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Alaska Blind Child Discovery

A cooperative, charitable research project to vision screen every preschool Alaskan

Consistent Optical Therapy for Amblyopia

  Rochester Optical contracts with Alaska Medicaid to supply cost-efficient spectacles for children (5/06).

I trained in ophthalmology at the Mayo Clinic in Rochester Minnesota. Rochester Optical is even farther away than that. As such, they can provide optional optical devices for Alaska citizens who might benefit from them for academic reasons. But I have serious concerns regarding their ability to provide of Alaskans who are under therapy for amblyopia.
Recall that amblyopia is deficient (and potentially permanent) learning of brain vision. An extremely important component of amblyopia therapy is providing clear images that are binocularly aligned. Two thirds of amblyopic patients have a substantial refractive component, either anisometropia, high hyperopia, high astigmatism, or occasionally severe myopic (staphyloma) or hyperopic (aphakic) anisometropia.
Refractive correction is often combined with patching or penalization therapy for the remediation of amblyopia. But there are many cases of amblyopia, if detected early enough, that can be successfully treated with early, and consistent refractive correction alone.
Imagine the follow scenario: a young diabetic child is sent to his home village with one fragile glass vial of insulin. Within a week, you get a report that the insulin vial just broke. Following your honorable cost-containment guidelines, you order insulin from Rochester New York to be efficiently and promptly delivered to the patient. By the mail. Surface.
The same thing happens with Medicaid and Denali KidCare refractive correction for amblyopia: spectacles take about 4-8 weeks to arrive, and when they break, kids go without the medically necessary benefit of optical clarity and accommodative relaxation for an additional 2 months. During this time, their initial mild-moderate refractive amblyopia (368.03, 369.76) morphs to a severe mixed form of amblyopia (368.01, 368.03, 369.72). Recovery from the more severe form of amblyopia takes much more intense therapy including compliant patching. It is often difficult to achieve compliant patching in rural or urban Alaska.
For two important reasons, I recommend a modification in the way optical correction is dispensed to children with amblyopia, and I offer a cost-effective paradigm:
1. Alaskan eye doctors who specialize in delivering Gold Standard Confirmatory Exams and delivering state-of-the art amblyopia therapy should have the freedom to prescribe rapid, sturdy optical amblyopia rehabilitative aids (spectacles or contact lenses).
2. The diagnoses for which these aids can be prescribed would be: refractive amblyopia (368.03), strabismic amblyopia (368.01), deprivational amblyopia (368.02), severe myopia (360.21) and aphakia (379.31).
3. Optical rehabilitation aids should apply only to Medicaid recipients aged 0 to 11 years.
4. Medicaid recipients will have at least one back-up pair or set of optical aids. This means the initial prescription should be filled with two sets.
5. At least one of the initial spectacles should have sturdy, widely-fitting frames (i.e Bambino™ flexible nylon frames).
6. Broken or lost optical rehabilitative aids should be rapidly replaced.
7. The eye doctor who prescribes the optical rehabilitative aids should not be financially rewarded by the dispensing optical business.
The most important reason to adopt this policy is to alleviate the future disability of residual amblyopia in Alaskans. It is the right thing to do. Robert W. Arnold MD

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WAMI medical student Dustin Lang places sturdy nylon spectacles on pediatric patient in rural Alaska
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Spectacles either sufficient, or a major component of most amblyopia therapy!


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