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Z Strab, VT, & Amblyopia - Final > 6 - Amblyopia Dx/Mx > Flashcards

6 - Amblyopia Dx/Mx Flashcards

1
Q

Amblyopia dx

A

Is a dx of exclusion

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2
Q

VA assessment

  • single line
  • single letter
  • single letter surround
A

Difficult with crowding phenomenon

When single letter > single line, prognosis for tx is better (due to absence of crowding)

Single letter can over-estimate, with surround offers more reliability

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3
Q

VA assessment

  • pinhole
  • S chart
  • contrast sensitivity
A

If VA doesn’t improve, amblyopia could be a DDx

Best way to monitor progress! -> improves slower than single letter or line during tx
-aka Flom Chart or Psychometric Chart

Can use to monitor therapy/patching progress

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4
Q

Management

  • better seeing eye
  • tx goal
A

Higher risk of loss of better seeing eye in amblyopia

Improve VA and binocular fusion

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5
Q

Obstruction removal

  • when
  • IOLs
  • poor prognosis if
A

ASAP - as soon as first 2 months of life

No - eye is still developing, PCO will invade

Unilateral deprivation exists beyond 3 months of life

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6
Q

Optical correction

  • when
  • why
  • method of choice
A

First step in mx plan

Offers clear retinal image

Cycloplegic refraction

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7
Q

Optical correction

-goal

A

Clear retinal image OU to allow binocularity and to stop the amblyogenic process
-i.e. balance b/w 2 eyes and alignment

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8
Q 
BEPEDS/MEPEDS:
Inter-ocular VA in children 30-72 months
-spherical equiv anisometropia = 40x’s more likely with \_\_D
-4x’s more likely with \_\_D
-1.5x’s more likely with \_\_D
A
  1. 00+ D
  2. 00-2.00 D
  3. 50-1.00 D
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9
Q 
BEPEDS/MEPEDS:
Inter-ocular VA in children 30-72 months
-astigmatic anisometropia = 6x’s more likely with \_\_D
-2x’s more likely with \_\_D
-1.6x’s more likely with \_\_D
A
  1. 00+ D
  2. 50-1.00 D
  3. 25-0.50 D
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10
Q

BEPEDS/MEPEDS:
Inter-ocular VA in children 30-72 months
-what condn is 9x’s more likely to lead to amblyopia than no strab

A

Esotropia

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11
Q

BEPEDS/MEPEDS:
Inter-ocular VA in children 30-72 months
-what race/ethnicity is 2x’s more likely to lead to amblyopia than White

A

Hispanic

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12
Q

Relationship b/w overall anisometropia and adjusted prevalence of VA diff >2 lines

  • strong __ relationship from __ to __D
  • nearly 100% prevalence at __D
A

Linear from 1D-5D

5D

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13
Q

BEPEDS/MEPEDS:
Binocular VA in children 30-72 months
-spherical equiv refractive error = 10x’s more likely with __D

A

4.00+ D

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14
Q

BEPEDS/MEPEDS:
Binocular VA in children 30-72 months
-astigmatism = 17x’s more likely with __D
-2x’s more likely with __D

A
  1. 00+ D

1. 00-2.00 D

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15
Q

Why cycloplege

  • 2 reasons
  • type of drug
  • if still suspect residual hyperopia
A

Amblyopic eye not sensitive to small changes during subjective refraction
Completely relax accomm

Anti-muscarinic

Atropine

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16
Q

Full vs partial rx

  • if cylco > subjective
  • if no other concerns (e.g. strab)
  • astigmatism
A

Slightly reduce

Reduce ~1D

Full cyl

17
Q

Full vs partial rx

  • why start with glasses (vs other managements)
  • F/U
A

Allows:

  • child to adapt to rx
  • you to determine amount of clarity gained
  • see how aggressive to be

Improves:

  • compliance
  • acceptance of subsequent management

3-4 months

18
Q

Full vs partial rx

  • when partial balanced rx can be issued (reduce by ~1D)
  • when full rx should be issued
A

Hyperopic anisometropic amblyopia WITHOUT esotropia

Accommodative ET

19
Q

Occlusion therapy

  • why (2)
  • when to alternate patching eyes
A

Improve visual function, eliminate EF

Isoametropia

20
Q

Occlusion therapy

-SE of atropine

A 
Hot as a hare
Dry as a bone
Blind as a bat
Red as a beet
Mad as a hatter
21
Q

Occlusion therapy

-barriers/concerns

A 
Compliance 
Development of strab - Eso due to lack of fixation
Occlusion amblyopia
Cosmesis
Skin irritation
Atropine SE
Diplopia
22
Q

Vision therapy

  • purpose vs optical correction
  • when to start
A 
OC = improve vision
VT = improve visual efficacy (movement, accomm, bincocularity)

After VA has improved to 20/40 in amblyopic eye

23
Q

Case considerations/trends:
Deprivation amblyopia
-when to initiate tx
-VT for __

A

After reevaluation

Binocular abnormalities (suppression, etc.)

24
Q 
Case considerations/trends:
Isoametropic amblyopia
-reevaluate after \_\_
-amblyopia tx
-VT for \_\_
A

4 months

If indicated, alternating occlusion

Binocular abnormalities (suppression, etc.)

25
Q 
Case considerations/trends:
Anisometropic amblyopia
-reevaluate after \_\_
-amblyopia tx
-VT for \_\_
A

4 months

If indicated

Binocular abnormalities (suppression, etc.)

26
Q 
Case considerations/trends:
Strabismic amblyopia
-reevaluate \_\_, consider \_\_
-amblyopia tx
-VT if \_\_
-surgery
A

VA and binocular status, prism

If necessary

Prognosis is good

Contraindicated in most acommodative ETs

Z Strab, VT, & Amblyopia - Final (7 decks)

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