapy has reportedly been very successful in elimination of asthenopic symptoms (excessive tearing, itching, burning, visual fatigue, and headache) in adults with convergence insufficiency, controlled studies have not been performed, and a clinical bias exists against prescribing vision therapy for adults with convergence insufficiency. METHODS: Sixty adult males over the age of 40 years (median age, 65 years) with convergence insufficiency were divided into three treatment groups: office-based vision therapy with supplementary home therapy, home therapy only, and a control group. RESULTS: Vision therapy was successful in 61.9% of patients who received in-office plus home therapy, in 30% of patients who received home therapy only, and in 10.5% of the control group. The success rate for patients who received active in-office vision therapy supplemented with home procedures was significantly greater than that for controls. Home therapy alone was less successful than in-office therapy. The success rate obtained with home therapy alone was not significantly greater than that demonstrated by controls. CONCLUSIONS: Vision therapy is effective in eliminating asthenopia (eyestrain) and improving convergence function in adult patients. In-office therapy combined with home therapy tends to produce better results than does home therapy alone.

(Ficarra AP, Berman JB, Rosenfield M, Portello JK. Vision training: predictive factors for success in visual therapy for patients with convergence excess. J Optom Vision Dev 27 (4): 213-219, 1996.) A retrospective study was conducted of 31 patients who had received vision therapy for convergence excess. The mean number of training sessions was 19. Vision therapy produced a significant reduction in symptoms of both distance blur and headaches. Prior to treatment, 55% of the patients experienced headaches related to near work; following therapy only 2 patients reported headaches. Before receiving vision therapy, 41% of the patients reported transient visual blur; after therapy only 3 patients still reported experiencing this symptom.

(Gallaway M, Scheiman M. The efficacy of vision therapy for convergence excess. Journal of the American Optometric Association, February; 68(2): 81-86, 1997.)  The records of 83 consecutive patients with convergence excess who were treated with vision therapy were reviewed to assess the impact of treatment on clinical findings and patient symptoms. RESULTS: Total elimination of symptoms in 84% of patients with the following improvements: mean divergence amplitude from 8 PD to 16 PD, recovery value from 2 PD to 10 PD, and accommodative facility from 1.5 cpm. to 8cpm. CONCLUSIONS: Vision therapy was successful in enhancing negative fusional vergence and eliminating symptoms in the vast majority of patients with convergence excess and should be considered an effective treatment for this condition.

(Gruning CF. Clinical management of nearpoint stress-induced vision problems. American Journal of Optometry & Physiological Optics, Jun;62(6):386-391, 1985.) Abstract: Functional vision problems caused by or associated with nearpoint vision stress include: accommodative disorders (insufficiency, ill-sustained, infacility); abnormal heterophorias (esophoria, high exophoria); and vergence disorders. These vision disorders cause problems with acuity, comfort, and performance (efficiency). A combination of lens prescribing, vision therapy, and work/study visual hygiene recommendations can eliminate or greatly reduce nearpoint stress-induced vision problems.

(Mazow ML, France TD, et al. Acute accommodative and convergence insufficiency. Trans American Ophthalmology Society, 87: 158-168, 1989.) Abstract: The facility of accommodation and convergence allows persons to read at close range. When these mechanisms fail, reading becomes tiring, frequently producing headaches and even diplopia. This study reviewed the treatment of 26 young patients with asthenopic symptoms who had a combination of profoundly decreased accommodation and convergence in the absence of any other neurologic symptoms or signs. Twenty-two of 26 (84.6%) patients were treated with orthoptic exercises to improve convergence. Twenty-one of 26 (81%) were given plus lenses to aid in accommodation. Patients were seen for mean f 3.3 visits over an average of 11.8 months. Seventeen of 26 patients (65.3%) showed definite improvement after treatment and were completely asymptomatic. Seven of 26 patients (26.9%) reported some improvement of symptoms. Two of 26 patients (7.6%) reported no improvement of symptoms. However, both of these patients had been treated for less than 2 months. Of the 24 patients whom experienced improvement in symptoms, their headaches decreased and their school performance improved dramatically.

(Pantano R. Orthoptic treatment of convergence insufficiency: A two year follow-up report. American Orthoptic Journal, 57: 73-80, 1982.) Pantano studied 207 subjects with convergence insufficiency who underwent vision therapy and evaluated them 2 years later. The majority remained asymptomatic with normal clinical findings. Those subjects who learned to control convergence and accommodation together had the best success.

