To the Od's and OMD"s primarily

[obxeyeguy]

I have a 4 yr old patient, amblyopic Od . Script is OD. +4.25+.50X 90
OS +1.75 sph
I don't have the acuity. Origionaly patched OS for 4Hrs a day for approx 3 months. On recent re-exam OMD said vision in OD is worse, Patching now 1 Day a week for 12 hours. I realize that I am giving you half at best the info needed, I am just trying to understand the patching logic. Any thoughts appreciated from those smarter than I.
Mark

[HarryChiling]

The idea is to allow the visual pathways to develop in the weaker eye, istead of the brain just ignoring the sub par vision provided through it.

[obxeyeguy]

The idea is to allow the visual pathways to develop in the weaker eye, istead of the brain just ignoring the sub par vision provided through it.
, That part I understand, I'm trying to figure the rational for the different patching regimen, from 4 hrs a day, to 12 hrs on one day. The child is 4, and patching 12 continuous hrs is next to impossible.
Mark

[DocInChina]

Patching without giving cognitive exercises is meaningless. The pathways need to be "re-awakened" which requires active information processing not passive staring into space. The patching schedule being implemented has no basis other than the doctor trying to show they are seeking a solution. To find a solution you have to understand the problem. In truth I feel bad for the poor kid being brought to the wrong doctor.

[drk]

Patching rationale is very confusing, and needs to be done with great regard to scientific studies. I believe there is much disagreement on the subject.

Having said that, I have very little specific knowledge on patching.

[npdr]

Patching is just one of the modalities to improve the prospects of amblyopia. Here are some key steps:

1. Diagnose correctly that it is amblyopia. Amblyopia, even in children should be a diagnosis of exclusion. All other causation should first be considered.
2. Determine the underlying etiology of the amblyopia. For example, is it anisometropia (meridional or otherwise)? Is it strabismic? Is it ex anopsia? Is it recent onset?
3. Then assess the goals and expectations of the parents and patient. No orthoptic or vision therapy regimen will be successful if there is no agreement by all parties involved that a particular direction is desired.
4. Lastly, based upon the patient's condition, you can balance active vs passive vision therapy; active vs passive patching,etc.

I think this case might have been taken out of context due to the limited amount of facts presented. I'm also decidedly disappointed that the responding posters who aren't medical or optometric are offering conclusions in the presence of so little information.

[obxeyeguy]

I think this case might have been taken out of context due to the limited amount of facts presentedI know that I was only giving Very limited info, its all I had also. Still appreciate the opinions, even in broad terms. Thanks docs
Mark

[HarryChiling]

I'm also decidedly disappointed that the responding posters who aren't medical or optometric are offering conclusions in the presence of so little information.

The case could also be made that I am decidely dissapointed in you for not responding sooner, the information I gave was vague and of no value other than to point out what I know about patching, which I might add is very little. I am an allied health professional that has worked in an ophthalmology practice that dealt with strabismus and amblyopia, that's where I earned my COA from, since I am the only non-OD that responded to this thread allow me to retort:

WHO CARES WHAT DISAPPOINTS YOU, and how could you possibly misconstrue this as a conclusion:


The idea is to allow the visual pathways to develop in the weaker eye, istead of the brain just ignoring the sub par vision provided through it.

[npdr]

Mr HarryChilling,

If the shoe fits, then it fits. It appears that you think that your exposure to pediatric and strabismic ophthalmolgic practice gives you significant insight to the art and science of amblyopia. Pardon me if your past experience has allowed you to be masterful even in this endeavor.

I also apologize if the timeliness of posting is measured by some standard. It is likely that non- medical and non optometric professionals might comment, but their wording reveals the depth of understanding of the issues. If the posters were so confident of their relevance of their posting, then it should be evident that no more postings would be needed. One need only to see the direction of the postings to know that this would have been difficult to achieve in the manner that would best resolve the original poster's dilemma and query.

[Fezz]

Mr HarryChilling,

If the shoe fits, then it fits. It appears that you think that your exposure to pediatric and strabismic ophthalmolgic practice gives you significant insight to the art and science of amblyopia. Pardon me if your past experience has allowed you to be masterful even in this endeavor.




When will it end with you, Doc?

You were able to come to this conclusion from Harry's one sentence response.


This axe that you continue to grind here is getting very old. Why must you always attack Harry? The personal attacks are unprofessional.

[HarryChiling]

Thanks Fezz, this would probably be better settle by PM. If my short and sweet comment was wrong in any way please point it out, but if you feel as though I am commenting on something that I should not be commenting on then get a life.

[obxeyeguy]

Any thoughts appreciated from those smarter than I.
Mark Harry, I asked for ANY thoughts, and yours was appreciated as much as the others. I said primarily to the OD"s and OMD"S, not just them. Didn't mean for it to become a turf war. I gave very general info and asked for a very general response.
Mark

[HarryChiling]

npdr has an axe to grind with me so he tryed his hand on this thread, it could have easily been another by any other subject. I just thought I would share what little I knew about it and if you like I can search my library at home for more info and post it.

Also check out:
http://onlineopticianry.com/wordpress/?p=113 an article by Alvaro Cordova on the subject of Vision Therapy, Strabismus, and Amblyopia

Great article with great information in it.

PS - flees of a thousand camels, flees of a thousand camels hehehe.........

[chip anderson]

How come no one has asked a pediatric ophthalmologist about this? I have worked with quite a few and a few orthoptists. Why do you think they would waste time and patient/parent nerves with all this patching if it never worked. Many times it works quite well, and if well monitored it can be determined when this is not the best approach to the problem. When it does, it's cheap, non-invasive and virtually risk free. When it does not work, then other avenues, exercises, surgery or whatever can be attempted.
Would you prefer the pediatric ophthalmologist (there is a reason they are M.D.'s) go knife happy right away, or send them to local O.D. for gourd shaking?

Chip

[HarryChiling]

Here is a link to some relevent articles that might help. Let me know which articles you want and I will get them for you for free.

www.sciencedirect.com (http://www.sciencedirect.com)

Search for strabismus, amblyopia, patching just give me the article and I will get it for you, that way you can get real information instead of just comments.

At $30.00 an article, I will be amazed if no one takes me up on this offer.

[chip anderson]

I am sure this link will give you more information than you can digest on the subject
www.orthoptics.org (http://www.orthoptics.org)
Chip

[drk]

Gourd shaking. Good one.

Risk free. Good one.

Let's put Chip and npdr in a wrestling ring and watch the hilarity ensue.

[DocInChina]

I'm also decidedly disappointed that the responding posters who aren't medical or optometric are offering conclusions in the presence of so little information.

In fact I am an optometrist who responded. Assuming the treating doctor correctly diagnosed the amblyopia, and the condition has worsened we can surmise that passive patching is the incorrect course of action. Unless there is a psychological deficit precluding patching with cognitive activities I am always against passive patching.

[obxeyeguy]

I don't have the acuity. Origionaly patched OS for 4Hrs a day for approx 3 months. On recent re-exam OMD said vision in OD is worse, Patching now 1 Day a week for 12 hours. I realize that I am giving you half at best the info needed, I am just trying to understand the patching logic. all I was trying to get was the patching logic. I sure did not mean to start a GWB war. I was just looking for ANY opinions on the subject.
Thanks to Harry and Chip for the web sites, I will read up tomorow, and Harry, no, I will not take you up on the $30 offer, but thanks.
mark