Treatment Protocols

Whether you are a primary eyecare professional, or a doctor providing advanced developmental vision and rehabilitation, you can find treatment protocols here that you can begin implementing in your practice.

Primary Eyecare Professionals


Advanced Amblyopia Model for Primary Care Optometrists
  • Begin with judicious prescription of lenses as needed
  • 2-4 week adjustment to lenses instead of 2-3 month adjustment
  • Return to office -progress eval. (92012) and sensory motor exam (92060):
  • Establish baseline VA, distance and near
  • Measure suppression with Worth 4-Dot, distance and near
  • Measure stereo acuity
  • Begin Binocular treatment immediately after adaptation to Rx
  • Anaglyph (TV-Trainer) MFBF (unilateral red filter on fellow eye, green filter on TV) video gaming
  • 1 hour per day 6 days per week (and/or)
Advanced Amblyopia home computer programs treatment programs in dichoptic mode (and/or)
  • Dichoptic iPad-type games (and/or) 1 hour per day 6 days per week
  • 3D pictures and movies as much as possible
  • Monitor q 4 weeks x 3 months with a progress eval. (92012) and sensory motor exam (92060)
  • Repeat refraction as needed. Target: VA >20/25, no suppression, RD Stereo acuity 20”
For those with remaining Amblyopia
  • Refer for Office-Based Optometric Vision Therapy that includes the following:
  • Intensive concentrated binocular vision development
  • Visual acuity development in a binocular field
  • Targeted visual information processing development
  • Oculomotor development
  • Visual-motor integration development

For those doctors providing advanced developmental vision and rehabilitation


TREATMENT PHASE 1

Anti-suppression, early binocular vision development

  • Monocular fixation in a binocular field (MFBF) with VMI on Sanet Vision Integrator (SVI) or Wayne Saccadic Fixator (WSF) or with younger children use creative game applications of filters – plus detail recognition
  •  Anti-suppression with dichoptic activities, ex: red/green video games
  • Aggressive large peripheral stereopsis stimulation in video gaming mode at every session, eg. VTS-4, Vivid Vision, minimum 15-30 minutes/ session
TREATMENT PHASE 2

Routine general skill development

  • Accommodative stimulation (mono, bi-ocular, binocular) – plus detail
  • Binocular ranges of fusion
  • Integration and flexibility with binocular and accommodation (BIM/BOP)
  • Oculomotor development
  • Begin visual information processing (VIP) development
TREATMENT PHASE 3 Advanced Visual Information Processing (VIP) development in Amblyopic eye vs fellow eye…equate
  • Advanced visual information processing in all VIP areas -monocular (using Bangerter foil, diffuser on fellow eye) – plus detail recognition
  • Visual Closure, Visual Spatial, Visual Figure Ground, Tachistoscopic, – plus detail recognition
  • Visual Motor Integration (VMI) – plus detail recognition
Monitoring weekly progress:
  • Visual Acuity: Snellen (single row, single letter/picture)
  • Suppression Zone: Worth 4 Dot – distance and near
  • Ranges of fusion in VT activity eg: Dog/Ring (VTS-4), Quoit Ring (vecto)
  •  Stereopsis- distance and near Wirt, and near RDS
Monitor Monthly (q 8-10 visits)
  • Visual Acuity – Snellen (SR, SL) distance & near CSF at near in Amblyopic eye
  • Dry Refraction with BVA Standard Binocular Evaluation: von Graefe phoria
  • Ranges of fusion- distance and near, suppression check, stereopsis: distance and near
  • Accommodation: PRA, NRA, +/- 2.00 with acuity suppression (Vecto #9)
  • KD Amblyopic eye vs non-Amblyopic eye
  • All relevant VIP testing (Amblyopic eye vs non-amblyopic eye)
Home: Minimum 5 hours per week (monitor dosing carefully)
  • Home Amblyopia.iNet
  • Home iPad Amblyopia
  • Tetris Blocks
  • Home 3D
  • Minecraft or something similar if available
  • Home 3D movies
  • PTS-2 – (Phase 3)
  • Monitor home dosing of MFBF and time on dichoptic video games
  • Use a diffuser (Bangerter foil) only for occlusion (monocular activities)

Prevention


Learn more about the prevention of Amblyopia with the InfantSee program.

infantsee.org