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Summer Final-VT > Amblyopia > Flashcards

Amblyopia Flashcards

1
Q

Amblyopia

A

Sensorimotor adaptations for abnormal BV

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2
Q

Decrease of VA in one or both eyes caused by abnormal binocular interaction or form deprivation

A

Amblyopia (aka functional amblyopia, lazy eye)

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3
Q

Amblyopia occurs when

A

The visua lapthway failed to develop properly due to inadequate stimulation

Pathway development was halted during visual immaturity

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4
Q

Imropvement of amblyopia with corrective lenses

A

Cannot be improved

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5
Q

Pathology and amblyopia

A

Absent

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6
Q

If amblyopia not treated

A

Persists throughout life

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7
Q

Most common cause of monocular visual improvement in children and middle aged adutls

A

Amblyopia

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8
Q

Decrease of VA is caused by ___ in amblyopia

A

From deprivation and/or abnormal binocular interaction

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9
Q

In addition to the loss of VA, amblyopia can result in

A
  • dysfunction of accommodation
  • poor eye alignment
  • reduced contrast sensitivity
  • dysfunction in spatial judgements
  • poor resolution
  • poor tracking
  • poor prognosis with the loss of the fellow eye
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10
Q

Prevalence of amblyopia

A
  • about 2% in Caucasian and AA preschool children (Baltimore PED eye study)
  • 2% of Hispanic and AA preschool children (multi ethnic PED eye disease)
  • consistent with established estimates of 2-4% in the US population
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11
Q

Cause or etiology of amblyopia

A

None that can be treated or reversed. None can be detected by physical examination of the eye
-implying that no diseases are seen

There is also poorer prognosis if there is loss to the sound eye

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12
Q

Laterality of amblyopia

A

Unilateral or bilateral

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13
Q

Severity of amblyopia

A

Can be mild or severe VA loss

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14
Q

When to be suspicious of amblyopia

A

If there is a loss of at least two lines of VA that is not caused by a-ethology or correctable by ordinary refractive correction

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15
Q

When should amblyopia be detected

A

Before the end of the critical period (8-10 years)

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16
Q

Critical period

A

During this critical period, the visual system is still developing; thereby, stimulation helps with the development of the visual system
-treatment will be better during this period

Abnormal input or a lack of input results in a blurred image
-this will persist if not treated

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17
Q

Abnormal input after normal critical period

A

Results in blur but not a halt to the sensory development of the VA

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18
Q

How could critical period be affected differently

A

By amblyogenic factors such as anisometropia vs isometropia

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19
Q

Treating refractive errors in young kids

A

There is a need for emmetropiation, where treating early could upset the natural change needed in these infants

But treating too late could also lead to amblyopia

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20
Q

Risk factors of amblyopia

A 
Prematurity 
Low birth wt 
ROP
Cerebral palsy 
Mental retardation
Genetic syndromes 
Family Hx
Maternal smoking, alcohol, and/or drugs
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21
Q

Causes of refractive amblyopia

A

Blur

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22
Q

Cause of deprivation amblyopia

A

Degraded image or occlusion

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23
Q

Cause of strabismic amblyopia

A

Different targets (no bifoveal fixation)

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24
Q

Examples of refractive blur

A

Anisometropia
Isoametropia
Meridonial

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25
Q

Examples of deprivation amblyopia

A 
Cataract
Ptosis
Corneal opacity
Posterior segment hemorrhage 
Prolonged penalization/occlusion
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26
Q

Strabismic amblyopia examples

A

Esotropia
Exo tropia
Hypertropia

Greater risk if constant

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27
Q

Isomatropic amblyopia

A

Caused by very high refractive error in both eyes

So high that a clear retinal image cannot be obtained

This results in a bialteral decreases in VA

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28
Q

High hyperopia can also cause an

A

Esotropia, but not always
Example is a 4 yo and hasn’t started school ye. No motivation to learn to accomodation

We have to count on the parents vigilance at this point

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29
Q

Anisometropia amblyopia

A
  • a child has normal refractive error with good VA in one eye and a significant refractive error and reduced VA in the other eye
  • binocualr integration is disrupted
  • commons comments from children: “my left eye never sees well”, “that’s my bad eye”
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30
Q

Parents detecting anisometropia amblyopia

A

Harder because the child relies heavily on the better seeing eye

A child could be missed if the eye dr does not do entrance tests properly

  • VA with both eyes open
  • not making sure each eye is properly to prevent peeking
  • skipping parts of the exam
  • assumptions that little children cant have visual impairments
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31
Q

