BVP - Treatment of Amblyopia - Week 3 Flashcards
How is occlusion for amblyopia treatment done, what does it force, and what does it inhibit?
Occluding the dominant eye
-forces the non-dominant eye to take up fixation
-reduces the dominant eye’s inhibition of amblyopic eye
List four types of occluders. Note which is not recommended and which is used in special cases.
3M opticlude patches
Material ‘over the spectacle’ patches
Opaque material stuck to spectacle lens - not recommended
Black contact lenses - special cases
What does full time occlusion entail? Does prescribing less than this achieve adequate results?
Child is required to wear the patch all waking hours, generally 6-7 days
Many practitioners prescribe less than this and appear to achieve adequate results
Is full time occlusion the mainstream approach?
Until very recently
How long does full time occlusion take to get a good response and how long will it take to get the majority of the effect? Explain the full effect.
Generally get a good response in 3 months
Will need 6 months to get the majority of the effect
If for another year or two, may improve another line or two
Is improvement in acuity with amblyopia treatment symptomatic or asymptomatic?
Asymptomatic
Do children as old as 12 respond as well as younger children to amblyopia treatment? Explain (3).
Yes but:
-response not as good
-response is slower
-compliance is poorer
How effective is full time occlusion in reaching the following goals in cumulative total percentage?
6/6
6/9 or better
6/12 or better
6/6 - 53%
6/9+ - 73%
6/12 - 87%
What is the compliance thought to be for full time occlusion?
~50%
Is compliance better or worse in lower socioeconomic groups?
Worse
Is compliance higher or lower in private practice?
Higher, allegedly
List four tips to improve occlusion compliance.
Parents need to be aware their child will not like it and be prepared
Child needs to be aware that occlusion is non-negotiable
Parents need to fill out an occlusion calendar so you know they are doing it
Child needs to be provided with some rewards for complying
Explain why full time occlusion was the mainstay treatment until only recently and explain what the ATS2B study proved. Make a comparison for the end result and rate of improvement, and the severity of amblyopia it applies to.
Minimal occlusion works perfectly
Major finding in ATS2B was that 2h occlusion worked as well as 6h occlusion for moderate amblyopia over 4 months
-same end result
-same rate of improvement
Consider minimal patching (2h per day). If stable visiond is achieved after 3 months, what effect does switching to 6h occlusion per day (full time) have on VA?
It improves further
Define recidivism. When is it more (2) and less likely (1)?
Some amblyopes get worse once treatment stops
Less likely if the cause of the amblyopia is treated
More likely if it is untreated
-residual strabismus
More likely if the child is younger