Amblyopia in Older Patients: Can Treatment Work?

Eyal Pat BScOptom MOrth1,2
Neryla Jolly DOBA(T) MA2
1 Sydney Orthoptic, Bondi Junction, Sydney, Australia
2 Epping Eye Surgery, Epping, Sydney, Australia

Aim: This paper aims to review the clinical outcomes of three patients with amblyopia who were treated beyond the critical period of 6 to 8 years of age.

Method: Three case studies are presented of patients with previously untreated monocular amblyopia, aged between 9 and 17 years. Guided by the active management and monitoring skill of an orthoptist, each patient undertook a combination of regular clinical visits for sensory and motor visual training, combined with home occlusion treatment.

Results: Each patient achieved improved visual acuity; the fastest and best result occurred in the oldest patient. All patients demonstrated the use of bifoveal fixation with a good level of sensory and motor fusion, with stereopsis in free space. Decompensation of orthophoria in one patient followed the occlusion treatment, however this then returned to binocular single vision following fusion training.

Conclusions: Amblyopia treatment in older children can result in improvement of visual acuity. Integral to the success of the process is the role of the orthoptist in motivating the patient to activate the amblyopic eye during the treatment procedures, including individual choice of the time and place for the use of the occlusion.