本文講述瞭患有交替性內斜、弱視的5歲男孩，如何通過鼻側遮蓋、視覺訓練等治療方法，避免手術，並建立正常雙眼視及立體視的康復之路。

ADRIAN P.’S STORY: (AGE: 5 YEARS, ALBACETE, SPAIN)

艾德裡的故事（5歲，西班牙阿爾瓦塞特）

WHAT ADRIAN’S PARENTS SAY:

艾德裡父母的講述：

Until he was 18 months old Adrian was a normal child. He started to walk shortly after his first birthday and had adequate motor abilities. When Adrian was 18 months old, we started to notice that in some pictures, and at other times when he had to pay attention visually, his left eye was turning in. At first we thought it might be something transient, without importance, but soon realized that the eye was turning more and more frequently, especially when he began pre-school at 3 years of age.

艾德裡在18個月大之前，一直很健康。剛過1歲生日，他就能走路瞭，日常活動看起來也沒問題。18個月時，我們註意到，當他盯著某個東西看時，左眼會向內偏斜。起初，我們認為這可能隻是暫時現象，沒放在心上，但很快我們就發現，他左眼內斜越來越頻繁，尤其是3歲上幼兒園後。

Adrian’s experience at school was very difficult: Mondays he came home very happy, but when Wednesday arrived he often came home frustrated, moody, and crying. At this point we decided to see a specialist in the National Health Service who told us that his vision was poor, and that he had a lazy eye. As a first step it was recommended that we patch the good eye 2 hours per day. After that time they extended patching to 4 hours per day and gave him glasses with an over-correction.

艾德裡的幼兒園生活很不愉快。每周一回到傢時，他都很高興，但到瞭周三，他常常悶悶不樂，有時還會哭。於是，我們決定去國傢衛生中心咨詢。專傢告訴我們，艾德裡視力很差，而且患有弱視。專傢建議每天遮蓋好眼2小時，後來延長到4小時，並讓他佩戴過矯的眼鏡。

Later, when Adrian was almost five years old, we were told to patch each eye alternately three hours per day because they realized that he had begun to alternate which eye he used. During this time, and coincident with the worsening of his visual condition, Adrian’s behavior was getting worse, and his motor skills were below average. Also during this time, Adrian began to stumble, he became afraid to go down steps, afraid to catch a ball with his hands, or to kick it with his feet.

艾德裡快5歲時，因為發現他交替使用眼睛，所以開始進行雙眼交替遮蓋，每天3小時。正是在這期間，艾德裡視力出現惡化，日常活動能力也開始出問題。他走路變得不穩，害怕下樓梯，不敢用手接球，也不敢用腳去踢球。

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After several visits to the ophthalmologist and not being happy with the results, an optician referred us to behavioral optometrist, Pilar Vergara. After the first visit with Pilar, we knew what had been wrong all this time. We realized that science had evolved much more than just putting a patch over the good eye which deprived our growing child of an important sense of vision when in school and playing sports.

我們去看過很多醫生，效果都不理想。後來一個配鏡師，向我們推薦瞭皮拉爾•維加拉醫生。見到皮拉爾醫生後，我們才真正瞭解，艾德裡到底是出瞭什麼問題。皮拉爾醫生告訴我們，醫學在發展進步，遮蓋早已不是弱視治療的唯一手段，而且，對於發育中的孩子來說，遮蓋好眼，會嚴重妨礙他們的日常活動和學習。

Pilar instructed us to immediately stop patching, and instead applied binasal occluders. Amazingly, with the binasal occluders, Adrian almost immediately had straighter eyes. We thought it was a miracle, but actually it was just applying neuroscientific knowledge to clinical treatment.

皮拉爾醫生讓我們立即停止眼罩遮蓋，開始采用雙鼻側遮蓋。令人驚喜的是，雙鼻側遮蓋後，艾德裡眼位很快就變正許多。我們覺得這簡直是奇跡！可實際上，這就是大腦神經科學，在弱視治療中的臨床應用。

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Pilar also replaced his glasses with contact lenses and he underwent syntonics therapy. Over the next three months, Adrian began to straighten his eyes and his visual acuity also improved.

皮拉爾醫生用隱形眼鏡，替換瞭艾德裡原來的框架眼鏡，並開始視覺訓練。接下來3個月，艾德裡斜視減輕，視力也有提高。

As a result of his improved vision and cosmetic appearance, Adrian’s behavior also improved. He is no longer defiant or subject to violent outbursts and is more attentive and loving. When he gets angry, you can talk with him and the anger is dissipates. He has become much less shy and more daring and playful. He has developed a good ability to draw and to represent places and situations. All of these changes occured in just a few months! He is now skillful in ball games, stumbles much less, and is more secure when going down stairs.

隨著視力提升和斜視減輕，艾德裡的日常行為開始改善。他不再叛逆，亂發脾氣，而是變得專註，有愛心。如果他生氣瞭，我們可以和他談心，他的怒氣很快就沒有瞭。他也不再那麼內向，變得大膽，愛玩瞭。他學會瞭畫畫，風景畫畫得很好。所有這些變化，都發生在短短幾個月內！現在，他喜歡球類運動，也很少有走路不穩，或者下樓梯害怕的情況瞭。

Adrian will now begin vision therapy and we are sure that it will be just what he needs to enhance and embed the improvements that have taken place with the binasal occlusion and syntonics.