- Ocular Motor Dysfunctions:  

 Ocular motor dysfunctions include Saccades Dysfunction and Pursuit Dysfunction.

(Brodney AC, Pozil R, Mallinson K, Kehoe P. Vision Therapy in a School Setting. Journal of Behavioral Optometry,12(4):99-103, 2001.) Abstract: The purpose of the present study was to evaluate the effects of vision therapy in a school setting in which elementary school children, enrolled in a reading-mentoring program, Caring Adults Teaching Children How (CATCH), were trained as a group. The experimental goal was to improve visual-motor and visual perceptual skills, with the use of vision therapy in short sessions given weekly at school, to children with reading difficulties. Sixty students were selected after the use of  the Developmental Eye Movement test’s (DEM) exclusion criteria and were randomly assigned into one of two groups: vision therapy and non-therapy. Both groups received CATCH tutorial visits once a week for 50 minutes. In  addition, the therapy group received a weekly 30 minute activity session in which three activities were completed from the following: oculomotor, accommodation, binocularity, visual motor and visual memory.  The results revealed that vertical and horizontal eye movements and accommodative facility were significantly improved after 22 sessions of  group vision therapy. These improvements were related to attentional mechanisms leading to improved reading abilities. We believe this preliminary study gives evidence of the advantages of a program whereby vision therapy is provided in the elementary school setting to advance deficient visual skills that are related to learning and cognitive enhancement.

(Fischer B, Hartnegg K. Effects of visual training on saccade control in dyslexia. Perception, 29(5):531-542, 2000.) Abstract: This study reports the effects of daily practice of three visual tasks on the saccadic performance of 85 dyslexic children in the age range of 8 to 15 years. The children were selected from among other dyslexics because they showed deficits in their eye-movement control, especially in fixation stability and/or voluntary saccade control. Their eye movements were measured in an overlap prosaccade and a gap antisaccade task before and after the training. The three tasks used for the training included a fixation, a saccade, and a distractor condition. In any of these tasks, the subject had to detect the last orientation of a small pattern which rapidly changed its orientation between up, down, right, and left, before it disappeared after some time. The task was to press one of four keys corresponding to the last orientation. The visual pattern was presented on an LCD display of a small hand-held instrument given to the children for daily use at home. The results indicate that daily practice improved not only the perceptual capacity, but also the voluntary saccade control, within 3 to 8 weeks. After the training, the group of dyslexics was no longer statistically different from the control group.

(Kulp MT, Schmidt PP. Effect of oculomotor and other visual skills on reading performance: a literature review. Optometry and Vision Science, April;73(4): 283-292, 1996.) Abstract: The diagnosis and management of many oculomotor anomalies is within the domain of optometry. Thus, a thorough understanding of these systems and their relation to reading performance is vital. Efficient reading requires accurate eye movements and continuous integration of the information obtained from each fixation by the brain. A relation between oculomotor efficiency and reading skill has been shown in the literature. Frequently, these visual difficulties can be treated successfully with vision therapy.

(Rounds BB, Manley CW, and Norris RH. The effect of oculomotor training on reading efficiency. Journal of the American Optometric Association, 62: 92-97, 1991.) Abstract: The purpose of this study was to record and measure, by means of a microcomputer, the reading eye movements and reading efficiency of a sample of “poor readers” from an adult, professional school population. A program of oculomotor enhancement training (vision therapy) was given to 10 students who failed an academically appropriate reading test. Their pre- and post- training reading performance was compared to that of a group of students who also failed the reading test but received no such training. All subjects' eye movements were monitored and recorded individually while reading, using a Visagraph Eye-Movement Recording System. The subjects were split into an experimental group (receiving training) and a control group (receiving no training). Following a 12-hour program of in-office” and “home” training, the group receiving oculomotor training showed trends toward improved reading eye movement efficiency (number of regressions, number of fixations and span of recognition), compared to that of the untrained group. 

(Wold, RM, Pierce JR, Keddington J. Effectiveness of optometric vision therapy. Journal of the American Optometric Association, 49: 1047-1059, 1978.) Wold et. al. reported on 100 consecutive optometric vision therapy patients whose eye movement skills were rated on the Heinsen-Schrock Performance Scale. This is a 10-point observational scale for scoring saccadic and pursuit eye movement performance. Only 6% of the children passed the eye movement portion prior to therapy. Post-therapy re-evaluation revealed that 96% of the children were able to pass.

