During my optometry residency last year, I had the fortune of attending Dr. Sanet’s 2-day course at the COVD Annual Meeting. Recognized as a leading expert in developmental optometry, Dr. Sanet discussed the superiority of monocular fixation in a binocular field(MFBF) over patching for the treatment of amblyopia (also know as “lazy eye”). MFBF is a vision therapy technique that teaches both eyes to work together as a team, instead of blocking the stronger eye to make the “lazy eye” catch up on its own.
My time as a student and resident at SUNY had already encouraged the use of MFBF as often as I could in the middle and end stages of vision therapy, but it had never occurred to me to use it in place of patching at the beginning as Dr. Sanet suggested. Yet the idea of promoting teamwork between the two eyes immediately made perfect sense, and I couldn’t wait to try it for myself.
Unfortunately, I had no new amblyopia patients for the remainder of my residency, and almost eight months passed before my first opportunity to try this patch-free strategy.
After discussing all the options with the eligible patient’s parent, we decided to skip the patch and give MFBF-only treatment a try. It made sense in this case to promote teamwork from the start instead of spending time strengthening the “lazy” eye alone. To everyone’s excitement, the results have been fantastic!
After 2 months of treatment purely with MFBF vision therapy activities, we were able to bring a 20/80 refractive amblyope with 5.00D of anisometropia down to 20/40. Not only has the acuity drastically improved, but we’ve also developed strong global and local stereopsis (3D vision), and the patient is continuing to improve. Through MFBF activities, we took an eye that was being figuratively crushed by its prescription and helped it work with its fellow eye for the first time in this child’s life.
Since this is just a single case from my personal experience, it’s still up for debate whether treatment with MFBF vision therapy has sped up the process as opposed to patching. Regardless, for this particular patient and parent, we were able to remove the stigma of the patch and alleviate the fear of spending multiple hours each day with sight from only one, weaker eye. Instead, we allowed the stronger eye to serve as a guide for the weaker eye and developed teamwork right from the start.
If nothing else, I have ended up with a new trick in my toolbox, an extremely grateful parent, and a kiddo who smiles at every weekly appointment when he sees the progress he’s made. A perfect win in my book.
The most rigid views
Will one day be overwhelmed
By the smallest change
Dr. Matthew Roe is an Assistant Professor at the Arizona College of Optometry (Midwestern University) where he currently teaches the Pediatric Optometry and Non-Strabismus Binocular Disorders courses. He additionally serves as a clinical preceptor in the Pediatrics, Vision Therapy, and Sports Vision clinics. He received his degree from the State University of New York College of Optometry, and is a Fellow of the American Academy of Optometry.