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Amblyopia

 


Undetected vision problems, such as lazy eye, convergence insufficiency, focusing problems caused below grade level performance and low grades in these childre.Orthoptics / Vision Therapy

Orthoptics is an unusual term for most people.  According to Webster's it is the treatment of defects in binocular vision and muscle imbalance by reeducation of visual habits, exercise and visual training.

Orthoptics was suggested by du Bois Reymond (1852) and MacKenzie (1854) and pioneered in the latter half of the nineteenth century by the French ophthalmologist Javal.  He was dissatisfied with the outcome of strabismus surgery performed by his father and sister.  He sought noninvasive means to treat strabismus (severe eye turns).  

Strabismus, more commonly known as crossed-eyes, is a vision condition in which a person can not align both eyes simultaneously under normal conditions.  One or both of the eyes may turn in, out, up or down. An eye turn may be constant (when the eye turns all of the time) or intermittent (turning only some of the time, such as, under stressful situations or when ill). Whether constant or intermittent, strabismus always requires appropriate evaluation and treatment.  Orthoptics is often done in lieu of surgery or as a precursor to surgery.

Orthoptics
Orthoptics is a medical term for the eye muscle training programs provided by orthoptists and optometrists. Vision therapy programs include orthoptics, but, technically there are broad distinctions between vision therapy and orthoptics. Orthoptics, which literally means "straightening of the eyes," is limited in scope to eye-muscle training and the cosmetic straightening of eyes. Orthoptics treat muscle problems only in regard to strength and do not focus on neurological and visual-motor issues in the comprehensive way in which vision therapy does. Treatment is home based.

Vision Therapy
Vision Therapy is an individualized, supervised, non-surgical treatment program designed to correct eye movements and visual-motor deficiencies. Vision Therapy sessions include procedures designed to enhance the brain's ability to control:

  • eye alignment,
  • eye teaming,
  • eye focusing abilities,
  • eye movements, and/or
  • visual processing.

Visual-motor skills and endurance are developed through the use of specialized computer and optical devices, including therapeutic lenses, prisms, and filters. During the final stages of therapy, the patient's newly acquired visual skills are reinforced and made automatic through repetition and by integration with motor and cognitive skills.

Vision TherapyWhile vision therapy includes the eye muscle training methods of orthoptics, it has advanced far beyond it to include training and rehabilitation of the eye-brain connections involved in vision. Clinical and research developments in vision therapy were closely allied with developments in neuroscience during the twentieth century. Research continues in the 21st century.

In vision therapy programs, optometrists look at the neurological control system and thus are treating the whole visual-motor system and altering reflexive behavior, which results in a lasting cure. Also, most optometrists rely on office based therapy, which they believe is more accurately performed and monitored.

Vision Therapy for strabismus generally consists of either weekly or bi-weekly office based therapy. In-office therapy is reinforced with home therapy. This is based upon a case-by-case determination. Milder intermittent cases may be handled with home therapy. Sequential activities are programmed to teach the patient how to use the eyes individually and as a team.  Skills taught include flexibility of focus, tracking, perception and kinesthetic awareness of eye position and binocularity.

Before beginning orthoptics, amblyopia (lazy eye) should be improved.  Otherwise there will be a tendency toward regression. 

Links 

National Eye Institute - Amblyopia
Optometric Clinical Practice Guideline for the Care of the Patient with Strabismus
Strabismus
New Yorker Magazine: Stereo Sue
Audio: NPR - Stereo Sue
Video: Vision Therapy & Adults

(Early history is gleaned from "Applied Concepts in Vision Therapy" by Leonard J. Press, O.D.



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