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Summer Final-VT > Amlyopia Management > Flashcards

Amlyopia Management Flashcards

1
Q

BPEDS/MPEDS study

A
  • looks at risk factors for amblyopia and anisometropia
  • > 2D is 40x chance that person has amblyopia
  • > 1D astigmatic anisometropia has a 6x chance of amblyopia

Significant for 0.5-2D anisometropia and 0.25-1D astigmatism anisometropia

Significant for esotropia
Significant for Hispanic

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2
Q

Relationship between overall ansimotreoptia and adjusted prevalence of VA difference > 2 lines with poorer than 20.32 in worse eye

A

Prevalence of amblyopia goes up as anisometropia goes up

Almost 100% prevalence at 5D anisometropia

This trend is also seen in anisometropia SE and astigmatic anisometropia

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3
Q

SE anismoretopia and chances of amblyopia

A

Increases with increase \

Same as in astigmatic anisometropia

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4
Q

Isoametropia and chances of amblyopia in both eyes

A

> 4D hyperopia clinically significant. 10x chance

1-2D astigmatism clinically significant. 2x chance
>2D astigmatism in both eyes 17X chance

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5
Q

Bialteral decreased VA (amblyopia) and increased SE hyperopia

A

Both increased

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6
Q

Astigmatism in better seeing eye and chances of bialteral decreased VA (amblyopia)

A

As the better seeing eye increased in astigmatism, the chance of bialteral amblyopia increases

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7
Q

Why cycloplegic

A
  • in amblyopia, the visual system is not able to respond well during the subjective refraction
  • the ambly;oic eye is not sensitive to the small changes to discriminate during subjective refraction
  • completely relaxing the accommodative will help give the Beth’s objective measurement of the refractive error present
  • cyclopentolate is an anti muscarinic
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8
Q

Prescribing: how much should I give

A
  • tough questions for even the most seasoned eye care professional
  • Rx practices should be based on the case you are treating
  • after the retinoscopy and subjective refraction, the prescription to issue is based on the findings and other relevant information
  • if you suspect residual hyperopia, atropine could be used to reveal the complete amount of hyperopia
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9
Q

Thoughts about Rxing

A
  • is the child’s refractive error still changing
  • accommodative strab?
  • will full Rx hinder emmetropixation
  • will the full correction five even better acuity than partial correction
  • is this child still in the critical period (neuroplastic)
  • how early do i have to treat this child
  • what is the prognosis
  • treatment goal
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10
Q

Full vs partial prescription

A
  • if cycloplegic > subjective, slightly reduce the Rx to allow for acceptance
  • reduce about 1D if there are not other concern like strab
  • if there is need for more VA improvement, can start to build up the plus
  • prescribe dull astigmatic correction, especially for children
  • start with the Rx first before introduction other management
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11
Q

Hey do we start with Rx first before introducing other management in amblpyia

A
  • this allows the child to adapt to the Rx
  • this allows you to determine the amount of clarity that is gained by correction only
  • this allows you to see how aggressive you may have to be
  • it improves compliance and the acceptance of subsequent management that may be introduced
  • follow up outdo be 3-4 months, depending on the case
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12
Q

Full vs partial Rx: if hyperopic anisometropia amblyopia is present without esotropia

A

A partial balanced Rx can be issued. Can be reduced about 1D

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13
Q

Full vs partial Rx: if hyperopic anisometropia amblyopia is preset and there is accommodatrive esotropia

A

Full Rx should be issued

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14
Q

Goal when Rxing for amblyopia

A

Balance between the two eyes and alignment is the goal when Rxing

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15
Q

Occlusion therapy

A
  • occluding the better seeing eye to stimulate the amblyopic eye and force it to improve visual function
  • it is also to eliminate EF
  • occlusion can be direct, full time or part time, with occluder (pharmacological penalization, patches, etc)
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16
Q

Penalization

A

A form of occlusion where atropine is used to blue the vision in the better seeing eye
-study uses have shown that both patching and atropine penalization are equally effective

17
Q

Barriers and concerns about occlusion therapy

A 
Compliance 
Development of strab 
Occlusion amblyopia (in the better seeing patched eye)
Cosmesis 
Skin irritation
Atropine side effects 
Diplopia
18
Q

VT for amblyopia

A
  • these are visual tasks and procedures to imrtpvoe vision
  • optical correction is to improve vision while VT is to improve visual efficiency ( eye movement, accomodation, and bincoualrity)
  • VT does not replace optical correction, itaugments it
  • VT can be started for visual efficiency after VA has improved to 20/40 in the amblyopic eye
19
Q

If BV status has improved, and VA has significantly improves towards normal

A

Monitor

20
Q

If BV status and VA have not improved enough,

A

Start amblyopia treatment

21
Q

Deprivation amblyopia management

A
  • remove any obstruction as soon as possible to minimize BV disruption
  • refractive error needs to be corrected as soon as possible to offer best vision
  • amblyopia treatment hsould be initiated, if indicated, after reevaluation
  • VT for any binocualr abnormaltiies (suppression, etc)
22
Q

Isoametropia amblyopia manamgent

A
  • correction as soon as possible with glasses or CL
  • reevaluate after 4 months
  • amblyopia treatment should be initiated, if indicated (this is a good one that could do alternating occlusion!)
  • VT for any binocular abnormities (suppression etc)
23
Q

Anisometropia amblyopia management

A
  • correction as soon as possible with glasses or CL
  • reevaluate after 4 months0studies have shown that VA can improve with just glasses
  • amblyopia treatment should be initiated, if indicated
  • VT for any binocualr abnornaliteis (suppression, etc)
24
Q

Manamgent of strabismic amblyopia

A
  • correction with glasses or CL
  • reevaluate VA with binocular status, could consider prism
  • amblyopia treatment if necessary
  • VT if prognosis is good
  • surgery (contraindication in most accommodative esotropia)
25
Q

What patient could use alternating amblyopia?

A

Isoametropia amblyopia

26
Q

Anisometropia amblyopia VA can improve by ____

A

25%

Summer Final-VT (10 decks)

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