- Strabismus:  

Strabismus is a misalignment of the two eyes. This condition may be called cross-eyes or wall eyes. There are various forms of strabismus such as Accommodative Esotropia, Esotropia, Exotropia, Intermittent Esotropia, and Intermittent Exotropia.

(Chryssanthou G. Orthoptic management of intermittent exotropia. American Orthoptic Journal, 24:69-72, 1974.)  This study reviewed the cases of 27 patients with intermittent exotropia (ages 5 to 33 years ) who received orthoptic treatment. A total of 89% of patients showed definite improvement, with 66.6% graded excellent or good 6 months to 2 ½ years after termination of orthoptic treatment.

(Coffey B, Wick B, Cotter S, et al. Treatment options in intermittent exotropia: a critical appraisal. Optometry and Vision Science, 69: 386-404, 1992.)  Pooled success rates of different treatment regimens for intermittent exotropia reported 59% for vision therapy, 46% for surgery, and 28% for passive therapy such as minus lenses, occlusion, and/or prisms.

(Cohen AH. Optometric management of binocular dysfunctions secondary to head trauma: case reports. Journal of the American Optometric Association, August; 63(8): 569-575, 1992.) Abstract: Exotropia, esotropia, hyper elements, visual sequencing problems, accommodative dysfunctions and inefficient Motor Planning are common consequences of head trauma. Optometric visual therapy is an effective treatment modality for these dysfunctions. Two case reports are presented in order to illustrate optometric management of patients exhibiting these problems secondary to head trauma.

(Etting G. Strabismus therapy in private practice: Cure rates after three months of therapy. Journal of the American Optometric Association, 49: 1367-1373, 1978.) Dr. Gary Etting, O.D., F.C.O.V.D. reported that a 65% overall success rate in patients with constant strabismus (57% of esotropes and 82% of exotropes), 89% success rate with intermittent strabismus (100% of esotropes and 85% of exotropes), and 91% success rate when retinal correspondence was normal.

(Flax N, Duckman RH. Orthoptic treatment of strabismus. Journal of the American Optometric Association, 49: 1353-1361, 1978.) Abstract: This paper examined the effectiveness of orthoptics as a viable treatment modality for strabismus. A review of pertinent literature and an analysis of the data was presented. The results of several studies show a combined functional cure rate of 72.4%.

(Garriott RS, Heyman CL, Rouse MW. Role of optometric vision therapy for surgically treated strabismus patients. Optometry and Vision Science, April;74(4): 179-184, 1997.) BACKGROUND: Occasionally, co-management involving both optometry and ophthalmology is needed to optimize treatment outcome for the strabismic patient. METHODS: JB, a 47-month-old consecutive esotrope presented to our clinic (Southern California College of Optometry). Two previous attempts to surgically correct her exotropia had failed and the parents sought another treatment approach. We recommended optometric vision therapy (VT) to improve sensorimotor fusion before any further surgery. After 31 VT sessions (bi-weekly for a time, then weekly), before a third scheduled surgery, sensorimotor fusion was good in the amblyoscope, but unstable with neutralizing prism in free-space. We recommended surgery be postponed, but the family proceeded. Esotropia recurred with constant suppression. After additional VT, JB developed stable sensorimotor fusion and random dot stereopsis in free-space with neutralizing prism. A fourth surgery was then performed resulting in esophoria at all distances with good sensory fusion. RESULTS: Twenty-one months postoperatively, JB remains nonstrabismic with good sensory fusion. CONCLUSIONS: Clinicians should understand the roles and limitations of available treatment options. Surgery reduces the magnitude of the deviation, whereas optometric VT (vision therapy) provides the unique role of establishing normal sensory processing.

(Goldrich SG. Optometric therapy of divergence excess strabismus. American Journal of Optometry & Physiological Optics, 57: 7-14, 1980.) A review and analysis of the vision training procedures were carried out over a period of 2 years at State University of New York (SUNY) University Optometric Center by 20 staff optometrists on 28 patients exhibiting divergence excess strabismus. Training included motility, accommodative rock, fusion, antisuppression, and stereoscopic skills by a variety of techniques and devices. Patients who exhibited smaller pre-training angles of deviation, increased maturity, and greater motivation responded most successfully to treatment. Of the patients reviewed, 71% attained a functional cure following sequential therapy procedures used in-office as well as home. Highest success rate occurred when office therapy was supplemented with home vision therapy. The results achieved in this study compare favorably with those obtained by traditional orthoptic procedures.

(Ludlam WM. Orthoptic treatment of strabismus. AM J Optom Arch Am Acad Optom, 38: 369-388, 1961.) Ludlam evaluated a sample of 149 unselected strabismics who received vision therapy and determined a 73% overall success rate. 

(Ludlam WM, Kleinman, BI. The long range results of orthopic treatment of strabismus. AM J Optom Arch Am Acad Optom, 42: 647-684, 1965.) Ludlam and Kleinman found that the long-term overall success rate of vision therapy to be calculated at 65%.

(Sanfilippo S, Clahane AC. The effectiveness of orthoptics alone in selected cases of exodeviations: the immediate results and several years later. American Orthoptic Journal, 20: 104-117, 1970.) Sanfilippo and Clahane designed a prospective study of the results of orthopic therapy for intermittent exotropia. 64.5% reported cured, 9.7% reported improvement, 9% reported fair. Subsequently after 5 years, 52% remained cured, 32% remained improved.(Tong, D. Treatment of Intermittent Esotropia Incorporating Peripheral Awareness Training. Journal of Behavioral Optometry, 10(5), 1999.) Abstract: The patient with intermittent esotropia at distance can be symptomatic for diplopia (double vision), which may interfere with driving, work performance, and school achievement. The cosmesis of the strabismus may also affect the patient’s self-esteem. This report describes a patient with intermittent esotropia at distance who underwent vision therapy to relieve her symptom of diplopia (double vision) and cosmetic concerns. After two sessions of therapy emphasizing peripheral fusion and divergence, the patient became kinesthetically aware of the eye turn and she was able to regain single vision with minimal effort. The patient remained non-strabismic at one- and three- month follow-ups. This case illustrates that vision therapy can effectively relieve the symptoms of a patient with intermittent esotropia once the patient is able to gain active control of her visual system.

(Wick B. Accommodative esotropia: efficacy of therapy. Journal of the American Optometric Association, 58: 562-566, 1987.) Abstract: Retrospective examination was performed on the records of 54 patients who had undergone treatment of accommodative esotropia. The patients were classified based on the Duane classification as having either convergence excess (n=11) or equal esodeviations (n=43). Over 90% of the patients achieved total restoration of normal binocular function with treatment. The results and implications of this study are discussed.

(Ziegler D, Huff D, Rouse MW. Success in strabismus therapy: A literature review. Journal of the American Optometric Association, 53(12): 979-9883, 1982.)  The purpose of this study was to review the literature pertaining to non-surgical cure rates for strabismus published since 1958 and compare it to Flom's prognostic model. From the studies which specified Flom's functional cure or its equivalent, it was determined that strabismic cure rates using vision therapy could be broken down as follows:

      • Constant esotropia - 29%
      • Intermittent esotropia - 73%
      • Constant exotropia - 53%
      • Intermittent exotropia - 62%

- Amblyopia  

Amblyopia is a reduction in visual acuity without anatomic damage and usually not corrected solely by glasses. This condition is also called lazy eye. Two common forms of amblyopia are Refractive Amblyopia and Strabismic Amblyopia.

(Birnbaum MH, Koslowe K, Sanet R. Success in ambylopia therapy as a function of age: a literature survey. American Journal of Optometry & Physiological Optics, May; 54(5): 269-275, 1977.) Abstract:  It is frequently stated that amblyopia is not correctable after the age of 6 years. Many practitioners report marked success for older patients. To evaluate these conflicting reports, we analyzed the results from 23 published amblyopia studies. Our analysis indicates that substantial numbers of patients over age 6 were successfully treated. Success rates under age 6 were not significantly better than those in older patients when the criterion for success was achievement of 20/30 acuity or better. When a criterion of 4 lines improvement was used, success rates at all ages under 16 were quite similar; in patients 16 and over, success by this criterion was significantly less frequent, but even in this group success was achieved by 42% of the patients.

(Garzia RP. Efficacy of vision therapy in amblyopia: a literature review. American Journal of Optometry & Physiological Optics, June; 64(6): 393-404, 1987.)  Abstract: In this paper the major optometric, ophthalmologic, and orthoptic literature on the efficacy of vision therapy for amblyopia has been surveyed. Over the past four decades there are many examples of the successful treatment of amblyopia in the form of well documented individual case reports or large sample studies. Although occlusion of the dominant eye has been applied universally, there are some instances of the successful use of minimal occlusion combined with extensive visual-motor therapy. Overall, the results of the literature review strongly support the use of active vision therapy as an integral part of the clinical treatment of amblyopia.

