Dichoptic therapy for amblyopia

Recent research has highlighted the possibility of a new treatment for amblyopia. Amblyopia is the medical term used to describe an eye that has reduced vision due to the eye and brain not communicating effectively.

This new amblyopia treatment has the potential to completely change the way amblyopia is managed and treated in both children and adults.

Traditionally, the mainstay of amblyopia treatment was, and still is, occlusion therapy. Occlusion therapy is more commonly referred to as patching. Patching, or occlusion therapy is where an eye patch is worn to cover up (occlude) the stronger eye. This forces the weak or amblyopic eye to work harder and develop cortical connections (brain to eye connections) thus strengthening the vision in the weak eye.

Occlusion therapy, or patching, is still the gold-standard of amblyopia treatment in children worldwide, and is often a very successful treatment for amblyopia. Patching of the eye has numerous pitfalls, and unfortunately is not always successful. For the most part, patching is only effective in children under the age of about 8-9 years of age due to the loss of cortical plasticity thereafter. This obviously limits the vision improvements in older children and adults with amblyopia. Other downsides to patching include compliance and the social or psychological impacts of wearing an eyepatch. Due to patching being an imperfect treatment, researchers have been searching for other methods of treating amblyopia.

New research has discovered that amblyopia may be able to be successfully treated in older individuals, adults and children, by way of a different method of treatment.

We are only now discovering that amblyopia is indeed a binocular problem. Amblyopia normally develops in only one eye, and therefore we have always thought of amblyopia as a uniocular issue. Amblyopia treatment has centred around this belief, with the solution being to patch the better seeing eye.

New research is showing that amblyopia is actually a binocular problem (both eyes), and new treatment for amblyopia is focussing on treatments using the two eyes together, rather than patching one eye. This new treatment is called dichoptic therapy.

Dichoptic means to view separate and independent images simultaneously from each eye.

The latest research into dichoptic therapy as a treatment for amblyopia is reported in the journal of AAPOS (The American Academy of Pediatric Ophthalmology and Strabismus). This study used an iPad game together with coloured stereovision glasses to allow each eye to view separate images simultaneously. The iPad game was played for 1-2 hours each week for 4 weeks. The study reported encouraging improvements to vision after just 4 weeks of treatment.

Sydney Ophthalmic Specialists is currently trialling dichoptic therapy for certain patients with amblyopia. In order to qualify for the pilot trial, patients must be at least 7 years of age, have vision of 6/9.5 or less in the amblyopic eye, and meet certain other criteria for inclusion. It is important to understand that dichoptic therapy is still in a trial phase and has not yet proven to be effective in more than a few recently published studies. Dichoptic therapy is also an adjunctive therapy at the moment, and it is important to continue with patching therapy if this has been prescribed for your child.

If you or your child has amblyopia and you would like to know more about the new pilot dichoptic therapy trial for amblyopia at Sydney Ophthalmic Specialists, please contact Orthoptist Sarita Beukes by emailing sarita@sosdoctors.com.au or by phoning (02) 9241 2914.

To read the full-text article and editorial about dichoptic therapy published in JAAPOS, please visit the links below: