Amblyopia treatment

Question 1

What is considered amblyopia?

Answer 1

Px will have reduced acuity in one eye- difference of 2 lines between the eyes.

Question 2

Can px have amblyopia in both eyes?

Answer 2

Yes, but
bilateral amblyopia is never as severe as unilateral amblyopia cus the two eyes are competing for territory in the brain, if one eye sees less well then the other eye will make up for it. If both eyes patched then vision won’t be as poor, for e.g. it will be only half a line or 1 line. Bilateral amb is difficult to diagnose.

Question 3

What 3 things does effectiveness of treatment depend on?

Answer 3

Age- earlier is better

Compliance

Cause of amblyopia

Question 4

How can an anisometropic amblyopia be treated?

Answer 4

Refractive correction to ensure that the image received by each fovea is clear

Question 5

How can a fully accommodative strabismus amblyopia be treated?

Answer 5

Hyperopic refractive correction to ensure that accommodation is not needed for distance vision (accommodation for reading is normal)

Question 6

How can a non-accommodative strabismus amblyopia be treated?

Answer 6

Hyperopic refractive correction will NOT correct misalignment in this case.

If the strabismus is unrelated to refractive error, surgical correction may be needed and referral would be appropriate.

Question 7

What problems can arise if treatment is done by eyes remain misaligned?

Answer 7

Diplopia

Question 8

What is the optometric treatment for amblyopia?

Answer 8

Refractive correction needed first FT wear for 18 weeks before patching

Occlusion (patching)

‘Active’ treatment (more than patching)

Question 9

Which eye is patched?

Answer 9

Non-amblyopic eye/GOOD EYE

Question 10

How long should patching be done for?

Answer 10

2 hrs daily in moderate amblyopia or 6 hrs in severe amblyopia

Until the amblyopic eye has returned to normal

Question 11

What if the child does not like wearing the patch?

Answer 11

Atropine in non amblyopic eye instead

Question 12

How does atropine help with amblyopia

Answer 12

It works the same as patching, it blurs that eye

Question 13

Can patching work if child is over 8 years old?

Answer 13

Yeah it can and even adults but obviously younger is more effective

Question 14

What is perceptual learning?

Answer 14

Improved ability (e.g. contrast sensitivity) after repeatedly practicing a particular task

If the task is visual, then visual function can get better even in the normal visual system, but also in amblyopia

Question 15

What is a type of perceptual learning?

Answer 15

Video games-do it with occluding the non amblyopic eye

Question 16

Who can perceptual leaning be used for ?

Answer 16

Affective in children as well as adults.

Question 17

Is perceptual learning done monocularly or binocularly?

Answer 17

Monocular but

binocular may also be good as it improves acuity and stereopsis

Question 18

What are some features of binocular treatments used for amblyopia

Answer 18

No patching-the amblyopic and non-amblyopic eye view different stimuli

An ‘active’ task for the amblyope

Special viewing systems

Games or videos

Question 19

Summarise the treatment options of amblyopia

Answer 19

Refraction first

Patching/atropine

Active treatment-perceptual learning to speed up treatment or