Charlie Brown, amblyopia, and me: A (not so short) personal history of the past forty years of diagnosing and treating amblyopia.

INTRODUCTION

During the past forty-plus years there have been many advances in our understanding of amblyopia. It has been my privilege to be able to have a close relationship with many of the people that made these contributions. It is the purpose of this paper to trace these changes as they developed from 1965 to the present.

AMBLYOPIA THROUGH THE DECADES

1950s and 1960s: Beginning with the introduction of electrodes that could record from a single cell in the mammalian visual cortex, researchers began to map out the normal physiology of the visual cortex, the lateral geniculate bodies and the retinal ganglion cells. Amblyopia, especially stimulus deprivation amblyopia, became a focus of many of these studies. As more and more information became available, clinicians began to understand the problems that they had been facing in such cases as congenital cataracts, unilateral congenital corneal opacities, etc. This led to a significant change in our approach to such cases with emphasis on earlier and earlier intervention to achieve better visual results. 1970S and 1980S: Scientific studies of patients using techniques such as Contrast Sensitivity Function, Teller Acuity Cards, and Neutral Density filters allowed us to begin to look at development of vision in infants, to characterize the differences between the various types of amblyopia and to better understand the need for amblyopia treatment. At about the same time, interest in vision screening in children allowed us to detect amblyopia at an earlier time of life, which then gave us a better chance of successful treatment. 1990S and the 21ST century: Arenewed interest in developing evidence-based results in keeping with the rest of the scientific medical community led to large multicenter trials looking at different modes of amblyopia treatment with the result of a wider armamentarium available to the practitioner.

CONCLUSION

While there have been many improvements in our knowledge of the etiology of amblyopia and its treatment, we still find that it is the practitioner, the orthoptist, the patient's family, and the child that make the final difference in success or failure. However, our ability to explain what and why we are doing has made this job easier and given us the tools we need to feel confident in our approach to this still common condition.