Amblyopia / Lazy Eye – No Patches, No Drops

At Wow Vision Therapy, we provide our patients with the most advanced patch-free treatment for Amblyopia (Lazy Eye) and age is not a barrier to success. If you or your child has amblyopia and you’ve been told the only treatment is an eye patch or “drops”, there is a better treatment approach that does not require patching or eye drops, is faster and has better outcomes. You can learn more about this safe and effective way to treat Amblyopia by checking out the Amblyopia Project, a VisionHelp Initiative, at amblyopiaproject.com. Wow Vision Therapy is located in St. Joseph and Grand Rapids, Michigan. For information on how to schedule an evaluation, visit our website at wowvision.net.

Advanced Amblyopia Treatment at Michigan College of Optometry

Amblyopia (Lazy Eye) affects 1 in 30 children worldwide! In this short video take a look at Clinical Professor, Dr. Dan Fortenbacher as he lectured to the students and faculty at Michigan College of Optometry (MCO) on July 26, 2013. Dr. Fortenbacher and Wow Vision Therapy resident, Dr. Edwards, presented on the pitfalls of occlusion therapy (patching) and discussed how the latest research shows increasing age is not the barrier to treatment once believed. Plus they outlined an advanced treatment model that yields faster and better results including 3-D stereo-acuity (depth perception) with excellent compliance and no patient discomfort.

MFBF treatment for amblyopia shows patching alone is not enough

Happy child 2 MFBF is a technique we use to accelerate vision development through office-based treatment of our patients with amblyopia. This latest research (October 2010), from Current Biology, shows that this MFBF(monocular fixations in a binocular field) treatment methods are evidenced based in Neuroscience. Read more in this interesting VisionHelp Blog post written by Dr. Leonard Press.

Research Support for MFBF Amblyopia Optometric Vision Therapy

The significance of this research is that occlusion therapy (eye patching) the “good eye”, when utilized as the sole treatment, does not address critical aspects of binocular vision development for patients with amblyopia.

Dr. Fortenbacher has previously blogged on this topic and explains why eye patching alone is not enough to treat amblyopia. Parents need to be aware of this advancement in amblyopia treatment which is based on solid research. If you have a child who has amblyopia and the only treatment recommended is an eye patch, consider finding a doctor who will provide office-based vision therapy and the MFBF technique. Eye patched child

Read Dr. Fortenbacher’s previous VisionHelp post here: Amblyopia treatment – Eye patching alone is no longer the standard of care

Early intervention critically important in children’s vision problems

When is it OK to “wait and see” if the problem goes away on it’s own?

What if your 6 year old child has been diagnosed with a binocular vision problem that appears to be interfering with her learning to read? You are seeing behaviors that look like she can’t concentrate on books. Her teacher is spotting some signs of trouble but can’t be sure that it is “her eyes”. You take her to an eye doctor who makes the diagnosis of a binocular vision problem called convergence insufficiency but dismisses treatment “for now” and opts for monitoring the problem. But, is it really ok to just wait and see?

As strange as it may sound, an outdated approach often recommended by many eye doctors when faced with a young patient (often 4-7 years old) diagnosed with certain forms of eye coordination problems, such as convergence insufficiency, is to simply monitor the condition and see if it goes away it’s own. In other words, no treatment is recommended.

In response to this and other vision problems in children, the University of Oregon Brain Development Lab has just produced this video on vision and the developing brain. See what the neuroscientists and the research is showing about the importance of early intervention.

Then check out the story of a mom (below) who wouldn’t accept “NO” for an answer when told that her 6 year old daughter (with convergence insufficiency) was too young to be treated.

Find out how a persistent mom dealt with this problem with her own 6 year old daughter. Read the heartwarming and inspirational story from Paige Melendres in Albuquerque, who was not comfortable with the “wait and see” recommendation by her first doctor.  Her story can be found by clicking on  CI:The Private Eye Goes Public -Part 1 and scroll down to comment #8. Her story has a happy ending and good advice for parents who may have a child who is struggling.

CI: The Private Eye Goes Public is a  VisionHelp Blog investigational series written by Dr. Leonard Press and Dr. Dan Fortenbacher dedicated to uncovering the important public health and patient care issues surrounding convergence insufficiency.

Dan L. Fortenbacher, O.D., FCOVD

Alice in Wonderland…the next wave of 3-D movies serves to help find children with Stereo Blindness

Alice in Wonderland2 Avatar 3-D has swept the world as the biggest movie of all times largely due to the new 3-D technology used in the production of this block buster film. Yes, 3-D movies have been around for a long time, but what makes Avatar unique is the combination of Polaroid and anaglyph technology in conjunction with an elaborate CG imagery and the new Fusion High Definition Camera system invented by James Cameron, writer and director of Avatar.