艾德裡目前仍在進行視覺訓練。我們相信，這能使之前的治療效果，得到更好地鞏固和提高。

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OPTOMETRIC DATA AND OPTOMETRIST’S COMMENTS:

驗光數據和醫生的講述：

Adrian was referred to my clinic by an optometric colleague. His parents were very concerned because the patching that they had done for two years had left Adrian worse, and they had been advised that surgery was the only option. They worried about the risks associated with surgery under general anesthesia.

艾德裡是轉診患者。他的父母非常擔憂，因為眼罩遮蓋兩年，艾德裡病情卻惡化瞭。而且之前的醫生告訴他們，手術是唯一選擇。但他們擔心，全身麻醉手術有風險。

Adrian’s parents told me that before patching, his eyes had turned a little, but not constantly. As the patching continued, the eyes began to turn more and more, and his character became more and more negative and emotional. He no longer wanted to go to school.

艾德裡父母告訴我，在遮蓋之前，艾德裡隻是輕度斜視，斜視也不頻繁。可遮蓋後，斜視卻變得越來越嚴重，性格也變得消極和情緒化，甚至產生瞭厭學的情緒。

During my evaluation, I found a large angle strabismus, measuring 50 prism diopters of deviation in the right eye, with suppression, amblyopia and a lack of stereoscopic vision. The visual acuity in the amblyopic eye was 20/40. A significant refractive error of 6 diopters of hyperopia (farsightedness) and 2 diopters of astigmatism in the non-amblyopic eye, and 7 diopters farsightedness and 2 diopters of astigmatism in the amblyopic eye.

檢查發現，艾德裡右眼斜視50個棱鏡度，伴有抑制和弱視，沒有立體視，視力0.5，有700度遠視加200度散光。左眼600度遠視加200度散光。

Adrian became my patient in June 2014. The Spanish edition of this book was already at the publishers, but even though his treatment had not been completed, his improvement was so important that I wanted to include his story, despite having to reorganize the layout of the book.

2014年6月，艾德裡開始治療時，這本書的西班牙語版已經交付出版社。盡管艾德裡的治療還沒有結束，但我覺得這個病例很重要，所以，即使要重新排版，我還是決定，在書裡加上艾德裡的故事。

OPTOMETRIC TREATMENT:

•New refraction

•Binasals

•Contact lenses

•Possible bifocal over the contact lenses to be worn for near work

•Syntonic phototherapy

•Optometric visual therapy

治療方案：

1）驗光復查

2）雙鼻側遮蓋

3）隱形眼鏡

4）近距學習時，在隱形眼鏡基礎上佩戴雙光鏡

5）共振色光療法

6）視覺訓練

圖39：A剛開始佩戴眼鏡 B雙鼻側遮蓋 C佩戴隱形眼鏡

It is easy to see the immediate improvement produced by the binasal occlusion, which has been maintained over time. I want to emphasize what I have previously written: the application of binasal occlusion requires an exact placement by an experienced clinician. Binasal occlusion should never be applied by parents or by inexperienced professionals because, if not applied correctly, the binasal occlusion can make the eye turn worse and hinder visual improvement.

采用雙鼻側遮蓋後，病情很快就有改善，而且沒有回退。這裡我想強調，雙鼻側遮蓋必須要由經驗豐富的臨床醫生來操作，隻有他們才能確定，雙鼻側遮蓋的具體位置。傢長或普通醫生不應進行此項操作，因為如果操作不當，很可能會加重病情，影響康復。

In addition to the binasal occlusion, I prescribed contact lenses. When Adrian has fully adapted to the contact lenses depending on his visual status I may prescribe bifocal lenses to be used for near work to give him enhanced performance when reading, writing, and using the computer. After beginning syntonics, further improvement can be seen (third photo).

除瞭雙鼻側遮蓋，我還給艾德裡配瞭隱形眼鏡。在他完全適應後，我準備配雙光鏡，以方便他近距離閱讀、書寫以及看電腦。隨著視覺訓練持續進行，艾德裡的病情，應該還會有進一步改善。

I addition to the dramatic cosmetic improvement, some degree of gross stereopsis is now present, even though Adrian still measures a small angle strabismus. We have begun an optometric vision therapy program, with the goal of teaching Adrian’s brain to use both eyes together so he can eliminate the amblyopia, restore binocularity, and develop good stereopsis.

目前，艾德裡斜視角度已大幅減小，並且建立瞭初步立體視。現在的訓練目標是，讓艾德裡大腦學會同時使用雙眼，消除弱視，建立正常雙眼視和立體視。

There is still a lot of work of Adrian, his family, and for me to do. In just three short months, there have been major positive changes in their lives, and without the many additional risks inherent with the outdated treatment of patching and surgery.

艾德裡病情的持續改善，還需要大量工作。短短三個月，他們的生活，已經發生瞭翻天覆地的變化，無需再忍受遮蓋的痛苦，也不用考慮手術的風險。

Pilar Vergara, DOO, FCOVD

Centro de Terapia Visual Skeffington.

Albacete, Spain

皮拉爾•維加拉醫生，COVD資深會員

斯凱芬頓眼視光診所

阿爾瓦塞特，西班牙

*（文章摘自: CROSSED & LAZY EYES MYTHS,MISCONCEPTIONS AND TRUTHS）