From the Guidelines
The term "teacher behind eyes" is not a recognized medical concept, but it may be related to the idea of amblyopia, also known as "lazy eye," which is a condition where the brain favors one eye over the other, often due to visual deprivation or obstruction. According to the American Academy of Ophthalmology's preferred practice pattern for amblyopia 1, visual deprivation amblyopia is caused by complete or partial obstruction of the visual axis, resulting in a degraded retinal image. This can be due to various factors such as congenital or early-onset cataract, corneal opacities, or vitreous hemorrhage.
- Key points to consider in the diagnosis and treatment of amblyopia include:
- Early detection and treatment, especially in children, to prevent long-term vision loss
- Removal of any obstruction or cause of visual deprivation, such as cataract surgery
- Correction of any refractive errors with glasses or contact lenses
- Patching or other therapies to strengthen the weaker eye and improve binocular vision
- It is essential to note that the prognosis for amblyopia treatment is better when intervention occurs at a younger age, with newborns having a better prognosis when the cataract is removed and optical correction is in place by 2 months of age 1.
- In cases where amblyopia is suspected, a comprehensive eye examination by an ophthalmologist or optometrist is necessary to determine the underlying cause and develop an appropriate treatment plan.
From the Research
Amblyopia and Vision Loss
- Amblyopia is the leading cause of vision loss in children, and it is treatable if diagnosed early 2
- The American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics recommend routine vision chart testing, red reflex testing, and examination for signs of strabismus to identify affected children 2
- Amblyopia can cause a range of perceptual deficits, including loss of visual acuity, position acuity, and contrast sensitivity, particularly at high spatial frequencies 3
Treatment of Amblyopia
- Treatments for amblyopia include patching, atropine eye drops, and optical penalization of the nonamblyopic eye 2
- Patching for two hours daily can be as effective as patching for six hours daily, and daily atropine can be as effective as daily patching 2
- Children older than seven years may still benefit from patching or atropine, particularly if they have not previously received amblyopia treatment 2
- Standard amblyopia therapy can result in an improvement in visual acuity and contrast sensitivity in adults with longstanding anisometropic or combined mechanism amblyopia, even if they had prior therapy 4
Compliance and Outcomes
- Compliance with patching is challenging, and a substantial proportion of amblyopic children fail to achieve normal acuity or stereopsis even after extended periods of treatment 3
- There is a statistically significant relation between visual acuity increase and compliance in children who have been prescribed patching therapy for their amblyopic eye 5
- Active vision therapy for amblyopia shows good results, and combining patching with active therapy can lead to better outcomes than patching alone 6
Vision Therapy and Perceptual Learning
- Vision therapy with a specific protocol and 2-h patching can lead to significant improvements in visual acuity and stereoacuity in children with amblyopia 6
- Perceptual learning with a computer game designed to favour the medium-to-high spatial frequency-tuned achromatic mechanisms of parvocellular origin can also lead to improvements in visual acuity and stereoacuity 6
- The most effective treatment for amblyopia may involve a combination of patching and active vision therapy or perceptual learning 6