Vision Therapy for Patients of All Ages

MICHAEL COLE, OD Child and Family Eye Care Center

Ongoing research and study continue to shed light on our understanding of eye care. A recent study published in BMC Ophthalmology titled “Efficacy of Vision Therapy for Unilateral Refractive Amblyopia in Children Aged 7-10 Years,” gives us some insight into a few different aspects of the topic of amblyopia. While this title may be a mouthful, the results are important to understand.

Amblyopia occurs when the communication between one eye and the brain is interrupted early in life. Due to these barriers in development, the brain does not learn to communicate well with the affected eye. As a result, the eye never “learns” to see clearly. This phenomenon may occur due to a very high glasses prescription in one or both eyes. Sometimes the reason starts with an eye turn or an opacity of the optics in the eye that does not allow light to pass through. Whatever the reason, the result is the same: an eye that does not see well.

One common (although outdated) perception about amblyopia treatment is that once a child is over 6 years old, treatment is ineffective. This study specifically chose children ages 7-10 to challenge this notion. Like many others before it, the results of this paper confirm that amblyopia treatment does not stop being effective past a certain birthday. In our office, we routinely treat patients with amblyopia well into adulthood.

Traditional treatment for amblyopia has been to patch or penalize the better-seeing eye and force the weaker eye to be used. This approach forces the brain to communicate with the weaker eye and increase communication capacity between the two. There are some major drawbacks to this method of treatment. First, as soon as the occlusion is removed, the brain immediately resumes ignoring the weaker eye. There is no situation under which the brain is taught to use both eyes at the same time under these conditions. In fact, binocular vision is being actively discouraged.

Another drawback of this type of treatment is that compliance is very low. As you might imagine, children despise being forced to wear a patch. With the better seeing eye occluded, vision becomes very blurry. Social interactions become more difficult while wearing a patch. Due to these and many other factors, the patch ends up not being worn and treatment is not completed.

But there is good news! Vision therapy has been and continues to be a more effective treatment option. Vision therapy is a prescribed set of activities and exercises designed to treat visual conditions that cannot be fixed with glasses, contact lenses, or surgery. This study had several conclusions: Patients treated with vision therapy had better outcomes than patching alone, completed treatment faster, did not regress after treatment, and were treated past the age previously considered ineffective.

Studies like this measure only visual acuity, or how clearly the eyes can see. However, treatment with vision therapy is much farther reaching than visual acuity alone. Other visual skills such as depth perception, eye tracking, and visual information processing are among the additional considerations taken into account when treating with vision therapy. Our treatment methods are faster, last longer, and are more complete than traditional methods.