Session: Poster session A
Can wandering fixation be treated by hours of occlusion ?
Introduction : Parapapillary fixation is usually considered as the most challenging functional amblyopia to treat . Our approach demonstrates that it requires only hours of initial occlusion .
Methods : In our last prospective study including 72 strabismic patients with pathologic dominance , we selected 8 patients aged from 1 to 6 years ( mean : 4.6 y ) with wandering fixation . Initial occlusion was prescribed from 40 to 250 hours ( depending on the age ) , day and night relayed immediately by optical penalization of +2.50 D for distance in the dominant eye and a 3 weeks period of 1% atropine in this eye to prevent cheating .
Results : All patients centered their fixation immediately after this short period of treatment . All of them achieved a final 10/10 of vision at the age of 12y except one ( 8/10 ) . Two patients required 2 years of atropine and intermittent occlusion ( 2 hours / day ) due to persistence of fixation of the dominant eye at distance ( instinctive fixation ) . One needed a reverse penalization due to complete reverse amblyopia .
Conclusions : In the future the vast majority of successful treatment for functional amblyopia has no more to be based on long term periods of occlusion but on a relay of optical penalization for distance maintaining a useful dissociation between the two eyes until the end of sensitive period . Some cases of strong dominance need associate 2 hours occlusion for months to achieve alternate fixation .
Methods : In our last prospective study including 72 strabismic patients with pathologic dominance , we selected 8 patients aged from 1 to 6 years ( mean : 4.6 y ) with wandering fixation . Initial occlusion was prescribed from 40 to 250 hours ( depending on the age ) , day and night relayed immediately by optical penalization of +2.50 D for distance in the dominant eye and a 3 weeks period of 1% atropine in this eye to prevent cheating .
Results : All patients centered their fixation immediately after this short period of treatment . All of them achieved a final 10/10 of vision at the age of 12y except one ( 8/10 ) . Two patients required 2 years of atropine and intermittent occlusion ( 2 hours / day ) due to persistence of fixation of the dominant eye at distance ( instinctive fixation ) . One needed a reverse penalization due to complete reverse amblyopia .
Conclusions : In the future the vast majority of successful treatment for functional amblyopia has no more to be based on long term periods of occlusion but on a relay of optical penalization for distance maintaining a useful dissociation between the two eyes until the end of sensitive period . Some cases of strong dominance need associate 2 hours occlusion for months to achieve alternate fixation .