Anisometropia amblyopia and uncorrected refractive error

A

Causes a constant blur that prevents the brain from getting clear information via the visual pathway

The effect of blur is highest in the critical period of development of the visual system (in the first years of life)

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32
Q

Hyperopic anisometropia

A

Amblyopia resulting from a difference of hyperopia between the 2 eyes is common

As little as 1D of hyperopic anisometropia can affect

  • proper fusion at D and N; and
  • cause amblyopia in the more hyperopic eye
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33
Q

If both eyes are hyperopic

A

The less hyperopic eye can maintain control, keep some motor and sensory fusion

In some cases, eso could develop

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34
Q

In hyperopic anisometropia, what can be affected

A

Stereo
W4D could sho fusion depending on the severity of the amblyopia
You could also pick up a scotoma

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35
Q

Myopia anisometropia

A

High unilateral myopia with lesser myopia in the other eye

36
Q

Will this person get amblyopia
OD: -0.75D
OS: -3.25D

A

Not likely. In this case because both eyes attain clarity at either distance or near

OD used for distance
OS used for near

37
Q

Meridonial amblyopia

A
  • caused by uncorrected high astigmatism in one or both eyes
  • this amblyopia can easily be missed due to the orientation of the astigmatism, eg. some children may be able to squint or compensate
38
Q

Amblyogenic risk factors: isoametropia astigmatism

39
Q

Amblyogenic risk factors: isoametropia hyperopia

40
Q

Amblyogenic risk factors: isoametropia myopia

41
Q

Amblyogenic risk factors: anisometropic hyperopia

42
Q

Amblyogenic risk factors: anisometropic myopia

43
Q

Amblyogenic risk factors: anisometropic astigmatism

44
Q

Form deprivation

A
  • obstruction of the line of sight that prevents a clear image toform on the retina
  • it can occur in one or both eyes
45
Q

Physical obstructions that can lead to amblyopia include (not limited to)

A 
Congenital cataracts
Ptosis 
Traumatic opacity 
Vitreous opacity 
Vitreous hemorrhage (shaken baby syndrome)
46
Q

Strabismic amblyopia

A
  • a unilateral strabismus is more likely to cause amblyopia
  • an intermittent strabismus or an alternating (even constant) is less likely to lead to amblyopia
  • with the absence of bifoveal fixation, there is confusion and diplopia
  • the visual system inhibits this by suppressing the image from the turn eye
  • due to this inhibition and suppression, there are cortical changes
  • EF develops because a non fovea point is used
47
Q

Strabismic amblyopia and the later onset

A

The later hte osnet of strabismus, the better the chance of reestablishing fusion that the patient already developed

If someone has good fusion before it happened, there is a very small chance its amblyopia. Esp if they are 70

48
Q

Hysterical amblyopia

A
  • psychological origin
  • anxiety
  • reduced VA OU
  • no significant refractive error
  • no strab
  • no ocular pathology
49
Q

Notes about hysterical amblyopia

A

-common in girls 8-14
-blurred VA complaints
0additiona testing, such as VF, merit testing and electrophysiology needed to rule out other problems
-parent education and the need for referral for psychological help

50
Q

Organic amblyopia cause

A

Toxic or nutritional

  • reduced VA OU
  • absolute scotoma present
  • history of an exposure or deficiency
51
Q

Notes on organic amblyopia

A
  • this can be seen in undernutrition or deficiency
  • progressive VA loss
  • may or may not be reversible
  • optive nerve atrophy is common
  • may need low vision for profound VA loss
52
Q

Intentionally providing wrong respsones for gain

A

Malingerers
-try to out play the dr
0they dont want to cooperate
-likely an absence of amblyogenic factors

Beware of them that actually have problems

Be patient
Communicate it’s pateint to determine the cause

53
Q

Tips for malingerers

A

Start the VA chart from 20/10
Use Plano lenses to get VAs
Use the OKN drum (va at least 20/200)
Electrophysiology
Clover leaf pattern on VF
Thorough history to r/o any true problems that cause decreased vision
When I n doubt because of inconsistent results, always cycloplege the patient

54
Q

Amblyopia treatment studies

A

-PED eye disease investigator Gouda (PEDIG) is a collaborative network that facilitates multicenter clinical research in strab, amblyopia and other eye disorders that affect children

Funded by NEI
USA, UK, and Canada

Helps with how we treat amblyopia today

55
Q

Level of evidence in research h

A

Pyramid starting at the bottom

  • editorials, expert opinion
  • case series, case reports
  • case-control studies
  • cohort studies
  • randomized controlled trials
  • systematic reviews
56
Q

