The use of Fresnel Prism as an additional treatment in a 10 year old girl with residual amblyopia

Title The use of Fresnel Prism as an additional treatment in a 10 year old girl with residual amblyopia
Author, Co-Author Alicia Feis
Topic Binocular Vision/Pediatrics
Program Number
Ballroom A-B
Midwestern University, Arizona College of Optometry

INTRODUCTION: Amblyopia effects about 3-6% of the population.  The most common cause of amblyopia results from anisometropia.1 The mainstay of treatment is spectacle correction followed by occlusion treatment.2 Unfortunately poor compliance, targeting only monocular mechanisms and poorer outcomes with increasing age often prevent full resolution of amblyopia.3,4 Interactive video games are currently being investigated as a novel way to treat amblyopia that allow binocularity.5 Preliminary results are positive, unfortunately the cost of treatment and access to this technology can be difficult for both the patient and doctor.

CASE REPORT: This case report highlights a 10 year old girl with anisometropic strabismic amblyopia that was treated conventionally with the addition of Fresnel Prism.  Spectacle treatment was initiated with little success 2 years prior. Entering aided visual acuity with her habitual prescription +4.25OD and +1.25 OS was 20/150 OD and 20/25 OS with no global stereo. Occlusion treatment with 6 hours of patching was added.  She demonstrated moderate compliance for 6 months with 20/25 OD and 20/20 OS end point acuities.  Unfortunately, regression occurred to 20/50 OD within 3 months after stopping treatment.  The patient refused patching treatment again, atropine was refused, vision therapy was not an option due to monetary reasons and current interactive computer technology was unavailable. Fresnel prisms were prescribed to decrease contrast sensitivity and blur the non-amblyopic eye to aim at a binocular approach to treat her amblyopia.  Compliance was no longer an issue and visual acuities resolved to 20/20 OD, OS and OU with an additional 6 months of treatment.  Regression of acuities after removing the Fresnel prism has yet to occur after stopping treatment 3 months prior.  

CONCLUSION: This case takes a common disease that has many proven treatment modalities and uses them in a unique way that could be utilized in a primary care setting.  

Affiliation of Co-Authors