马塞拉的故事 // 5岁，美国孟斐斯
WHAT MARCELA’S PARENTS SAY:
马塞拉的父母的讲述：
We first noticed Marcela’s strabismus in her left eye at 9 months of age. We were referred to a local ophthalmologist who recommended that Marcela undergo surgery to straighten her eye. The surgery was performed when she was 15 months old and was followed by a patching therapy using a “blackout” patch; an adhesive pirate patch that would stick to her face, covering her right eye.
马塞拉在9个月大时，我们第一次注意到,她左眼斜视。当地眼科医生建议，通过手术让马塞拉眼位变正。马塞拉在15个月大时，进行了斜视手术，术后开始眼罩遮盖，一个像海盗一样的眼罩，紧紧贴在马塞拉脸上，罩住了她的整个右眼。
The blackout patch was uncomfortable for Marcela. It caused the nystagmus (involuntary oscillatory eye movements) in her left eye to become more pronounced, making it difficult for her to see. She would rip off the patch to keep from having the nystagmus. In an effort to continue with the therapy, the doctor recommended we use arm braces to prevent Marcela from reaching her face and pulling off the patch.
对马塞拉来说，这个眼罩很不舒服，导致她左眼眼球震颤（不由自主的摆动眼球）变得更加明显，使她很难看清楚。为了避免眼球震颤，马塞拉经常把眼罩拿掉。为使治疗能继续，医生建议我们使用手臂支架，让马塞拉的手碰不到脸，防止她拿掉眼罩。
During each patching session, Marcela would scream and cry, obviously uncomfortable and unable to see. After countless tries, and a lot of stress on our daughter, we gave up on the blackout patching therapy and never went back to that doctor.
每次遮盖期间，马塞拉都会尖叫、大哭，显然，她很不舒服，也无法看清楚。无数次尝试，给女儿带来了巨大折磨，最终，我们放弃了眼罩遮盖，再也没有回去找那个医生。
Though Marcela’s eyes were straight and the nystagmus was not bothersome (unless her right eye was occluded), we did notice something strange about her behavior. When watching television or looking at the computer, Marcela would turn her head almost 90 degrees to the right to keep both eyes focused on the screen. She would sit like this for extended periods of time, never straightening her head toward the screen.
虽然马塞拉眼位正常，而且，眼球震颤也不算严重(除非遮住她的右眼)，但我们还是注意到，马塞拉的一些奇怪举动。看电视或看电脑时，马塞拉会头部右转将近90度，以便双眼都能盯着屏幕，她会这样坐很长时间，从不把头正对屏幕。
We came to understand that even though Marcela’s eyes had been straightened, the focal point in her left eye had not changed. Marcela’s brain was still using that “off-centered” focal point to focus on 2D objects. This is when we decided to look for a doctor or program that could assess her vision for any additional abnormalities and help correct this behavior.
我们开始明白，虽然马塞拉眼位已经变正，但她左眼注视点并没有改变。马塞拉的大脑，还在使用“偏心”注视点，来看平面物体。就在这时，我们决定去找医生，检查马塞拉是否有视功能异常，并帮助她纠正这种行为。
Around Marcela’s second birthday, we learned about the optometric vision therapy program at the Southern College of Optometry. After an initial assessment, Marcela was accepted into the program with a goal of improving the vision in her left eye and addressing this head-turning behavior. At the initial evaluation, the distance acuity was measured at 20/100 in the left eye. It was determined that Marcela did not have any binocularity due to suppression of the left eye.
马塞拉快过第二个生日时，我们了解到，南方眼视光医学院有视觉训练项目。初步检查后，马塞拉开始接受治疗，目标是改善左眼视力，解决转头问题。治疗前，马塞拉左眼看远视力0.2，存在抑制，没有双眼视功能。
The therapy began with translucent occlusion patching. A lens which blurred her right eye’s view was placed in a pair of glasses (no other prescription), to encourage Marcela to use and improve the vision in her amblyopic left eye. With this patch, she would perform tasks such as popping bubbles, rolling and kicking balls, and interactive activities on the iPad. Marcela really enjoyed the games because it didn’t seem like homework at all!
治疗从半透明遮盖开始，通过半透明薄膜，降低右眼视力，鼓励马塞拉使用左眼，来提高弱视眼视力。使用这种遮盖，马塞拉可以戳泡泡、滚球和踢球等，还可以玩iPad上的互动游戏。马塞拉很喜欢这些游戏，因为它们看起来，一点都不像训练！
Three years later, Marcela is still working with therapists in the optometric vision therapy program. Her visual acuity has improved a lot, and she does not turn her head as much when watching the television or looking at the computer. Even though she is still slightly suppressing her left eye, she’s now showing signs of depth perception! We definitely see an improvement in her progress and are amazed at how well she’s doing.
三年后，马塞拉的视觉训练仍在继续，她视力有很大提高，看电视或电脑时，头部转动也少多了。尽管马塞拉左眼仍有轻微抑制，但她现在已经有了深度视觉！
我们真真切切地看到了进步，对治疗结果非常开心。
TREATMENT:
• Bangerter filter
• Eye hand coordination procedures while wearing the Bangerter patch
• Optometric vision therapy
治疗方案
1） Bangerter压抑膜
2） 手眼协调训练（佩戴Bangerter压抑膜时）
3） 视觉训练
Marcella began treatment with a translucent Bangarter filter. This allowed the experience of the patching while allowing for peripheral vision in the patched eye. Patching was advised for two hours per day.
马塞拉的治疗，从使用Bangerter压抑膜开始。压抑膜不影响好眼周边视力，每天遮盖两小时。
At the age of three, we started Marcela in a program of optometric vision therapy. Prior to the therapy, the acuity was measured at 20/30 and 20/80 at distance 20/100 and 20/400 at near, in the right and left eyes, respectively. A VEP was performed which showed only slight delays in the left eye with the presence of summation at lower spatial frequencies.
马塞拉三岁时，开始视觉训练。训练前，她右眼看远视力0.6，左眼0.25，右眼看近视力0.2，左眼0.05。视觉诱发电位显示，在较低空间频率上，左眼有轻度延时。
At the conclusion of Marcella’s therapy program, I am happy to report that the visual acuity now measures at 20/25 and 20/40 at distance and 20/25 and 20/100 at near, in the right and left eyes, respectively.
在马塞拉阶段治疗评估时，我很高兴地告诉她，现在右眼看远视力0.8，左眼0.5，右眼看近视力0.8，左眼0.2。
I am happy with the progress that Marcela has made so far and I look forward to seeing her complete her therapy over the next few years. Her course of therapy will continue, but we are giving breaks to allow Marcela to mature so she better understands the activities. I am confident that the passive approach of patching would not have allowed the visual acuity gains or improved posture to be made in Marcela’s case.
我对马塞拉取得的进步非常满意，期待接下来一两年，她能完成全部治疗。训练仍在继续，但会给马塞拉更多休息时间，好让她理解这些训练步骤。我相信，在马塞拉的案例中，单纯被动遮盖，无法取得这些成果。
Marc B. Taub, OD, MS, FAAO, FCOVD, FNAP
马克•托布医生，FAAO，COVD资深会员
Southern College of Optometry
主任，视觉康复中心
Chief, Vision Therapy and Rehabilitation
南方眼视光医学院，美国
（文章摘自: CROSSED & LAZY EYES MYTHS,MISCONCEPTIONS AND TRUTHS）