Sunday, June 2, 2013

Identification and treatment of amblyopia



Amblyopia is the leading cause of vision loss in children. It is treatable if diagnosed early, making identification of affected children critical. The American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics recommend that clinicians routinely perform age-appropriate vision chart testing, red reflex testing, and examination for signs of strabismus. The U.S. Preventive Services Task Force recommends vision screening for all children at least once between three and five years of age to detect the presence of amblyopia or its risk factors. Photoscreening may be a useful adjunct to traditional vision screening, but there is limited evidence that it improves visual outcomes. Treatments for amblyopia include patching, atropine eye drops, and optical penalization of the nonamblyopic eye. In children with moderate amblyopia, patching for two hours daily is as effective as patching for six hours daily, and daily atropine is as effective as daily patching. Children older than seven years may still benefit from patching or atropine, particularly if they have not previously received amblyopia treatment. Amblyopia recurs in 25 percent of children after patching is discontinued. Tapering the amount of time a patch is worn each day at the end of treatment reduces the risk of recurrence.

Comments: I usually edit abstracts before putting them on MainosMemos, but this particular abstract has several  problems and inaccuracies that I had to call to your attention.....

What they said/What they should have said/Statements not supported by science

What they said:...It is treatable if diagnosed early.....
What they should have said:...It is treatable at any age.....

Several studies with adults who have amblyopia have clearly shown that amblyopia is treatable in adults. (Dichoptic training enables the adult amblyopic brain to learn., The effect of video game training on the vision of adults with bilateral deprivation amblyopia., Prentice award lecture 2011: removing the brakes on plasticity in the amblyopic brain., Perceptual learning reduces crowding in amblyopia and in the normal periphery., Video-game play induces plasticity in the visual system of adults with amblyopia., Can human amblyopia be treated in adulthood?) and many more......

What they said:...The U.S. Preventive Services Task Force recommends vision screening ....
What they should have said:...The U.S. Preventive Services Task Force was completely wrong when they recommend  vision screening ...

What they said is NOT supported by science. Vision screenings are so bad that the data collected cannot even determine if they are worthwhile or not according to Cochrane's Reviews. Vision screenings are a waste of time. Our children deserve full comprehensive eye and vision examinations

Cochrane Reviews notes that depending upon the study.....




"...The aim of this review was to find studies that evaluated the effectiveness of school vision screening programmes in first identifying children with reduced vision. No eligible randomized studies were found. There is a clear need for reliable evidence to measure the effectiveness of vision screening;....... The authors concluded that there is, therefore, a need for some robust evaluation of the screening programmes that are in place to see if they are truly effective or not. Any such evaluation would have to also look at how much screening programmes cost and what effect untreated amblyopia has on quality of life...."...and...additional information from this blog

The said: ...Children older than seven years may still benefit from patching or atropine, particularly if they have not previously received amblyopia treatment...What they should have said: Children and adults will benefit from treatment no matter their age...

The bottom line on all this is that vision screenings do not have any science behind them, amblyopia can be treated at any age, and glasses and patching may be only the beginning when it comes to treating amblyopia. Amblyopia is a BINOCULAR vision dysfunction. To treat amblyopia you should include binocular vision therapy. Optometric vision therapy does just that. For a doctor who can help go to the College of Optometrists in Vision Development, Optometric Extension Program Foundation....or  if you live in Chicago, see me at Lyons Family Eye Care or the Illinois Eye Institute. DM

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