This new generation of high definition 3-D cinematography is paving the way for many the future of film making. We will now begin to see a new wave of films with this technology including the latest Walt Disney Pictures: Alice in Wonderland.

Last week Dr. Carl Hillier was interviewed on San Diego Living TV-6. In his segment he talks about stereo blindness and a simple test parents can do with their children with the 3-D glasses to determine if they have suppression utilizing the “vis-a-vi” technique.

This was another excellent news segment for parents and teachers to understand the importance of binocular vision and how these new 3-D movies can be not only very entertaining but also help serve to identify a child who has binocular dysfunction.

Binocular vision problems occur in nearly 15% of the population and are usually treatable. All primary care optometrists are trained to diagnose a binocular problem. If your optometrist identifies a problem with your child’s binocular vision, there is help. Office-based vision therapy is safe and proven effective treatment in the majority of cases. If your doctor identifies your child with a binocular vision problem, but does not provide office-based vision therapy, he or she should refer you to a doctor who does. To find a doctor who provides office-based vision therapy go to The College of Optometrists in Vision Development at www.covd.org  and click on the Doctor locator. Look for those doctors who are Board Certified Fellows.

Below is the San Diego Living TV-6 interview with Dr. Hillier:

For Windows Media Play users you can view the TV interview when you click here

If you are a Mac user you can view the TV interview when you click here.

Dan L. Fortenbacher, O.D., FCOVD

New England Journal of Medicine ringing endorsement of Sue Barry’s book and vision therapy

Fixing my gaze From the latest issue of the New England Journal of Medicine (7-2-09) – Book Review- provides an unqualified and ringing endorsement of Dr. Sue Barry’s book (Fixing My Gaze), and of the specially trained and imaginative optometrists who provide vision therapy, in part:

“Capitalizing probably more on latent neuronal connections than on the creation of new ones, Barry benefited from orthoptics — a hidden corner of restorative medicine. With contrived ocular exercises, specially trained and imaginative optometrists treat patients whose eyes are cosmetically aligned but imperfectly foveated.  The simplicity of the exercises and of the apparatus (such as beads on a string, papers taped to walls, and strips of film) is bracing for a profession enamored with technology.

The book’s main contribution, however, is exposing the wrong-headed dogma that acuity and binocular vision can be restored only during a critical developmental period. Surgical correction of strabismus is dominated by this notion, first posited by Claud Worth in his landmark 1903 book, Squint: Its Causes, Pathology, and Treatment, and set at a hard stop at 2 years of age by his student Francis Chavasse. The experiments of Hubel and Wiesel are often cited as confirming the lost malleability of the adult brain, but Barry points out that they did no such thing because there was no attempt at restoration of fusion. Her experiences and those she recounts from others belie the “nothing else can be done” message that ophthalmologists gave to her and to her mother throughout her childhood.

Several visual scientists have now demonstrated the reversibility of infantile loss of vision and stereopsis, but blindness to these findings and under appreciation of the solutions offered by orthoptics still persist.”

This is one more example of the growing scientific and medical support for office-based vision therapy in the treatment of binocular vision problems like strabismus.

Dan L. Fortenbacher, O.D., FCOVD

A Neuroscientist’s Personal Story in “Fixing My Gaze”

Fixing my gaze The bloggers are buzzing with praise for Dr. Susan Barry’s personal account of her experience in obtaining binocular vision and the ability to see in 3-D.

Dr. Barry has done what no one in the scientific community has done before. She beautifully writes her own story. This is a must read for all parents who have a child with vision related learning problems or strabismus (crossed eyes).

You can also hear Dr. Barry on this NPR podcast.Click here to listen to a facinating interview.

Dan L. Fortenbacher, O.D.,FCOVD

The Benefit of “Two-Eyed” Vision…The Ability to See 3-D!

Littlejoe_200 A common question asked by parents of children with strabismus (“crossed-eyes”) is, “What is my child seeing?”

My answer is, “It is not what they are seeing, it is what they are not seeing”.

What the child with a crossed eye is not seeing is 3-D or stereo vision. In other words they are missing out on a quality of vision experience that is often difficult to put into words, but, in general means the ability to see the volume of space that exists between objects in our environment.

