Amblyopia Library

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.

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
    • 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
    • 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 Vivid Vision VR
  • Detailed, action oriented monocular (amblyopic eye) video game play
  • Home 3D movies
  • PTS-2
  • Monitor home dosing of MFBF and time on dichoptic video games
  • Use graded occlusion (Bangerter foil) for monocular activities when possible

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