Amblyopia Diagnosis And Managment Flashcards
How do you diagnose amblyopia
Diagnosis of exclusion
Detailed history of amblyopia/eye turn
- eye turn
- which is the better seeming eye
- medical history
- probing birth history
- fam Hx
- history of any treatment
- medications
- development and learning concerns
Exam for amblyopia
- VA
- CT
- ocular motility
- pupils
- accommodation
- BV function
- cycloplegic refraction
- ant and post seg
Why VA for amblyopia
Single line: crowding phenomenon causes difficulty with single line acquitted
Single letter: when single letter acuity is better than single line acuity, prognosis for treatment is better because of the absence of crowding
Single letter surround: VA can be over estimated with single letter, a single letter or optotype with crowding bars offer more reliability
Pinhole
If VA does not improve, amblyopia could be a differential
S chart
Flom chart or Psychometric chart
Best way to monitor progress of amblyopia. Improves slower than single letter or line during treatment
Contrast sensitivity
Can also use to monitor therapy progress
Which is better to test VA for amblyopia
Single letter
Issues of VA with amblyopia
Crowding is an issue
Not treating amblyopia
There are dire consequences if amblyopia is not treated promptly
Loss of better seeing eye in amblyopia
High risk of loss of better seeing eye
Treatment goal for amblyopia:
Improvement of VA and BV fusion
Amblyopia management
- remove the obstruction
- optical correction
- occlusion/penalization of better seeing eye-patches, filters, atropine
- near point activities with penalization
- VT
- surgery fro persistent strabismus (If indicated)
Removing the obstruction
Remove it ASAP: as soon as the first two months of life
Resulting refractive error needs to be corrected 1-2 weeks after cataract removal (some infants may need as much as +24.00 to +30.00 correction)
-no IOLS yet bc the eye is still developing, PCA will invade
Prognosis for good vision becomes poorer the older the child is
Removing the obstruction: poor prognosis
If a unilateral deprivation exists beyond 3 months of life
Get consultation asap- this is emergent
Refraction and Rxing for amblyopia
- determination of refractive error is the first step in the management plan for a patient with amblyopia or strabismus
- optical correction is with glasses or CL
- correction offers a clear retinal image
- cycloplegic refraction is the method of choice to determine the refractive error in children
The goal for optical treatment in amblyopia
Clear retinal image for each eye to allow BV
-and stopping any amblyogenic process (accomodative ET sc in VT-really?)
Retinoscopy on a deviated eye
May not yield the correct amount of refractive error because the retinoscopy is done off axis
Glasses for amblyopia
Inexpensive way to start
Safety
Carrier for other medications (prisms or bifocals)
Contacts for am.yopia
- cosmesis
- aniseikonia is better in anismoreopia
- less restriction of VF
- reduced prism imbalance when looking off axis
- could be started after improved VA
Which is better for amblyope, glasses Vs contacts
Occlusion therapy very likely, so no difference
Aniseikonia and refractive correction for amblyopia
Not the most urgent issue in amblyopia, especially when deep
-may be appararent to the child after successful treatment- patient closing an eye or has diplopia
Isoametropia amblyopia: astigmatism
> 2.50D
Amblyopia isoametria: hyperopia
> 5D
Isoamatropia amblypia: myopia
> 6D
Anisometropia amblyopia: hyperopia
> 1D
Anisometropia amblyopia: myopia
> 3D
Anisometropia amblyopia Astigmatism
> 1.50D
