I just diagnosed a dense cataract OD on a 3yr 8month old boy. He/family had no prior exam or knowledge of the cataract. He had no meausrable VA or ability to "count fingers". His fixation and tracking with OD alone was extremely low. He had a variable exotropic posture. He has high myopia OD -11.50 while OD was +3.00 which did not improve acuity. Retinal health appeared ok for what could be viewed. He was seen by a pediatric OMD who advised surgery with implant followed by 10 hours of patching daily for an undetermined amount of time. Since the surgeon is out of the area all treatment of the amblyopia would be left to me with periodic visits to him. I called him to discuss the plan, informing him I was concerned with his recommended patching protocol and that I would reduce the patching in favor of supplementing with vision therapy. I asked him if he was familiar with VT as an option. He stated he was not opposed to the vision therapy as long as the patching was 8-10 hours. I am unsure that I want to continue care on the case as I am not in agreement with the treatment plan.
Question: 1. Who has treated a deprivation amblyopia case like this and what can I expect a VT program to do for him. I informed mother that the ability to achieve localization, movement detection, visual motor etc would be a benefit but did not want to promise more than that.
2.. How do you handle a surgeon like this? He seemed unconcerned when I expressed my concern on such an agressive patching protocol and the likelyhood that it would interfere with development in many other ways..... I have another case where after 2 years of patching the good eye and poor results in the aphakic eye... now we have very poor visual development, poor processing and visual motor etc.. We bagged the aphakic eye to do VT on the sighted eye to get some improvement in visual skill and processing.
3. If we do decide to proceed with surgery and VT-- what advice to you have in treating a case like this. Child coop is rather low at this age.
Thanks for any help!