Patching for Lazy Eyes
It can be tricky with patching the eyes (in Occlusion Therapy) as it can interfere with daily activities in school (for children), at work (for adults) or at home. Although this might be recommended by your eye doctor, there are other ways to treat amblyopia (lazy eyes). For example, children and adults tends to tolerate better with therapy using Bangerter Filters than patching the eyes like a pirate. This has to be prescribed and dispensed by an optometrist.
In addition, children and adults can also attend vision therapy which utilizes orthoptic and optometric exercises to treat amblyopia and improve binocularity.
Patching the eye (or occlusion therapy) is NOT the only treatment option if you have amblyopia (lazy eyes).
While patching often really helps when you are first diagnosed with lazy eyes, vision therapy takes you further into the treatment to restore binocular vision.
At IGARD, we provide vision therapy (also known as binocular therapy) to restore binocular vision and address a wide range of functional deficits that are associated with lazy eyes. For example, lazy eyes can affect your depth perception skills, eye-focusing skills, eye-hand coordination skills and visual perceptual skills. It can also affect other aspects of daily living, such as driving in adults, reading performance, and postural stability (or balancing) in children and adults – just to name a few!
If you have only been offered patching as a treatment option, you are not alone; because patching is the standard treatment of lazy eyes for hundreds of years (and it is still the standard treatment in many hospitals and clinics throughout the world). However, vision therapy is based on the modern understanding of binocular vision and its underlying neural circuits. So, we are effectively training the brain to use the two eyes to work together as a team!
Who’s the Vision Therapy provider in Singapore?
Dr. Yap Tiong Peng is not your typical eye doctor (He is not an eye surgeon. Your child doesn’t need to worry about any nasty eye drops!). Dr. Yap is adept at providing non-surgical treatment options for vision problems for both children and adults. He focuses on “function” rather than “structure” alone, so he tends to look at vision problems from a different angle from the eye surgeon (something good, especially if you have already seen many eye doctors!)
Qualified since 1998, Dr. Yap is Fellowship-trained in U.S. and Australia and U.S. Board Certified in Vision Therapy and Children Visual Development – First person in Singapore to receive the clinical qualifications: FCOVD and FACBO, fully accredited in Behavioural Optometry (U.K., U.S.A. and Australia) and Ph.D. (Faculty of Medicine and Health, University of New South Wales, Australia). He also graduated from Imperial College London (U.K.) and the University of Manchester (U.K.).
Fun facts #1:
Do you know? From 2012 to 2022, Dr. Yap is ranked the Top 5 Experts in Singapore by Expertscape in the fields of amblyopia (lazy eyes), astigmatism, and visual evoked potentials (brainwaves). Cool, isn’t it?
Fun facts #2:
Why is long-term patching not a good idea? Why is the testing of visual acuity considered “old school”? This is a recent article that you might wish to read: https://bmjophth.bmj.com/content/7/1/e000914
Fun facts #3:
We will only offer vision therapy to you if you are ready; i.e. you must be assessed by us to be suitable for the treatment, you must tell us that you want to start vision therapy and we will have to assess that you are ready before we are able to start any treatment.
Amblyopia: Challenges and Opportunities
The Lasker/IRRF Initiative for Innovation in Vision Science – Read Here
A Systematic Review
Active Vision Therapy for Anisometropic Amblyopia in Children – Read Here
A poster presentation at the Asia Pacific Optometric Conference 2015 (Kuala Lumpur, Malaysia) by Yap Tiong Peng Senior Consultant Optometrist, IGARD Group Singapore. By analysing brainwaves (visual electrophysiology or visual evoked potentials), he found that the child with bilateral refractive amblyopia has substantially longer latencies (~350msec) compared to the control subject (~150msec). Binocular waveforms were slightly greater compared to all monocular waveforms due to the effects of binocular summation, but latencies were substantially longer in the binocular waveforms compared to monocular waveforms possibly due to binocular suppression. In summary, he found that abnormal binocular interaction is likely present at the cortical level for the child with bilateral refractive amblyopia and the cortical suppression is orientation-specific to the principle meridians of the child’s astigmatism. Cortical deficits was found in the amblyopic child even in the absence of anisometropia and strabismus.
Rate of re-occurrence and abnormal binocularity following strabismus surgery in children (Research study published in the American Journal of Ophthalmology):
Results: Of 11,115 children having strabismus procedures, 851 (7.7%) underwent reoperation. The reoperation rate was 7.4% for fixed suture surgeries, 9.6% for adjustable suture surgeries (p=0.18), and 44.9% for botulinum injections (p<0.001). Age under 2 years was associated with higher reoperation and abnormal binocularity rates (p<0.001). For horizontal strabismus, the postoperative abnormal binocularity rate was 12.8% for fixed suture surgery and 26.5% for botulinum injection (p=0.005). Reoperation rates tended to be higher with adjustable sutures (odds ratio [OR] 1.69, 95% confidence interval [CI] 0.94 to 3.03, p=0.08), or botulinum toxin injection (OR 10.36, 95% CI 5.75 to 18.66, p<0.001) and lower with 3- or 4-muscle surgery (p=0.001). Esotropia, hyperopia, and botulinum injection were independently associated with higher rates of postoperative abnormal binocularity (p<=0.005). For vertical surgeries, predictors of reoperation were adjustable suture use (OR 2.51, p=0.10) and superior oblique surgery (OR 2.36, p<0.001). http://www.ajo.com/article/S0002-9394(15)00677-7/abstract
Photo: Senior Consultant Optometrists Yap Tiong Peng and Rachel Kelly (IGARD Group Singapore) lectures on the topic Appreciating Vision and Treating Amblyopia. This is part of a series of continuing education courses in Paediatric Optometry produced by IGARD in collaboration with Singapore International Eye Cataract Retina Center.