(Krumholtz I, FitzGerald D. Efficacy of treatment modalities in refractive amblyopia. Journal of the  American Optometric Association, June; 70(6): 399-404, 1999.) BACKGROUND: The pediatric clinic of the SUNY State College of Optometry/University Optometric Center (New York) develops a yearly quality management plan to monitor patient care. One of the areas retrospectively reviewed for all outcomes is refractive amblyopia. METHODS: A retrospective review of records was performed on patients diagnosed with refractive amblyopia. With the use of a prescribed protocol, each patient's progress was tracked for a period of 6 months. Major emphasis was placed on outcome as related to treatment modality. Treatment alternatives were optical correction alone, optical correction in conjunction with patching, and optical correction and patching with vision therapy. RESULTS: Improvement criteria included a 2-line increase in visual acuity on the Snellen chart and an increase of 20 seconds of arc of stereopsis, as measured by the Wirt circles. The groups that patched with correction and those that received vision therapy had similar visual acuity improvement's; however, the latter group had a significantly greater improvement in stereopsis. Both groups performed significantly better in both categories when compared to the group receiving optical correction alone. CONCLUSIONS: Though patching alone may be sufficient for improvement of visual acuity, binocular performance is significantly better when vision therapy is included in the treatment regimen.

(Lee, R. Active Vision Therapy on an Adult Strabismic Amblyope. Journal of Behavioral Optometry, 10(5), 1999.) Abstract: Studies have shown that treatment of amblyopia after “visual maturity,” which occurs around the age of 9, can improve not just visual acuity, but overall visual functioning. Nevertheless, many clinicians do not treat amblyopia if patients appear ”too old.” The case of a 45-year-old amblyope who was successfully treated is presented. The age of when treatment can be instituted is discussed, as well as the efficacy of different treatment modalities (i.e. occlusion and spectacle correction versus occlusion, spectacle correction, and active vision therapy)

(Rutstein RP, Fuhr PS. Efficacy and stability of amblyopia therapy. Optometry and Vision Science, 69(1): 747-754, 1992.)  To determine the efficacy and stability of therapy, the charts for 64 amblyopes with strabismus and /or anisometropia who had been treated by direct occlusion were reviewed. For patients aged 7 years or less (N=39), 90% showed some acuity gain, with 69% achieving at least a doubling of acuity. Fifty-four percent obtained 20/40 or better after an average treatment period of 3.8 months. Some reduction in visual acuity (VA) subsequently occurred for 75% of those patients followed. For patients aged eight years or more (N=26), 77% showed some acuity gain with 31% (8/260 improving at least 0.3 log units. Twenty-seven percent obtained 20/40 (6/12) or better after an average treatment period of 4.2 months, although no patients older than 10 years (N=13) achieved 20/40 . Loss of some of the acuity gain subsequently occurred for 67% of those followed. These findings indicate that VA can be improved by patching therapy in most patients older than 7 years, but the acuity improvement is somewhat less than in younger patients. At least 67% of all amblyopes followed for one year lost some of the acuity gain after cessation of therapy, regardless of the age when treated. As a reduction of the acuity gain is likely to occur within the first year after cessation of therapy, it is recommended that amblyopic patients of all ages be followed at regular intervals.

(Saulles H. Treatment of refractive amblyopia in adults. Journal of the American Optometric Association, December;58(12): 959-960, 1987.) Treatment of amblyopia has been relatively ignored in the adult population. In a retrospective study at the University of Michigan Health Service, 10 patients with refractive amblyopia showed visual acuity improvement in their amblyopic eye after completing simple vision therapies.

(Selenow A, Ciuffreda KJ. Vision function recovery during orthoptic therapy in an adult esotropic amblyope. Journal of the American Optometric Association, 57(2); 132-140, 1986.)  Orthoptic therapy was instituted in a 29-year-old patient having moderate amblyopia, constant small-angle esotropia, and large and steady eccentric fixation. This combination of factors, especially the age, pointed toward a poor prognosis for attainment of markedly improved vision function. Rate of recovery of several monocular vision functions was monitored during one year of orthopic therapy. Results showed substantial improvement in most areas, thus providing evidence of neural plasticity at multiple sites in the visual pathways in this adult amblyope.

