Amblyopia with Eccentric Fixation: Is Inverse Occlusion Still an Option?
Daisy J. Godts, CO
Antwerp University Hospital
Introduction: To present our treatment protocol for patients with amblyopia and eccentric fixation who do not respond to conventional occlusion therapy.
Methods: In this consecutive case series, 11 patients were included, age 3.5 to 5, with mixed amblyopia and eccentric fixation, who had minor improvement of visual acuity (VA) despite good compliance after 6 hours to full-time occlusion of the dominant eye (VA ranged from 20/800 to 20/63). Total inverse occlusion of the amblyopic eye was done for 4 to 8 weeks to convert steady eccentric fixation into wandering fixation. No binocular viewing was allowed. Once the fixation became wandering, the dominant eye was occluded day and night and in most patients a red filter was placed before the amblyopic eye to stimulate foveal fixation.
Results: In nine children the fixation became central and VA improved to at least 20/32 in the amblyopic eye, the VA of the dominant eye did not change.
Discussion: In our case series inverse occlusion was used to eliminate the eccentric fixation point in amblyopic children where conventional occlusion failed to restore central fixation. Our goal of inverse occlusion was not to improve vision but only to eliminate the eccentric fixation point.
Conclusion: Inverse occlusion followed by conventional occlusion is still a valuable option to improve vision in amblyopic eyes with eccentric fixation. Placing a red filter before the amblyopic eye may be helpful to stimulate foveal fixation.
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Cowle JB, Kunst JH, Philpotts AM: Trial with red filter in the treatment of eccentric fixation. Brit. J. Ophthal. 1967; 51: 165-168.