domingo, 12 de junio de 2011

ARGUMENTACIÓN DE LA EVIDENCIA Y VALIDEZ CIENTÍFICA DE LA TERAPIA VISUAL


Este post se encuentra dedicado a disipar algunas dudas e incredulidades acerca de la evidencia científica que existe publicada sobre la validez en el funcionamiento de la Terapia Visual.
Tras la búsqueda de estudios publicados al respecto, el resultado del “review” es el siguiente (adjunto conclusiones de los estudios encontrados):

CONCLUSIONS REVIEW :
Optometric VT was highly successful in both patients with childhood intermittent exotropia of the basic type. Most importantly, optometric VT eliminated the patients’ symptoms of asthenopia and diplopia without the need for surgery, and Basic exotropia accounts for approximately 50% of all intermittent exotropias.
[1] Angela Peddle O.D.ª, Esther Han O.D.a et al: Vision therapy for basic exotropia in adults: 2 case studies, Optometry - Journal of the American Optometric Association, In Press, Corrected Proof, Available online 22 April 2011.

Further results of the study are presented and the implications of these result with regard to the treatment of divergence excess are briefly discussed.
[2] Kent M. Daum: Divergence excess: Characteristics and results of treatment with orthoptics, Ophthalmic and Physiological Optics, Vol 4, p. 15–24, Enero 1984.


These data support the validity of vergence training and increase the plausibility of previous clinical reports of orthoptics success.
[3] Grisham JD, Bowman MC, Owyang LA, et al: Vergence orthoptics: validity and persistence of the training effect, Optometry and vision science, Vol 68(6), p.441-51, Junio 1991.

Orthoptics acts to change the time constant and magnitude of vergence adaptation to BO prisms, which leads to a concomitant reduction of CA over a similar time course. This process appears to underlie the increase in positive fusion limits. `
[4] Thiagarajan P, Lakshminarayanan V, et al: Effect of vergence adaptation and positive fusional vergence training on oculomotor parameters, Optometry and vision science, Vol 87(7), p. 487-93, Julio 2010.

Surgery with preoperative orthoptic/occlusion therapy had the highest success rates. Surgery with orthoptic/occlusion therapy was more effective in reducing exodeviation.
[5] Edwin C Figueira MS, Stephen Hing FRANZCO, Intermittent exotropia: comparison of treatments, Clinical & Experimental Ophthalmology, Vol 34, p. 245–251. Abril 2006.

Nearly all patients in the current clinic sample exhibited either complete or marked reduction in their oculomotor-based symptoms and improvement in related clinical signs, with maintenance of the symptom reduction and sign improvements at the 2- to 3-month follow-up. These findings show the efficacy of optometric vision therapy for a range of oculomotor abnormalities in the primarily adult, mild brain-injured population.
[6] Kenneth J. Ciuffreda, O.D., Ph.D. Daniella Rutner, et al: Vision therapy for oculomotor dysfunctions in acquired brain injury: A retrospective analysis, Optometry - Journal of the American Optometric Association, Vol 79, P.18-22, Enero 2008.


Científicos del Deparment of vision State College of Optometry, University of New York han demostrado la eficacia y dan bases científicas de la Terapia Visual optométrica en trastornos no estrábicos, acomodativos y vergenciales: Los hallazgos encontrados claramente apoyan la validez de la terapia visual. Además, los resultados son coherentes con los principios generales del aprendizaje motor.
[7] Kenneth J. Ciuffreda, O.D., Ph.D: The scientific basis for and efficacy of optometric vision therapy in nonstrabismic accommodative and vergence disorders, Optometry - Journal of the American Optometric Association, Vol 73(12), p.735-62, 2002.

Convergence peak velocity was significantly slower in CI subjects compared with controls, which may result in asthenopic complaints reported by the CI subjects. Vision therapy was associated with and may have evoked clinical and cortical activity changes.




[8]Alvarez, Tara L.*; Vicci, Vincent R.† et al: Vision Therappy in Adults with Convergence Insufficiency: Clinical and Functional Magnetic Resonance Imaging Measures, Optometry & Vision Science,Vol 87, pp E985-E1002, Diciembre 2010.


LINKS DONDE PODEIS ENCONTRAR LOS ANTERIORES ESTUDIOS Y ABSTRACS:
















http://onlinelibrary.wiley.com/doi/10.1111/j.1442-9071.2006.01199.x/abstract

http://www.optometryjaoa.com/article/S1529-1839%2807%2900605-7/abstract


Para concluir con este “refreshing”, decir que todavía, y a pesar de todas estas evidencias es necesario seguir haciendo estudios exhaustivos sobre el funcionamiento de la Terapia Visual. Hay mucho aún por investigar y por demostrar no sólo del éxito de la TV en Insuficiencias de convergencia, Trastornos no estrábicos o acomodativos donde ya se han dado evidencias científicas; sino en el tratamiento de ambliopías, supresiones, fijaciones excéntricas, correspondencias retinianas anómalas en estrabismos, así como en terapias pre y post-quirúrgicas tanto en cirugías refractivas, de cristalino, o de reinserciones musculares con trastornos o disfunciones binoculares, donde aún queda mucho por validar.


Escrito por el Instituto de Oftalmología Avanzada
Esther López Artero
Dpto. Terapia visual.

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