From owner-i_see@indiana.edu Mon Dec 11 18:32:43 EST 1995 Date: Mon, 11 Dec 1995 17:55:08 -0500 (EST) From: Alex Eulenberg Subject: Re: amblyopia Status: RO X-Status: On Mon, 11 Dec 1995, Jeff Sanders wrote: > Does anyone know if it is possible to cure amblyopia > or lazy eye? Yes, yes, yes, amblyopia can be cured, and contrary to popular belief: 1) you don't have to wear a patch all day, 2) there are lots of things you can do to improve vision in the "lazy" eye on top of the patching, 3) there is no age limit for improvement! One of the most important aspects of amblyopia is training the eye to USE THE FOVEA, or central part of the eye, for detail viewing. This is called "central fixation" Many persons with amblyopia -- for whatever reason -- repress foveal vision. That is, they use a less sensitive part of the retina in order to see things. This is called "eccentric fixation". Just wearing a patch won't necessarily get you to use the most efficient part of your retina, and just forcing yourself to "try to see" while still engaged in the old habit of seeing with the wrong part of the eye, will only cause eyestrain. Your best bet is to see a licensed eyecare practitioner who can help you "find your fovea", and who can prescribe various activities to get you to use it correctly. To find one (the practitioner, not the fovea!) in your area, please see under "finding help" at http://silver.ucs.indiana.edu/~aeulenbe/i_see.html In addition, William Bates's book "Better Eyesight Without Glasses" gives lots of tips on how to acquire central fixation. In fact, the book was originally published by the author's so-called "Central Fixation Publishing" company. According to Bates, lack of central fixation underlies all vision problems, and achieving central fixation will cure all errors of refraction (i.e. elmiminate the need for glasses). Bates evidently had stricter standards for "central fixation" than what is used today, since most modern practitioners do not find eccentric fixation in the majority of people whom they feel need glasses, and they also find many amblyopes with what they define as central fixation. But in any case, if central fixation is what you need, the Bates system of perceptual and memory training is one tool with which you can acquire it. --Alex ========================================================================= From owner-i_see@indiana.edu Tue Dec 12 11:05:48 EST 1995 Date: Tue, 12 Dec 1995 10:04:34 -0500 (EST) From: Alex Eulenberg Subject: optometric amblyopia treatment Status: RO X-Status: Optometrist Merrill Allen, Professor Emeritus at Indiana University, has developed a flash-therapy treatment with a device known as the "Translid Binocular Interactor". It is used by many optometrists across the US for the cure of amblyopia and strabismus. Dr. Allen writes in one article (in /Frontiers in Visual Science/, Springer-Verlag, 1977), referring to its use in treating amblyopia... :The success rate of [patching the better eye] is only about 50% with the :younger patients being more responsive. In fact, an oten repeated :clinical statement is that anyone older than eight years cannot be :treated if they have amblyopia. Another clinic "rule" is that corrected :acuities poorer than 20/200 are probably organic, and, therefore, cannot :be treated. :Fortunately, treatments that are more aggressive than the occluder [patch] :are available, and the eight year rule and the 20/200 rule appear to be :myths. For example, Fig. 1 [curve decreasing logarithmically from 20/2600 :at 0 hours to 20/250 at 57 hours] shows the recovery curve for a :nine-year-old female having an initial corrected acuity of 20/2600 who was :treated with flash therapy applied in the macular region of the amblyopic :eye. Similar recoveries have been observed for patients in their 30s and :with acuity of light perception only. Older patients have not been :available for treatment. My oldest patient for the successful treatment of :lifetime strabismus was 58 years of age. :The shape of this visual acuity recovery curve seems to be typical based :on clinical experience and may be used for prediction purposes. All :patients do not respond at the same rate, either due to treatment :differences, to depth of the anomaly or to age, but the curve shape sems :to be similar for all. Thus if it took 45 hours to attain 20/200, 20/100 :will take approximately 90 hours, 20/50 approximately 180 hours :and 20/25 approximately 360 hours of treatment. At the rate of one hour :per day, 20/25 would thus be expected in one year starting at 20/2600 in :this nine year old's case, assuming the same intensity of therapy :continued throughout. Here's an abstract of an article appearing in the official journal of the American Academy of Optometry: * * * "Anisometropic amblyopia: is the patient ever too old to treat?" By Bruce Wick, Michael Wingard, Susan Cotter, and Mitchell Scheiman /Optometry and Vision Science/, vol 69, no. 11 (Nov 1992), pp. 866-78 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 h/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 6 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 of 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. Bruce Wick and Michael Wingard