(Wick B, Wingard M, et. Al. Anisometropic amblyopia: Is the patient ever too old to treat? Optometry and Vision Science, 69(11): 866-878, 1992.) This report describes a sequential management program for anisometropic amblyopia that consists of four steps: (1) the full refractive correction, (2) added lenses or prism when needed to improve alignment of the visual axes, (3) 2 to 5 hour/day of direct occlusion and (4) active vision therapy to develop monocular acuity and improve binocular visual function. The records of 19 patients over six years of age who had been treated using this sequential management philosophy were evaluated. After 15.2 weeks of treatment the Amblyopia Success Index (ASI) documented an average improvement in visual acuity of 92.1% with a range from a low of 75% by a 49-year-old patient to a maximum of 100% achieved by 42.1% of the patients (8 of 19). Patients who had completed therapy one or more years ago (N=4) maintained their acuity improvement. From these results, we conclude that following a sequential management plan for treatment of anisometropic amblyopia can yield substantial long-lasting improvement in visual acuity and binocular function for patients of any age.

Birnbaum MH, Koslowe K, Sanet R. Success in amblyopia therapy as a function of age: a literature survey. Am J Optom Physiol Opt, 54:269-75, 1977. Abstract: It is frequently stated that amblyopia is not correctable after the age of 6 years. Many practitioners report marked success for older patients. To evaluate these conflicting reports, the results from 23 published amblyopia studies were analyzed. The analysis indicates that substantial numbers of patients over age 6 were successfully treated. Success rates under age 6 were not significantly better than those in older patients when the criterion for success was achievement o 20/30 acuity or better. When a criterion of 4 lines improvement was used, success rates at all ages under 16 were quite similar; in patients 16 and over, success by this criterion was significantly less frequent but even in this group success was achieved by 42% of the patients.

Cotter SA. Conventional therapy for amblyopia. In: Problems in Optometry, RP Rutstein (ed), 3(2): 312, 1991. Abstract: Amblyopia is an important socioeconomic problem because the amblyopic patient's risk of becoming blind is markedly higher than that of the general population. Conventional treatment involves appropriate refractive correction, occlusion of the dominant eye, and active vision therapy. The specific occlusion regimen is determined based on the patient's age, binocular status, acuity level, and performance needs. Successful amblyopia treatment is dependent on several factors, of which patient compliance is the most important. There is not evidence that treatment should be withheld on the basis of age. Close follow-up is essential and maintenance therapy is often necessary.

Garzia RP. Efficacy of vision therapy in amblyopia: a literature review. Am J Optom Physiol Opt, 64:393-404, 1987. Abstract: This paper surveyed the major optometric, opthalmologic, and orthoptic literature on the efficacy of vision therapy for amblyopia. Over the past four decades there are many examples of the successful treatment of amblyopia in the form of well documented individual case reports or large sample studies. Although occlusion of the dominant eye had been applies universally, there are some instances of the successful use of minimal occlusion combined with extensive visual-motor therapy. Overall, the results of the literature review strongly support the use of active vision therapy as an integral part of the clinical treatment of amblyopia.

Hokoda SC, Ciuffreda KJ. Different rates and amounts of vision function recovery during orthoptic therapy in an older strabismic amblyope. Ophthal Physiol Opt, 6:213-20, 1986. Abstract: Orthoptic therapy was instituted in an 11-year-old patient having deep amblyopia, constant small-angle esotropia with anomalous retinal correspondence, and past history of minimal success with such therapy. This combination of factors pointed toward a poor prognosis for substantial recovery of vision functions. Rate of recovery of several monocular and binocular vision functions was monitored during the course of 18 months of intensive orthoptic therapy. Results showed marked improvement in several monocular vision functions, suggesting presence of considerable residual neural plasticity of multiple sites in the visual pathways of this older amblyope.

Rustein RP. Alternative treatment for amblyopia. In: Problems in Optometry, RP Rustein (ed), 3(2): 331, 1991. Abstract: Although constant occlusion of the nonamblyopic eye is regarded as the most effective method for treating amblyopia, there are difficulties and risks associated with its use. Accordingly, other treatment modalities have been developed. This chapter reviews the more recent alternative forms of amblyopia treatment. Included are minimal occlusion, penalization, orthoptic training, partial and sector occlusion, and the experimental pharmacologic agents. The basis and efficacy of each procedure are discussed.

