In 1962 Thomas S. Kuhn authored The Structure of Scientific Revolutions and, in doing so, gave birth to the concept of “paradigm shift.” Kuhn argued scientific advancement is not evolutionary, but rather “a series of peaceful interludes punctuated by intellectually violent revolutions.” Furthermore, he believed paradigm shifts do not just happen; instead they are driven by individuals – intellectual agents of change. The significance of a paradigm shift, of course, is that it fundamentally changes the way in which we think. It is a pivotal moment in which one time-honored conceptual view is replaced by another.
In health care, and in eye care in particular, we have seen our share of paradigm shifts. More than a half century ago the introduction of IOLs resulted in a paradigm shift in cataract management. More recently, anti-VEGF therapies have proved a paradigm shift in caring for wet age-related macular degeneration patients. As you would expect, these examples share a commonality with other eye science paradigm shifts; namely, they have occurred inside the eye. That is, until now.
We are in the midst of yet another paradigm shift in eye care – one involving amblyopia. What makes amblyopia so intriguing is the fact this change is taking place outside of the eye.
For what seems like forever, amblyopia treatment has been dogma. Early diagnosis is critical, full-time patching imperative and no souls are saved beyond 9 years of age. However, this all seems to be changing. For certain amblyopes, part-time patching works as well as full-time, and the actual patch can be replaced by atropine penalization. While these advances alone are significant, the real paradigm shift has occurred in our “window of opportunity.” In short, amblyopia treatment is no longer just for kids.
Conventional wisdom has always believed the human visual cortex loses its plasticity around age 9 and, therefore, any attempts to improve the amblyopic eye had to transpire at an early age. In this issue of Primary Care Optometry News, our feature article, “Amblyopia therapy options expand beyond patching for children and adults,” provides an exceptional overview of why this no longer appears to be true. The most exciting developments lie in individualized, computer-based, interactive patient therapies … especially those targeted toward adults. While still in their infancy, these technologies are already yielding promising outcomes for amblyopia as well as in collateral applications such as post-refractive surgery, multifocal IOLs and athletes.
Given the significant number of untreated adult amblyopes, it is more critical than ever that optometrists become fully engaged. It is not only a great opportunity to provide a new level of care for a previously neglected segment of the population; it is also a great way to reinvigorate our practices … until the next paradigm shift.