|Year : 1983 | Volume
| Issue : 5 | Page : 568-569
A combined approach by spectacle correction occlusion and active pleoptic treatment in management of amblyopia
AP Shroff, OP Billore, AK Dubey, PR Antani
Rotary Eye Institute, Dudhia Talao, Navsari, India
A P Shroff
Rotary Eye Institute, Dudhia Talao, Navsari-396 445
Source of Support: None, Conflict of Interest: None
|How to cite this article:
Shroff A P, Billore O P, Dubey A K, Antani P R. A combined approach by spectacle correction occlusion and active pleoptic treatment in management of amblyopia. Indian J Ophthalmol 1983;31:568-9
Occlusion, inverse occlusion, occlusion with full spectacle correction, occlusion with contact lens correction, pleoptic treatment, all have been tried separately in treating amblyopia from time to time by various workers, in patients of younger age group averaging from the earliest possible time to start the treatment upto 12 years of age.
In our series, conventional occlusion, full spectacle correction and active pleoptic treatment on a coordinator, all simultaneously were tried.
| Material and Methods
We used Jamisons rubber occluder (conventional occlusion), full spectacle correction and Cupper's Coordinator. 26 patients between the age of 6 to 35 years were subjected to detailed examination including state of refraction, fundus examination, detailed orthoptic check up on synoptophore and state of fixation. Our series included orthophoric, heterophoric and microheterotropic patients, type of amblyopia mainly being anisometropic. One large angle squint was first corrected surgically and subsequently subjected to the above treatment. All patients were given active pleoptic treatment by direct foveal stimulation method, making use of Haidingers brushes. During this period they were made to wear full correction in the amblyopic eye and the sound eye was constantly occluded.
In order to evaluate the role of age factor, we devided our patients into 3 age groups.
Group A - 6-12 years
Group B - 13-18 years
Group C - above 18 years.
We recorded the results into 4 grades
Grade I Improvement of 3 or more lines on Snellen's chart over previous vision.
Grade II Improvement of minimum 2 lines on Snellens' chart over previous vision.
Grade III Improvement of less than 2 lines on Snellens' chart over previous vision or an improvement to some line from a visual acuity unrecordable on Snellens' chart before treatment.
Grade IV Cases showing no improvement, or an improvement which could not be scientifically expressed.
Following table shows Grade wise improvement in different age groups.
Group A out of 9 cases
1 case improved to Grade I
2 cases improved to Grade II and
6 cases improved to Grade III [Table - 1]
In all, 5 cases imroved to Grade I, 5 cases improved to Grade II, 11 cases improved to Grade III and 5 cases to Grade IV. It is notable that in Group C, which included patients above 18 years of age, 2 cases improved to Grade I, 2 cases to Grade II and 3 cases to grade III, irrespective of the age of the patient and the depth of amblyopia. It is more than certain that age has a definite influence on the rate, extent and the permanency of recovery, but looking at the comparable results obtained in Group C, we feel it is not a waste attempt to take trial even in case of long standing and older age.
Besides the real improvement in visual acuity, we found that by combining the 3 methods, the treatment is made easily acceptable and results readily appreciable to the patients. An amblyopic patient would generally dislike occlusion of his sound eye, as it is inconvenient and unfashionable and the rate of improvement with occlusion alone is so slow that the patient often turns impatient particularly in cases of children and abandons the treatment. However, when he is given full spectacle correction to achieve maximum visual acuity at the then level of amblyopia, he is comfortable to some extent and when he is given simultaneous pleoptic treatment which he takes both as a novelty and a challenge, the treatment becomes acceptable and interesting to them. Moreover surgeon's noting day to day progress of the patient and the rapid recovery encourages him all the more to be regular and strict towards his treatment which again is an additional help.
After stopping the treatment and discontinuing the occlusion simultaneously we followed the patients upto a period of 11 months and we found that the visual acuity achieved in the amblyopic eye at the end of the treatment remained to the same level. We feel that if a better quality of vision could be provided in the amblyopic eye at the beginning of treatment by contact lens correction, the treatment would have been more effective. This could not however be done for economic reasons.
In conclusion we will simply mention that besides the satisfactory improvement that has resulted in our series of 26 cases, our patients both the children and the adults were cooperative, agreeable and regular in their treatment. They felt an active interest was being taken in them, and their treatment was a dynamic process which as much involved the surgeon as it involved themselves. We shall emphasise that the condition of amblyopia should be actively dealt with and age should be so much of a guide line to begin the treatment, as it has been in past.
[Table - 1]