may be reached at the College of Optometry, University of Houston.... (713) 743-2053 Susan Cotter's number in Olympia Fields, Illinois is (312) 481 5600 Mitchell Scheiman's number in Philadelphia is (215) 276 6057 * * * Anther outspoken researcher in the field of amblyopia therapy is Arnie Sherman, OD, of Merrick, New York (516) 868 2266 Dr. Sherman, taking an issue with one of the assumptions of the abovementioned study, argues that full correction of refractive error in amblyopia is counterproductive. Writes Dr. Sherman ("Alternative Treatment for Anisometropic Amblyopic Patients: A Case Report", Journal of Optometric Vision Development 1993, vol. 24, pp. 25-27): :Correcting the full refractive error is often counterproductive and may :cause the patient to readapt once more and create a larger refractive :error in order to maintain functioning in every day tasks. This phenomenon :typically occurs with hyperopic strabismic amblyopes who continue to :increase in hyperopia even after the full Rx found under cycloplegia is :worn for a short period of time. The same view with regard to full correction is held by Dr. Allen. See "How to Eliminate Hyperopia" on the I_SEE page. http://silver.ucs.indiana.edu/~aeulenbe/i_see.html ========================================================================= From owner-i_see@indiana.edu Wed Dec 13 10:16:07 EST 1995 Date: Wed, 13 Dec 1995 09:58:29 -0500 (EST) From: Alex Eulenberg Subject: Translid Binocular Interactor Status: RO X-Status: On Tue, 12 Dec 1995, William Stacy wrote: >Alex: Are you sure that 'many' optometrists are still using that >instrument? Dr. Allen says 1 out of 5 "Vision Training" optometrists use it. I called one optometrist in Ohio (Drusilla Grant) and she says she uses it. > Has ANYONE studied it??? (besides Allen) Definitely not, which irks Allen. Not even the typical "we tried your new technique and it didn't work, so there" study. However, somebody did go ahead early on and steal Allen's patent (which has now expired) and marketed an identical device. For what it's worth, the TBI is described (neutrally) in Schapero's 1971 amblyopia text, along with other inventions of Dr. Allen (such as the sectored rotating disk, which produces the same effect). Ciuffreda et al's 1991 amblyopia textbook, however, does not mention the device at all, or Allen. --Alex ========================================================================= From aeulenbe@indiana.edu Thu Dec 18 06:34:38 1995 Date: Mon, 18 Dec 1995 01:20:02 -1200 From: heal-hi@aloha.net (Joan Levy) Subject: Re: Amblyopia Status: RO X-Status: >---------- Forwarded message ---------- >Date: Mon, 11 Dec 1995 16:52:00 +0500 >From: Jeff Sanders >To: i_see@indiana.edu >Subject: amblyopia > > >Does anyone know if it is possible to cure amblyopia >or lazy eye? I have heard of patching the "good" eye >in order to make the lazy one work harder. Does anyone >know if this really works or not? I would also like to >know how long the eye must be patched. Any help on this >subject would be greatly appreciated. > >Thank you, > >Jeffrey Alan Sanders > > Biofeedback Vision Retraining has been used successfully with lazy eye. Peter Behel in the San Francisco Bay area was doing the work a while back. > ~ ~ Joan Levy, Kauai, Hawaii ~ ~ ~ Healing Arts Resources Kauai - BodyMind & Breath Center ~ ~ 808-822-5488/5231 - FAX-823-8088 ~ ~ heal-hi@aloha.net - 75644.342@compuserve.com ~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ========================================================================= From owner-i_see@indiana.edu Tue Dec 19 08:36:06 EST 1995 Date: Tue, 19 Dec 1995 05:08:18 -0800 From: ws@ix.netcom.com (William Stacy ) Subject: amblyopia Status: RO X-Status: >>Does anyone know if it is possible to cure amblyopia >>or lazy eye? I have heard of patching the "good" eye >>in order to make the lazy one work harder. Does anyone >>know if this really works or not? I would also like to >>know how long the eye must be patched. Any help on this >>subject would be greatly appreciated. >> >>Thank you, >> >>Jeffrey Alan Sanders >> >> > > >Biofeedback Vision Retraining has been used successfully with lazy eye. >Peter Behel in the San Francisco Bay area was doing the work a while back. I would imagine that biofeedback could be helpful, but to answer Jeffrey, yes patching the good eye forces the lazy eye toward better, more central fixation, since the root cause of amblyopia is that the brain has never really learned how to 'aim' the eye well. You can easily see how this works if you direct your gaze to any edge of your computer monitor and realize that you can't read anyting on the screen except very large letters. Amblyopia is like not being able to aim the eye closer to the letters you want to read. As to how long, patching works best in small children where I've seen dramatic improvements after a month or 2 of continuous patching. With older kids it takes longer and with adults it can really be tough mostly due to the inconvenience of walking around all day with the good eye patched. The time is also related to the depth of the amblyopia. 20/400 takes a LOT longer than say 20/40. Bill =========================================================================