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    Vision Therapy for amblyopia
    An_244495 posted:
    Has anyone had any experience and success with vision therapy for amblyopia? I've read that vision therapy can help correct your vision but does it also correct the eye turning in? Will the eye go straight with vision therapy?
    I guess I'm used to the problem with my vision because I've never had any problems reading, playing sports, or driving or anything like that so I just want to try vision therapy to make the eye go straighter if possible. I don't want to spend all the money on the vision therapy if it's not going to actually make the eye go straight.
    Alan M Kozarsky, MD responded:
    Vision therapy is a controversial subject. It is generally a prolonged and expensive therapy with very little scientific data to show objective benefit.

    The main treatment for an amblyopic (lazy) eye is diagnosing early and treating with best eyeglass correction and patching the good eye before the age of 8 or 10.

    Any other treatment, especially later in life, is not likely to have much benefit in terms of improving vision, improving "cooperation" of both eyes, or in improving alignment of your eyes.

    Scientific evidence indicates that wearing the proper glasses (or contact lenses) for excessive farsightedness (if present) or surgically changing the eye position are the more reliable ways to prevent your eye from turning in.
    djp823 responded:
    Check out the story of neurobiologist, Dr. Sue Barry before accepting old dogma.
    An_244542 replied to djp823's response:
    I have met Stereo Sue and had a nice conversation with her. Her story does not mean the "old dogma" is incorrect. It is important to understand that she is an exceptional case. It is also important to point out that she still does not have great stereo acuity (3D or depth perception). She does have stereo ability, but only to a small degree. Her story proves that the adult brain is still capable of adapting and making new connections. However, her story does NOT prove that vision therapy works for strabismus. In fact, she openly says that she needed three surgeries to align her eyes.

    Vision therapy is often ridiculously expensive, and will not correct a misalignment of the eyes. Glasses can make a big difference in certain situations. If not, then surgery is often necessary to achieve a good alignment.

    There are also much less expensive ways to correct amblyopia. However, after the age of 10 (roughly), the success rates of amblyopia treatment drastically decline, no matter what treatment regimen is used.
    djp823 replied to An_244542's response:
    Sue Barry is not as exceptional as you may think. Other patients just don't have the resources that she had. I won't address your point on cost which is ridiculous to bring up. Vision therapy is not a panacea for curing strabismus but I wouldn't dismiss it either. What Sue Barry has shown is the adult brain is more plastic than old dogma has acknowledged and there are studies to back her up. For this person vision therapy in combination with surgery may be the best option, much like physical therapy and orthopedic surgery. My point is not to let irresponsible physicians deny patients even the possibility that vision therapy is an option. Just find an optometrist who is well versed in developmental/functional vision.
    Work together for the common good of this person and others.
    srb00 replied to An_244542's response:
    I am Sue Barry, Stereo Sue. Indeed, my stereo acuity is subnormal but is stable and approaching the normal range. Most importantly, my stereo ability has improved my vision dramatically and is of enormous benefit in many routine activities including driving.

    Strabismic surgery may improve eye alignment but may not result in the acquisition of stereopsis, especially in patients over the age of one. Most patients have to be taught how to make proper vergence movements of their eyes. This is where optometric vision therapy comes in. In many cases, patients may benefit most from the combined skills and tools of ophthalmologists and optometrists, that is, surgery and optometric vision therapy respectively.

    Current scientific studies indicate that the adult visual system is far more plastic and capable of improvement that previously thought. Below is a small sample of papers in scientific peer-reviewed journals on visual plasticity and improvement in patients with amblyopia and strabismus:

    Astle A. T., McGraw P. V., & Webb, B. S. (2011). Can human amblyopia be treated in adulthood? Strabismus, 19, 99-109.

    Ding J. & Levi D. M. (2011). Recovery of stereopsis through perceptual learning in human adults with abnormal binocular vision. Proceedings of the National Academy of Science, 108, E733-E741.

    Xu, J. P., He, J. J., & Ooi, T. L. 2010. Effectively reducing sensory eye dominance with a push-pull perceptual learning protocol. Current Biology, 20, 1864-1868.

