Vision Therapy - YES or NO

[OptArnir]

Hello everyone,

lately I discussed with several eye care profs about vision therapy and I got some interesting views about it. How much do you all feel there is a need for vision therapy? If you have any experience especially with children - how do you motivate them to do the exercises at home? Which tools do you use?

Here are some interesting steps pointed out as a general approach: https://www.amblyoplay.com/blog/item...n-therapy.html

Thanks for your answers!

[Chris Ryser]

There is more:

A Randomized Trial Comparing Bangerter Filters and Patching for the Treatment of Moderate Amblyopia in Children

Objective: To determine whether visual acuity improvement with Bangerter filters is similar to improvement with patching as initial therapy for children with moderate amblyopia.

Design: Randomized, clinical trial.
Participants: We enrolled 186 children, 3 to 10 years old, with moderate amblyopia (20/40 –20/80).

Methods: Children were randomly assigned to receive either daily patching or to use a Bangerter filter on the spectacle lens in front of the fellow eye. Study visits were scheduled at 6, 12, 18, and 24 weeks.

Main Outcome Measures: Visual acuity in amblyopic eyes at 24 weeks.

Results: At 24 weeks, amblyopic eye improvement averaged 1.9 lines in the Bangerter group and 2.3 lines in the patching group (difference in mean visual acuities between groups adjusted for baseline acuity 0.38 line). The upper limit of a 1-sided 95% confidence interval was 0.76 line, which slightly exceeded a prespecified noninferiority limit of 0.75 line. Similar percentages of subjects in each group improved 3 lines (Bangerter group 38% vs patching group 35%; P 0.61) or had 20/25 amblyopic eye acuity (36% vs 31%, respectively; P 0.86). There was a lower treatment burden in the Bangerter group as measured with the Amblyopia Treatment Index. With Bangerter filters, neither a fixation switch to the amblyopic eye nor induced blurring in the fellow eye to worse than that of the amblyopic eye was required for visual acuity improvement.

See all of it:
http://www.privateeyeclinic.com/publ...nger%20ter.pdf

[rbaker]

You might want to contact BIOS (British & Irish Orthoptic Sociey)

https://www.orthoptics.org.uk/

[Chris Ryser]

• Qualifications & Training
• Admissions & Certification
• Orthoptic Fellowship Programs

see at:

http://orthoptics.org/become-an-orthoptist

[OptArnir]

Thanks, both of you! Will look more into it on the links you provided.

Chris, that study looks interesting, didn't come across it yet. I am now even more surprised about how differently people approach VT for children with amblyopia. I know some that are claiming only eye patching works and don't offer any alternatives that can be less intrusive. Even more, they are mostly very actively against anything new. It is an interesting field, which can be understood as both a treatment as well as a preventive measure for potential future problems.

[Chris Ryser]

Thanks, both of you! Will look more into it on the links you provided.

Chris, that study looks interesting, didn't come across it yet. I am now even more surprised about how differently people approach VT for children with amblyopia. I know some that are claiming only eye patching works and don't offer any alternatives that can be less intrusive. Even more, they are mostly very actively against anything new. It is an interesting field, which can be understood as both a treatment as well as a preventive measure for potential future problems.

OptArnir, This is nothing new, it began in the 1950s in St.Gallen, Switzerland, with the Ophthalmologist, Professor Dr, Alfred Bangerter, starting a whole new trend in the field of ophthalmology.

As a young optician working for my father, I was heavily involved with the construction of the instruments for the clinic. My father's business also produced the special occluders forever since.

The basic training of amblyopia in the Pleoptic and Orthoptic School, St. Gall.

The basic training of amblyopia in the Pleoptic and Orthoptic School, St. Gall.

Author:	Marlene Steidele
Publisher:	St. Gall, Printed and published by J. Zehnder, 1963.
Edition/Format:	[IMG]file:///C:\Users\CR\AppData\Local\Temp\msohtml1\01\clip_image001.gif[/IMG] Print book : English View all editions and formats
Database:	WorldCat
Rating:	(not yet rated) 0 with reviews - Be the first.
Subjects =click	· Orthoptics. · Amblyopia. · Pleoptics.
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source:
http://www.worldcat.org/title/basic-training-of-amblyopia-in-the-pleoptic-and-orthoptic-school-st-gall/oclc/15335047

[Stet]

Hi OptArnir
The treatment of amblyopia has definitely progressed in recent years and the paper quoted in this thread is from the excellent PEDIG group. I've used Bangerter foils for a while and the thing I particularly like about them is that they enable the patient to maintain some sort of binocularity while working on acuity improvement. It just makes it so much easier for the patient to achieve a decent long term binocular result. To me visual acuity isn't the only thing that should be emphasised when treating amblyopia, I feel it's really important to work on other visual skills that an individual needs in their every day world so that acuity gains are more likely to be maintained. Hope all that makes sense.