Reduced stereoacuity will hopefully get back to normal naturally if stop patching:
No treatment is necessary.
Prisms are rarely given to child, as it might cause diplopia.
ARC might have changed back to NRC already, because VA improved to 6/6 which parafoveal region can’t normally achieve this acuity.

If Tom is still 5 years old, there is a chance to get back to normal stereoacuity level, but if this doesn’t happen, there’s very little we can do.

(stereopsis develops until about the age of 7)

Patching doesn’t help to improve steoropsis even it is only a part time occlusion.
After VA improve, or parafoveal fixation is “fixed”. Steoropsis is going to improve with time as long as he is still younger then 7.

Hey guys

"Initial treatment consists of occlusion therapy to shift an eccentric point of fixation onto the fovea centralis."
-Ophthalmology: A Short Textbook by Gerhard K. Lang

So don't need to look into this as it would have been solved with the occlusion therapy. Also, if the vision has been brought back to the fovea- it would no longer be suppressed. Still need to look into how to improve stereoacuity- although I think we just need to give the binocular vision cells time to develop.

Since the microtropia 'stems' from aniseikonia- it would make sense for us to consider reducing the aniseikonia in our treatment. Otherwise Tom will just suppress again!
Pickwell's BV Anomalies talks about reducing the spectacle magnification in cases of aniseikonia via the following:
1) Lens power. The higher the Rx, the more spectacle magnification. Maybe consider a partial correction in both eyes- the rest can be overcome by accommodation, and since the power of the lenses is less (i.e maybe 2-3DS) there will be less spectacle magnification.
2)Lens Form. Aspheric lenses are thinner, flatter and lighter.
3) Lens Thickness. The thicker the lens- the more the spec mag. Consider using a higher refractive index for the thicker lens.
4) Reducing Back Vertext Distance of the spectacles helps reduce the overall spec mag. Note: the best form of correction would be contact lenses but Tom is too young.
They also mention Isogonal lenses- but I'm not sure I understand those too well so going to try and look into it a bit more.

We dont need to put all this information in, but as long as we know it we should be okay

Hope this helps...I'll bring it tomorrow so we can decide on how much to put in, if any.
See you tomorrow.

i'll just looked at the OLD part...
the lens I was thinking about was just to eliminate the diplopia in the peripheral part of the lens, it is nothing to do with aniseikonia...
So I agree that the only thing we can do is to try to decrease the vertex distance and use a high index (thinner) lens.