Rustein RP, Fuhr PS. Efficacy and stability of amblyopia therapy. Optom Vis Sci, 69:747-54, 1992. Abstract: To determine the efficacy and stability of therapy, we reviewed the charts of 4 amblyopes with strabismic and/or anisometropia who had been treated by direct occlusion. For patients aged 7 years or less (N=39), 90% 935/39) showed some acuity gain, with 69% (27/39) achieving at least a doubling of acuity (0.3 log units). Fifty-four percent obtained 20/40 (6/12) or better after an average treatment period of 3.8 months. Some reduction in visual acuity (VA) subsequently occurred for 75% (24/32) of those patients followed. For patients aged 8 years or more (N=26), 77% (20/26) showed some acuity gain with 31% (8/26) improving at leas 0.3 log units. Twenty-seven percent (7/26) obtained 0/40 (6/12) or better after an average treatment period of 4.2 months, although no patients older than 10 years (N=13) achieved 20/40 (6/12). Loss of some of the acuity gain subsequently occurred for 67% (12/18) of those followed. These findings indicate that VA can be improved by patching therapy in most patients older than 7 years, but the acuity improvement is somewhat less than in younger patients. At least 67% of all amblyopes followed for 1 year lost some of the acuity gain after cessation of therapy, regardless of the age when treated. As a reduction of the acuity gain is likely to occur within the first year after cessation of therapy, it is recommended that amblyopic patients of all ages be followed at regular intervals.

Saulles H. Treatment of refractive amblyopia in adults. J Amer Optom Assoc, 58:959-60, 1987. Abstract: Treatment of amblyopia had been relatively ignored in the adult population. In a retrospective study at the University of Michigan Health Service, 10 patients with refractive amblyopia showed visual acuity improvement in their amblyopic eye after completing simple vision therapies.

Selenow A, Ciuffreda KJ. Vision function recovery during orthoptic therapy in an adult exotropic amblyope. J Amer Optom Assoc, 57:132-40, 1986. Abstract: Orthoptic therapy was instituted in a 29-year-old patient having moderate amblyopia, constant small-angle esotropia, and large and steady eccentric fixation. This combination of factors, especially the age, pointed toward a poor prognosis for attainment of markedly improved vision function. Rate of recovery of several monocular vision functions was monitored during one year of orthoptic therapy. Results showed substantial improvement in most areas, thus providing evidence of neural plasticity at multiple sites in the visual pathways of this adult amblyope.

Selenow A, Ciuffreda KJ. Vision function recovery during orthoptic therapy in an exotropic amblyope with high unilateral myopia. Am J Optom Physiol Opt, 60:659-66, 1983. Abstract: Orthoptic therapy was instituted in a 6 1/2-year-old patient having deep amblyopia, constant exotropia, and high unilateral myopia. The combination of these factors pointed toward a poor prognosis for attainment of normal monocular and binocular vision function. Rates of recovery of several vision functions were monitored during orthoptic therapy. Results showed marked improvement in most areas, thus providing evidence of neural plasticity at multiple sites in the visual pathways.

Wick B, Wingard M, et al. Anisometropic amblyopia: is the patient ever too old to treat? Optom Vis Sci, 69:866-78, 1992. Abstract: Amblyopia is an example of abnormal visual development that is clinically defined as a reduction of best corrected Snellen acuity to less than 6/9(20/30) in one eye or a two-line difference between the two eyes, with no visible signs of eye disease. We describe a sequential management program for anisometropic amblyopia that consists of four steps: (1) the full refractive correction, (2) added lenses or prism when needed to improve alignment of the visual axes, (3) 2 to 5 hours/day of direct occlusion, and (4) active vision therapy to develop monocular acuity and improve binocular visual function. We examined records of 19 patients over six years of age who had been treated using this sequential management philosophy. After 15.2 (+/-7.7) weeks of treatment the Amblyopia Success Index (ASI) documented an average improvement in visual acuity of 92.1% +/- 8.1 with a range from a low of 75% by a 49-year-old patient to a maximum of 100% achieved by 42.1% of the patients (8-19). Patients who had completed therapy 1 or more years ago (N=4) maintained their acuity improvement. From these results we conclude that following a sequential management plan for treatment of anisometropic amblyopia can yield substantial long-lasting improvement in visual acuity and binocular function for patients of any age.

 

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