Surgery to correct crossed eyes may offer a cosmetic solution to crossed eyes, but surgery alone does not automatically provide the patient with stereo vision. However, office-based vision therapy is an effective treatment to not only help the patient acquire straight eyes, but also develop the brain’s to gain the ability to see…3D!

Recently, Joe Palca (childhood photo above) columinist of National Public Radio, covered this in more detail with a personal perspective. Click here to read the article and even better to hear the audio story!

Dan L. Fortenbacher, O.D., FCOVD

Vision Therapy for Amblyopia…Building a house with more than just a hammer

Child_covering_eyes Lazy eye or amblyopia, is the #1 cause of preventable and reversible blindness in children. Amblyopia can be caused by a variety of eye conditions, but the most common reasons why a child develops amblyopia is due to eye teaming failure (strabismus) or significant unequal refractive error between the two eyes. In either case, the reason behind the cause of amblyopia is due to an interference with the vision from each eye reaching the brain. Since humans are not born with 20/20 acuity, good vision must gradually develop naturally during infancy and toddler-hood. However, if something gets in the way of that normal sight development, then the result can be poor vision in one eye…amblyopia.

One interesting fact is that amblyopia is a diagnosis that is universally understood among eye care professionals as a condition that responds to vision therapy. The most common form of vision therapy for amblyopia is patching or occlusion therapy. Yes, patching therapy is an example of a “passive” form of vision therapy! The rational behind using occlusion therapy is that by patching the “good eye” you “force” the amblyopic eye to begin to do the work of seeing. So, occlusion therapy is the most universally accepted form of vision therapy in the eye care community. However, patching has many limitations as a stand alone treatment.

Patching can be accomplished with using a “black patch” to occlude the “good” eye or it can be in the form of a bandage that tapes over the good eye so that the child can not peek around the eye-wear frame. Patching can also be done pharmacologically, ie with a special eye drop called Atropine that will temporarily prevent the good eye from focusing by interfering with the focusing muscle of the eye.

But, it is important to know that “stand alone” occlusion therapy can bring about other signficant problems. First it is important to understand that when you cover up one eye in a child who does not see clearly in the other eye, that alone is very disruptive to that child’s spatial orientation, motor development and coordination. To find out for your self put on someone else’s glasses that results in you experiencing blurred vision and then cover one eye and walk around your house. How does that feel? Now imagine you are a young child and just learning how to coordinate you body and learn in the classroom and now you must wear a cover on your good eye. Do you think you would be very happy?

The second problem with patching is that it reinforces the child to be a one-eyed person. In other words, occlusion therapy does not teach a patient with strabismus how to see with two eyes since it reinforces the use of only one eye.

Third, using patching therapy alone is the equivalent of having only 1 tool in a tool box to build a house.

For example, if you set out to build a house and the only tool you had in your tool box was a hammer, then you most likely would only be able to hit nails. What type of house would you be able to build with just a hammer and nails?? A house that was not very well built or functional.

The same is true in when working with a patient with amblyopia. While occlusion therapy has been prescribed by optometrists and ophthalmologists for over 100 years in the treatment and management of amblyopia, as a stand alone treatment it often leaves the patient with an incompletely developed visual system where there is a lack of “two-eyed” vision and poor or no depth perception.

While there is a place for occlusion in the treatment of amblyopia, it is a passive form of treatment and it must be judiciously prescribed and monitored. But, most importantly, the child with amblyopia represents a patient with a complex binocular vision problem that requires more than the limitations of patching the “good eye”!

Active office based vision therapy guided by the doctor and vision therapist (in conjunction with appropriate lenses, prisms and when appropriate occlusion) is the proven treatment for children with amblyopia in the 21st century. Active vision therapy builds binocular vision, depth perception and function of the visual system. This is the “glue” to maintain your child’s vision after treatment.

If your child has been diagnosed with amblyopia don’t settle for a treatment plan that involves just an eye patch, just like you would not expect the builder of your home to have only a hammer as the only tool in his tool box.

Your child’s doctor may begin with the judicious application of occlusion treatment as a starting point, for possibly a couple hours per day for a few weeks and monitor your child’s progress. It will also be important for you to ask your doctor if he or she doesn’t mention it in the beginning, who they would recommend your child to see for vision therapy to help with development of their binocular vision. It could make a difference that will affect their entire life.

Good binocular vision (with depth perception) means success for the patient recovering from amblyopia. That is what active vision therapy brings to child with amblyopia. A whole toolbox full of tools to build a complete and functional “visual home”.

Dan L. Fortenbacher, O.D.,FCOVD