Amblyopia 3 Flashcards
If the brain did not develop correctly during its critical period…
Amblyopia will most likely develop
What is corneal dystrophy? Macula schisis? Retinitis pigmentosa?
What do they all have in common?
Cornea tearing away.
Macula lifting away from the retina.
Affected RPE cells.
They are NOT amblyopia
What must you assess about birth history?
Premature?
Low birth weight?
Critical period.
What tests must you asses when checking for amblyopia?
Detailed history (birth, family, patching/eyedrops)
VAs
Cover test
Ocular motility
Pupils
Accommodation
Binocular function (stereopsis, W4D, fixation)
Cycloplegic refraction
Anterior and posterior segment evaluation
What are 3 amblyopia treatments?
Optical treatment
Occlusion therapy
Vision therapy
What is the first step in the management plan for a patient with amblyopia or strabismus?
Determination of refractive error
Retinoscopy on a deviated eye may not yield the correct amount of refractive error because…
The retinoscopy is done off axis
What is the method of choice to determine the refractive error in children?
Cycloplegic refraction
Why cyclopentolate?
In amblyopia, the visual system is not able to respond well during the subjective refraction.
The amblyopic eye is insensitive to the small chances to discriminate during subjective refraction.
Completely relaxing accommodation will help give the best objective measurement of the refractive error present.
Cyclopentolate is an…..
Anti muscarinic drug
When prescribing, how much should i give?
Tough question for all practitioners.
Depends on the treatment.
Prescription is based on findings and other relevant info.
If you suspect residual hyperopia, what could be used and why?
Atropine
To reveal the complete amount of hyperopia
The goal for optical treatment is…
Clear retinal image for each eye (to allow binocularity)
Stopping any amblyopic progress
What must you start with before introducing other management? Why?
Prescription
So the child can adapt to the prescription. Follow up 3-4 months after
If hyperopic anisometropic amblyopia is present without esotropia…
A partial balanced prescription can be issued
If an accommodative esotropia is present…
Close to the full prescription should be considered
When prescribing, what is the goal?
Balance between the two eyes and alignment
Occluding the best seeing eye to stimulate the amblyopic eye and force it to improve visual function
Occlusion therapy
Also to eliminate eccentric fixation
How long must a patient undergo occlusion therapy per day?
Full time or part time, if part time, as little as 2 hours per day
A form of occlusion where atropine is used to blur the vision in the better seeing eye
Penalization
Part of occlusion therapy
Which is better, patching the better seeing eye or atropine penalization?
Studies have shown that they are equally effective.
Side effects of atropine penalization
Hot as a hare Dry as a bone Blind as a bat Red as a beet Mad as a hatter
Anticholinergic
Barriers and concerns for occlusion therapy
Compliance Development of strabismus Occlusion amblyopia (in the better seeing patched eye) Cosmesis Skin irritation Atropine side effects
Visual tasks and procedures used to improve vision
Vision therapy
Difference between visual therapy and optical correction
Optical correction is to improve vision
Vision therapy is to improve visual efficiency (eye movement, accommodation, and binocularity)
Does visual therapy replace optical correction?
Nope.
It augments it
Process of treating Deprivation Amblyopia
- Remove any obstructions
- Correct refractive error
- Treat amblyopia
- Vision therapy
Process of treating isoametropic amblyopia
- Correct refractive error with glasses or contacts
- Reevaluate within 4 months
- Treatment for amblyopia should start
- Vision therapy
Process of treating anisometropic amblyopia
- Correction as soon as possibly with glasses or contacts
- Reevaluate after 4 months (VA could have improved)
- Amblyopia treatment
- Vision therapy
Process of treating strabismic amblyopia
- Correction with glasses or contacts
- Reevaluate VA and binocularity
- Amblyopia treatment
- vision therapy
- Surgery
What’s the issue with surgery in strabismic amblyopia?
It is contraindicated in most accommodative esotropia
