Newer Binocular Therapies in the management of Amblyopia

E poster 107Dr Mihir Kothari, Vivek Rathod, Ms Shruti Lad and Mr Md Oli Ullah Abdal

Kanohi Vision Center, Dadar, Mahatme Eye Hospital, Nagpur, Jyotirmay Eye Clinic, Thane

drmihirkothari@jyotirmay.com

Financial Conflicts - None

Amblyopia• 3-5% Population prevalence = VERY COMMON

• Commonest cause of monocular blindness in age group 20-50 years

• Next to refractive error – an ophthalmic disorder with the best opportunity-cost

• Standard of care is still “Occlusion therapy!”

Limitations of Present Treatment of

Amblyopia• Poor effect in older

children and adultso <50% patients between 7-12

years and <25% below 17 years respond to occlusion

• Does not address the deficits in binocular systemo Patching doesnot improve

fusion, stereopsis, fine motor skills and hand eye coordination all of which have important impact on quality of life of the patient

• Residual Amblyopiao Is seen is >85% patients

despite of 6hr/patching after 3 months

• Poor Compliance to patching o Maximum compliance was

50% in PEDIG study• Recurrence of

Amblyopiao When patching is stopped it

happens in 25% if stopped suddenly

1-Ophthalmology 2003, 2-IOVS 2013, 3- J AAPOS 2004, 4-PRER 2013, 5-Ophthalmology 2003

Aim• To report the efficacy of newer

Binocular Vision Therapy for the management of amblyopia

• In patients with residual amblyopia not responding to conventional patching in CHILDREN, OLDER CHILDREN AND ADULTS

Inclusion Criteriao Residual anisometropic / strabismic or

mixed amblyopia

o No OTHER comorbidity

o Not responding to atleast 3 months of 6

hr/day or more of patching

o 100% compliance

MethodsGroup 1 – Home Vision

TherapyGroup 2 – Office Vision Therapy

• Dichoptic therapy was given

• Android game stereo block was given to play

• 5 hours / week regieme• Red green Goggles• Full time refractive

correction with spects / contact lenses

• No patching was given

• Dichoptic therapy was given

• Sanet Vision Integrator and Vision Therapy System 4 were used

• Full time refractive correction with spects / contactlenses given

• Patching was continued 2hrs/day

Group 1 – Stereoblock settings given to the

patient

Amblyopic Eye Dominant Eye

Group 2: Sanet Vision Integrator and Vision Therapy System

4

SVI VTS4

Touch screen computerUsed for anti suppression exercisesPatient wear red-blue goggles

3D screen computerUsed for fusion exercisesPatient wears LCD stereo goggles

ResultsGroup 1 - Android Group 2 – SVI,VTS4

• 7 patients

• 6-15 years

• 5 strabismic amblyopes

• 1-3 lines improvement

• Mean 1.8 lines

improvement

• 16 eyes, 11 patients

• Mean age 12.5 years

• 5 had bilateral, 6 unilateral• Mean improvement

o bilateral amblyopia (n=10) was 2.6 LINES p<0.01 (paired t test)

o unilateral amblyopia (n=5) was 0.28, p=0.05

• Maximum improvement o bilateral amblyopia was 5 lines o unilateral was 0.6 (6 lines)

• 4 patients age > 18 years experienced mean 2.5 lines improvement

Dichoptic Treatments - Principle

• A (contrast adjusted) stimulus is presented exclusively to each eye

• The image of right eye was visible only to that eye

• The image of the left eye was visible only to the left eye

• The brain was forced to integrate the images into a single perception

Dichoptic Treatments – Conceptulised

Advantages

• Better and Prolonged Plasticity of binocular

neuronso Effective for

• Residual amblyopia

• Adult amblyopia

• Faster effects

• Better compliance

• Effect on binocularity (fusion and stereopsis)

• Maintained vision (lack or recurrence)

• Effect on visuo-motor skills (improved hand eye coordination)

• Etc…

Conclusion• Newer binocular treatments can be

considered for residual/adult amblyopia or

patients with poor compliance to patching

• Patching along with binocular treatment may be

more effective than binocular therapy alone