Randomized controlled trials

A

-scientifically sound

57
Q

Systematic reviews

A

Sound research papers and integrates everything and synthesize a finding

58
Q

Objective of ATS 1

A

RCT comparing patching and atropine for moderate amblyopia (20/40 to 20/100) in children less than 7 years

59
Q

Outcome of pathing vs atropine

A

VA in the amblyopic and sound eye after 6 months

60
Q

Conclusion of patching vs atropine

A

Atropine and patching have similar improvement, and both are appropriate for initial treatment of moderate amblyopia in children aged 3 to less than 7 years

61
Q

Results of pathing vs atropine

A

Patching slightly better than atropine but both close

62
Q

Notes about atropine and patching

A

Both treatments were well tolerated
-more pateitns in the atropine group had reduced acuity in the second eye at 6 months, but this did not persist with further follow up

63
Q

Objective of patching vs atropine F/U

A

To compare patching and atropine for moderate amblyopia (20/40 to 20/100) in children less than seven 18 months after completion the ATS 1

64
Q

Treatement in patching vs atrophied F/U

A

FU for patching or atropine done for 6 months to observe effects of treatment, further treatment, better 6months and 2 years, was at the discretion of the investigator

65
Q

Outcome of the patching vs atropine FU

A

VA in the amblyopic eye and sound eye after 2 years

66
Q

Results of the patching vs atropine FU

A

Average improvement from baseline in both groups, patching slightly better

67
Q

Conclusion on patching vs atropine FU

A

After the initial 6 month treatment, there was no significant difference between the atropine or patching when followed by best clinical care until 2 years

68
Q

How long should we patch or atropine for

A

Probably at least 2 years because there was the greates improvement

69
Q

Objective of full time vs part time patching

A

RCT tocompare full time patching (all hours or all by 1 hour per day) to 6 hours of family patching for severe amblyopia (20/100 to 20/400) in children less than 7

70
Q

Treatment of full time vs part time patching

A

Full time patching or 6 hours of patching per day, each combined with at least 1 hour of near VA when patching

71
Q

Outcome of full time vs part time patching

A

VA in the amblyopic eye after 4 months

72
Q

Results of full time vs part time patching

A

6 hour patching group had the same effect as full time patching, no point in full time patching

A lot of improvement in 4 months

73
Q

When do we want to see a patching patient back

74
Q

Notes of full time vs part time patching

A

VA in the ambl;yiov eye improved similar amount in both groups

75
Q

Conclusion of full time vs part time patching

A

6 hours daily patching and full time patching produce similar improvement in treating severe amblyopia in children 3 to less than 7 years of age

76
Q

Patching 2 vs 6 hours results

A

Average improvement in VA in the amblyopic eye from baseline was the same in both group

77
Q

Conclusion of 2 vs 6 hours patching

A

Similar VA improvement

78
Q

Objective of amblyopia treatment in kids 7-17

A

RCT to evaluate the effectiveness amblyopia treatment (20/40 to 20/0400) in kids 7-17

79
Q

Outcome of amblyopia treatmetni nchildren aged 7-17

A

Children with VA improvement 10 or more letters by 24 weeks

80
Q

Results of ambl;tapia treatment in kids 7-17

A

In 7-12 years old

  • VA improvement in optical correction group: 25%
  • VA improvement in treatment group: 53%

In 13-17

  • VA improvement in optical correction group: 23%
  • VA improvement in treatment group: 25%

But more responders in the treatment group and 20% in the optical correction group IF THEY HAD NEVER BEEN TREATED WITH PATHCING AND/OR ATROPINE BEFORE

81
Q

The older kids that did well with pathcing and atropine

A

They do better if they have never been treated with patching and/or amblyopia before

82
Q

Conclusion of amblyopia 7-17

A
  • amblyopia improves with optical correction alone in about 1/4 of patients aged 7-17, but most required additional treatment for amblyopia because of residual deficits in VA
  • 13-27: 2-6 hours of pathcing daily works well is not been previously treated at all
83
Q

Daily vs weekend atropine: objective

A

Comparing daily atropine toweekend atropine for the treatment of moderate amblyopia in children younger than 7

84
Q

Results of atropine daily vs weekend

A

At least 20/25 or VA equal to better eye seen in

  • daily atropine group: 47%
  • weekend atropine: 53%

Stereopsis was their same

85
Q

Conclusion of atropine daily vs weekend

A

Same magnitude

Just give it to them on the weekend

Summer Final-VT (10 decks)

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