WHEN THE AMBLYOPIC EYE BECOMES THE BETTER EYE - LOW VISION REHABILITATION IN A CASE OF MACULAR HOLE

Title WHEN THE AMBLYOPIC EYE BECOMES THE BETTER EYE - LOW VISION REHABILITATION IN A CASE OF MACULAR HOLE
Author, Co-Author Nicole Hooper, Stanley Woo, Kara Hanson
Topic
Year
2005
Day
Program Number
055165
Room
Affiliation
University of Houston, College of Optometry
Abstract BACKGROUND: Amblyopia is a leading cause of monocular vision loss in adults. However, the presence of amblyopia does not exclude opportunistic eye disease such as macular hole and retinal detachment. We present a case of a recurrent macular hole in the sound eye, necessitating low vision rehabilitation (LVR) successfully using the contralateral amblopyic eye.

CASE REPORT(S): HS, a 71 year-old Caucasian male, presented for LVR with a history of long-standing, untreated, refractive amblyopia with a mild cataract OD, and a recurrent macular hole with repaired retinal detachment and pseudophakia OS. His primary visual goals were to see theater, opera and movies, along with improving his outdoor vision. A trial frame refraction indicated best corrected acuity of +9.00-1.00x130, 10/80-, OD; -0.50-1.00x165, 10/100-, OS. He reported symptoms of aniseikonia with initial correction, but adapted well and could attend to the image of interest with either eye. Acuity OD improved to 10/60- over the course of treatment. A 4x20 Beecher monocular allowed him to see 20/25 OD. The addition of a +8.00 eye piece allowed maximum range of focusing without needing spectacle correction. With additional training, he was able to use his uncorrected left eye for localization, and attend to detail with his amblyopic right eye through the device, analogous to a monovision concept. The referring ophthalmologist continues to monitor and manage his ocular health.

CONCLUSIONS: LVR can maximize quality of life and independence in the treatment of ocular disease. Amblyopia is not a contraindication for LVR, and may in fact provide superior performance. As in this case, a monovision-like setup provided a good prognosis for success with distance tasks. Though plasticity of the visual system is not expected at this advanced age, it is interesting to note the improvement in visual acuity with full correction. It will also be interesting to see if visual performance improves further with increased use of the amblyopic eye.
Affiliation of Co-Authors University of Houston, College of Optometry, University of Houston, College of Optometry
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