    Levi DM. (2005). Perceptual learning in adults with amblyopia: a reevaluation of critical periods in human vision. Developmental Psychobiology 46: 222—232.
    An_244542 replied to djp823's response:
    Actually, the topic of cost SHOULD be brought up in this situation. Please note that the author of the original post is concerned about cost. The answer to his/her question is that vision therapy will NOT straighten the eyes. If the author would like to have the eyes aligned, then surgical intervention is likely required. Vision therapy may have some therapeutic benefit in specific situations. However, in my area, it is prescribed far too often for conditions that would obviously be better treated by other means (and I don't mean only strabismus surgery).
    An_244616 replied to An_244542's response:
    It's apparent that you have no background or training in vision therapy which makes your opinions on the field just that, opinions. It's great you acknowledge there is a place for vision therapy but it sounds like you have a narrow view on the field. The author is looking for help and cost is secondary to the question of what is the best route to explore. You don't know the status of his/her visual system and you are quick to dismiss vision therapy. The point is to get a consultation with an optometrist well versed in vision therapy who has a working relationship with an ophthalmologist.
    djp823 replied to An_244542's response:
    Why anonymous?
    djp823 replied to An_244542's response:
    Dr. Barry discredited your "authority" and knowledge on the subject so I will defer to her post. The experts on developing depth perception, which is the reason the brain will maintain eye muscle alignment, are optometrists with vision therapy as a background.
    srb00 replied to An_244542's response:
    We need to define better the term "eye alignment." If, after surgery, an individual's eyes are aligned to within 8 prism diopters, then the person's eyes will usually appear cosmetically straight. In addition, the individual may enjoy some crude stereopsis. However, most adults with strabismus also have a vertical misalignment between their two eyes, and this vertical mismatch will prevent the individual from fusing the images between the two eyes and seeing in stereo depth.

    To coordinate the two eyes well, one doesn't keep the eyes "straight" all the time. One must turn in the eyes to aim both of them at a near target and turn out the eyes from this converged position to aim both eyes at a far target. If the two eyes are not aimed at the same spatial location, then stereopsis will not result. These disparity vergence movements develop in a child with normal vision within the first months of life but have not developed well in someone with a lifelong strabismus. Thus, after surgery, the patient may simply go back to their entrenched visual habits of looking at a target with one eye and turning the other, especially because the eye turn makes it easier to suppress the strabismic eye's image. After surgery, therefore, optometric vision therapy is necessary for the individual to take advantage of the better eye alignment and to learn to make disparity vergence movements. Only then will he or she be able to acquire stereopsis. Moreover, once the individual is able to fuse, then he or she is more likely to use her eyes in a coordinated fashion and keep the eyes aligned. Thus, a combination of approaches is, in many cases, the best way to treat strabismus.

    I had an excellent eye surgeon and good cosmetic results from my surgery. Nevertheless, after my surgeries, my eyes were still misaligned by 8 prism diopters for a far target and by 25 prism diopters for a near one. Moreover, I had a vertical misalignment of 3 to 5.5 prism diopters for near and far viewing respectively. Thus, I was not able to fuse images from my two eyes at any viewing distance. Through optometric vision therapy, I eliminated the horizontal misalignment for both near and far. My eyes look and are much more aligned than prior to vision therapy, and I enjoy dramatically better vision and stereopsis.
    AChanceToGrow responded:

    I invite you to check out our Vision Therapy Symptoms Checklist. One of the symptoms we list is the eye visibly turning in. This list is addressed towards children, but adults can also benefit from Vision Therapy.

    Good luck!
    momamouse replied to Alan M Kozarsky, MD's response:
    My Daughter is 10 this year, she has struggled through 5 years of vision therapy. We done 2 10 week sessions per year costing thousands of dollars, hours of lost work and a ton of gas. Her vision HAS improved but she is still not seeing 20/20 even with her glasses on. Her prescription is 4.75 and 1.25. The 1.25 has actually gotten worse. Our optometrist now tells us she needs to do a few more 10 week sessions. At her age I have to wonder how effective the treatment is and how much of the progress is just natural improvements. I'm really wondering if we should continue to shell out money or if her eye sight at this age is set?

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