Amblyopia is eligible for a medical expense reimbursement (ryoyohi).
After prescribing therapeutic glasses, we ask families to submit the amblyopia instruction form (jakushi shijisho) to the health insurance association office or similar.

Since opening, we have cared for many children with amblyopia.
Amblyopia very often improves.

Once amblyopia has “resolved,” the child no longer qualifies for the amblyopia instruction form.
Even so, we also judge whether the child still needs to keep wearing glasses for the remaining refractive error.

Here we describe our policy, including the definition of amblyopia.

Our Policy on Issuing the Amblyopia Instruction Form

What Is the Amblyopia Instruction Form?

The amblyopia instruction form (official name: instruction form for the preparation of glasses and similar devices for amblyopia treatment) is a medical document that directs the making of the glasses or contact lenses needed to treat amblyopia. It plays an important role in helping patients obtain appropriate visual aids and, where applicable, receive reimbursement.

Definition and Diagnosis of Amblyopia

What Is Amblyopia?

Amblyopia is a condition in which, for some reason, the development of visual function is disrupted during the period when the visual system is developing, so that vision does not reach a sufficient level even with full correction.
In general, we define amblyopia as a best-corrected visual acuity of less than 1.0.

Main Causes of Amblyopia

• Strabismic amblyopia: caused by abnormal binocular vision function
• Anisometropic amblyopia: occurs when there is a large difference in refractive state between the two eyes
• Form-deprivation amblyopia: occurs when there is some obstruction in the eye, such as a congenital cataract

How It Is Diagnosed

Amblyopia is diagnosed by an ophthalmologist based on a comprehensive assessment including visual acuity testing, refraction testing, and binocular vision testing.

Criteria for Issuing the Instruction Form

Who Is Eligible

• Patients diagnosed with amblyopia
• Patients currently undergoing amblyopia treatment
• Patients with a significant refractive error who are at high risk of amblyopia (as a preventive measure)

When We Issue It

• After the diagnosis of amblyopia at the first visit
• When a regular examination confirms that amblyopia has progressed or improved
• When the treatment plan needs to be changed

Criteria for Discontinuing Issuance

• When best-corrected visual acuity has improved to 1.0 or better and is stable
• When, judging from the child’s age and treatment course, no further improvement is expected

Criteria for Re-issuance

• Under 5 years old: at least 1 year after the previous issuance
• Age 5 to under 9: at least 2 years after the previous issuance

Goals and Methods of Amblyopia Treatment

Treatment Goals

The main goals of amblyopia treatment are to improve best-corrected visual acuity to 1.0 or better and to normalize binocular vision function.

Main Treatment Methods

1. Refractive correction with glasses or contact lenses
2. Occlusion therapy for the better eye (eye patching)
3. Orthoptic training
4. Surgery when necessary (such as strabismus surgery)

Treatment Period

Amblyopia treatment is often long-term and in some cases continues for several years or more. Regular examinations and review of the treatment plan are important.

What the Instruction Form Contains

Basic information

• Patient name, date of birth, and address
• Diagnosis (type of amblyopia)
• Name of the issuing medical institution and the doctor in charge

Visual acuity and refractive state

• Uncorrected visual acuity (right eye / left eye)
• Corrected visual acuity (right eye / left eye)
• Refraction values (sphere, cylinder, axis)

Prescription details

• Detailed prescription for glasses or contact lenses
• Instructions for special lenses (if needed)
• Wearing instructions (full-time wear, part-time wear, and so on)

Other instructions

• How and how long to carry out occlusion therapy
• Content and frequency of orthoptic training
• Date of the next examination

Care After Amblyopia Treatment

Care after successful treatment

• Continuing regular follow-up
• Explaining the risk of recurrence and guidance on prevention

Changes to the subsidy system

• If amblyopia improves, the patient may no longer be eligible for the subsidy
• Criteria differ by local government, so each case needs to be checked individually

Ongoing follow-up

• Guidance for maintaining visual function
• Explaining considerations at school and at home

Points to Note About Issuing the Instruction Form

Responsibilities of the medical institution

• Making an appropriate diagnosis and treatment plan
• Recording and explaining information accurately

Responsibilities of patients and parents

• Understanding the contents of the form and cooperating with treatment
• Attending regular visits and reporting progress

Ethical considerations

• Avoiding unnecessary issuance of the form and providing it appropriately only to patients who truly need it
• Taking care to respond attentively to each patient’s age and circumstances

Frequently Asked Questions (FAQ)

Q1: Can amblyopia be cured completely?
A1: Significant improvement can be expected with early detection and early treatment, but results vary from person to person.

Q2: Does the amblyopia instruction form have an expiration date?
A2: Usually it is valid until the date of the next examination, but the exact period may differ depending on the medical institution.

Q3: Do I still need glasses after amblyopia improves?
A3: Glasses may still be needed after improvement to maintain vision. Please follow your doctor’s instructions.

Q4: Is amblyopia treatment effective in adulthood?
A4: Visual plasticity declines with age, but some effect can be expected even in adults. An individual evaluation is needed.

This information is a general explanation. The approach may differ depending on the individual case, so please consult your doctor for details.

Latest Policy on Issuing the Instruction Form After Amblyopia Treatment

Care After Amblyopia Improves

If amblyopia has improved, the child is 7 years or older, and corrected visual acuity has reached 1.0, the child is usually no longer eligible for the amblyopia instruction form. However, the following points need attention:

• Visual development may still be unstable, and there is a medically recognized risk that vision may fall back below 1.0.
• Taking this risk into account, we previously sometimes issued the instruction form even after improvement.
  (for the purpose of correcting the refractive error)

Important Points About Subsidies

• After the instruction form is issued, whether the subsidy applies is decided by the public authority.
• Medical institutions cannot control this decision.
• If the subsidy is applied, the cost of the glasses is covered.
• If it is not applied, the patient pays the full cost of the glasses.

New Policy

To avoid difficulty in communication and misunderstandings with patients, our clinic has adopted the following policy:

1. When amblyopia has improved, the child is 7 years or older, and corrected visual acuity is judged to have reached 1.0, we do not, in principle, issue the amblyopia instruction form.
2. This judgment is made by comprehensively considering the patient’s age, treatment course, stability of visual acuity, and other factors.
3. If the instruction form is not issued, the full cost of glasses or contact lenses is paid by the patient.

Requests to Patients

• Please continue regular vision tests and watch carefully for changes in vision.
• If your vision decreases or other symptoms appear, please see us promptly.
• Even after amblyopia treatment, please follow your doctor’s instructions and manage your vision appropriately.

Thank You for Your Understanding and Cooperation

This new policy was adopted in order to provide patients with the best treatment and clear information.
If you have any questions or concerns, please do not hesitate to ask the doctor or staff.
We appreciate your understanding and cooperation.