When only a patch is used to cover the good eye, it is like putting the brothers in separate rooms. When we do this, the acuity of the amblyopic eye often improves, but then after the patch is removed the visual acuity in the amblyopic eye goes back to its lower level. Why? Because the bully brother never learned to cooperate with his less assertive brother so he again reverts back to his old ways and prevents the less assertive brother from speaking.
In the program of optometric vision therapy when the eye is patched, we do monocular exercises to make the less assertive eye more like Rambo. Then,when the eyes are put together, it is more likely that the bully will accept him. Once this occurs we teach them to work effectively together, like brothers should, in their communication with mom. We make each of the eyes work well separately, and most importantly, we teach them to work together! This takes time and training, but if done well, the results will last for a lifetime. It makes perfect sense, doesn’t it?
A scientific study by Drs. Firzgerald and Krumholtz at the State University of New York, State College of Optometry illustrates this point. They studied how well visual acuity gains from treatment were maitained 1-2 years after the treatment was concluded. What they found was quite dramatic. In patients who received optical correction (glasses) only, 50% lost some or all of their visual acuity improvement. In the group that received optical correction, occlusion, and optometric vision therapy, 100% maintained their visual acuity improvement!
They concluded, “ Maintenance of visual acuity gains were best if vision training is an integral part of the treatment plan and there was a strong relationship between improvements in stereopsis (good binocular vision) and the maintenance of visual acuity gains over time.”
To summarize, the problem in amblyopia is not the eye, but the inability of the two eyes to co-exist together. This is why we say amblyopia is a problem of binocular competition. This is not a concept; it has been known for some time. Dr. Kenneth. J. Ciuffreda in his book, Amblyopia: Basic and Clinical Aspects, wrote about binocular competition being the major contributor to amblyopia more than 20 years ago!
总之，弱视不是眼睛的问题，而是两只眼睛不能同时使用。所有，我们说弱视是双眼竞争的问题。这不是新的概念，早在20多年前，《弱视：基础和临床应用》这本书里，Kenneth. J. Ciuffreda博士就写过，双眼竞争是引起弱视的主要原因。
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