Beyond patching: Stella’s vision therapy now includes MFBF

The Treat Game: Stella's baby helps find matches during vision therapy

The Treat Game: Stella's baby helps find matches during vision therapy at home

Stella’s developmental optometrist views patching as a first step in amblyopia treatment. Patching (in our case, Magic tape over the lens of the stronger eye) boosts the acuity of the weaker eye. Stella’s lazy eye is growing stronger, and vision therapy is more and more focused on training her eyes to work together for strong binocular fusion, in an effort to encourage stereoscopy, prevent or minimize regression and provide a lasting fix.

Stella’s daily patching time now feels pretty turn-key, even though (as is my nature) I do it on the fly. She does a solid hour, at least, first thing in the morning, kicked off by some video watching. Sometimes it says on and patching is done by late morning. Sometimes patching is completed in two or three chunks. I seize opportunities strategically. If she’s engrossed with a toy that demands a ton of hand-eye coordination, I’ll throw on her patch to give her amblyopic eye a workout. We’ve got patching down! Vision therapy? Or more accurately, getting 20 to 30 solid minutes of vision therapy done at home? Still a challenge. But as her weaker eye improves, the nature of  her vision therapy is changing. The latest exercises seeming to provide more improvement bang for our frustration buck. So we’re trying harder than ever.

Ever since Stella’s vision therapy progress evaluation which showed great gains, we’ve been doing a bit of what Susan Barry discusses on page 150 of Fixing My Gaze: monocular fixation in a binocular field (MFBF). This means that instead of being completely excluded via the patch, the stronger eye is merely put at a disadvantage. Her dominant eye is still able to receive and contribute visual input, allowing the eyes to work together, but the amblyopic eye is forced to do the heavy lifting. Several doctors/researchers, over several decades, have endorsed the effectiveness of this approach (Brock, Cohen and Hess for starters). Our experience with MFBF is limited but growing.

Almost every day, Stella dons a green-tinted patch over her strong eye and watches a video on our TV, the center of which is covered by a transparent red sheet. Her strong eye can’t see what’s in the red area thanks to the green tint, but it can still see what’s going on the periphery. In order to take in all the action and view the complete picture, her un-patched amblyopic eye has to pick up the slack and garner what is usually the most important part of the scene (whatever is centered, like close-ups of facial expressions, etc.). Her eyes are working together but her weaker eye has to perform at a higher level, setting the stage for binocular fusion. This work counts as patching time, so hooray for that!

"Carl's Cards" as shown on bernell.com

"Carl's Cards" as shown on bernell.com

In addition to the delight turning previously somewhat guilt-inducing TV time into a wonderful therapeutic tool, we get to play what has come to be known as “The Treat Game.” And no, it’s nothing like Candyland (until the very end). Four or five times a week, Stella puts on red/green glasses (essentially 3D glasses) and pick out ten to twelve matching pairs of cards (click here to see them at bernell.com) from a large deck. Think of it as an MFBF matching game. I spread out, all over the kitchen floor, one card from each matching pair. One by one, Stella pulls a card from the pile in my hand. She is tasked with finding its match on the floor, scanning the room to do so. The visual twist? In each pair of matching cards, one consists of a deep red background with a black shape–meaning only her red-covered eye can see the black shape, as her green-covered eye sees a completely black card with no shape. The other card from each pair consists of a white background with an orange shape–so that only her green-covered eye can see the shape, with her red-covered eye seeing a completely blank card with no shape. So in order to successfully match, Stella has to use both eyes equally. She can now handle a dozen matches without much trouble. It’s a bit taxing to wear these glasses and her two-year-old attention span doesn’t help, so I usually provide a small but very compelling treat as incentive for her persistence in finding all the matches. Hence “The Treat Game.” Much celebration ensues upon her 12th match. And two very small pieces of chocolate do the trick.

I feel a bit guilty. Stella and I have been travelling and I slacked on her vision therapy regimen–with permission, though we should’ve stepped it up sooner. But, I’m eager to kick vision therapy back into high gear at home, with some help that I am procuring (more on that in a future post). It’s definitely not easy, and we don’t always meet our daily goals. But Stella continues to progress, and as the type of exercises we do evolves, our commitment and excitement grows. Well, mine does anyway, especially in relation to another very fascinating and effective form of vision therapy that we’re doing, which I’ll share soon, once we gain a bit more experience and understanding.

With all this in mind, I keep our snack cabinet stocked with chocolate. No, not for Stella. For me! Sometimes a pick-me-up is in order, don’t you think?

(I blog about our journey at lifeandtimesofstella.com.)

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4 responses to “Beyond patching: Stella’s vision therapy now includes MFBF

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  4. Where did you find these glasses and cards? I am very interested, but live in a rural area with no access to vision therapy and specialists who are extremely resistant to vision therapy (I really have no idea why!), so it’s going to be DIY over here, I think. I figure benign stuff like the card game can only serve to increase the likelihood of stereoscopic vision. My son has already had one failed surgery and has esotropia with no ambylopia– YET. I feel like time is of the essence, as he is still cross-fixating. I will definitely try to find that book, too. Can you direct me to any other online resources? I would be most grateful.

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