when focusing on a particular bead, the bead farther from the patient should appear as two. Suppression can be checked with this exercise by making sure the patient sees two strings meeting at each bead; if the patient is suppressing an eye, he or she will report only one string at the bead. Endurance may also be improved, as this exercise is quite tiring after only a few minutes. The reason Brock string is my favorite vision therapy exercise is because it is easy to explain to the patient and it gives immediate feedback on whether the patient is using both eyes when focusing both near and far. In the end, vision therapy is what you make of it. It’s hard work for the patients (and the doctors), but it’s also a time of fun and reward in most cases. Vision therapy provides a chance at improving your patient’s quality of life, one Brock string at a time! Madhurima Kota, OD Amblyopia, often referred to as lazy eye, and strabismus, commonly known as crossed eyes, are two prevalent ocular disorders that have posed challenges in patients of all ages. These conditions typically manifest during childhood, potentially leading to lifelong visual impairment if not diagnosed and treated early. Traditional treatment options have included patching, corrective lenses, surgery, and vision therapy. However, with recent advancements in artificial intelligence (AI), there are new effective interventions revolutionizing how these conditions are diagnosed, treated, and managed. Amblyopia occurs when vision in one eye does not develop properly, resulting in the brain favoring the other eye for functional vision. While amblyopia is considered a diagnosis of exclusion, some of the more common causes that can lead to it include strabismus, refractive errors, or visual deprivation. Current treatment methods of amblyopia include patching the stronger eye, vision therapy, atropine drops, and dichoptic visual training with virtual reality headsets. Although there are options, it is important to note that these approaches face limitations. Compliance with treatments like patching is poor, and outcomes are variable depending on the age of diagnosis and the severity of the condition. Strabismus, which can be congenital or acquired, is a condition where the eyes are misaligned, leading to double vision and/or poor depth perception. It can also lead to amblyopia if left untreated. While surgery is a common approach to correcting the alignment of the eyes, it doesn’t address the neurological aspects of the disorder, such as the brain's ability to fuse the two images received from both eyes. In both cases, early intervention is critical for achieving the best possible outcome. Unfortunately, if diagnosis happens too late, the treatment may not yield optimal results for the patient. Artificial intelligence has the potential to transform the treatment and management of amblyopia and strabismus through early detection, leading to a more accurate diagnosis. Optometrists can use AI to aid in and provide advanced metrics on eye movement tracking, an analysis of retinal scans and photographs, and videos to catch subtle signs of these conditions before diagnostic symptoms become noticeable through routine eye exams. For example, AI can assess ocular alignment and movement to detect early indications of strabismus, while independent eyetracking devices can monitor visual performance to spot amblyopia. As there are already approved eye tracking devices on the market to evaluate for other binocular vision disorders, AI can utilize the results of these tests and analyze patients with their peers to assess for trends leading to amblyopia. In the current treatment and management of these conditions, vision therapy has been a popular option among many practitioners. While traditional vision therapy programs are personalized to the patient and their diagnoses, they are limited in the possibilities of actives available to help reach the end goal. AI can assist in modifying the exercises to adapt to the patient’s progress as they continue throughout their program. Without the limitation of physical materials, the possibilities of activities to train all binocular disorders are endless. AI has the potential to integrate virtual or augmented reality into vision therapy. These systems can create immersive environments where the patient engages in games and exercises designed to improve binocular vision, eye coordination, depth perception, and more. While there are already VR headsets designed to assist in certain binocular vision conditions through specific games, there is not a complete program that allows for continued monitoring and tracking based on all of the patient’s diagnoses. AI algorithms can observe a patient’s progress in these virtual environments and adjust the therapy to provide optimal visual training, ensuring that patients remain engaged and motivated throughout their treatment. This level of personalization will lead to a more efficient and effective treatment compared to traditional methods. The treatment of amblyopia and strabismus is often not a one-time intervention, but rather an ongoing process that requires regular monitoring and follow-up visits. AI can play a critical role in longterm management by providing continuous accurate data of the patient’s visual development. This advance in optometry has the potential to extend beyond the exam room. AI-powered applications can enable Optometry & Visual Performance 299 Volume 13 | Issue 4 | December 2025
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