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BOARDS2: amblyopia/strabismus > ET > Flashcards

ET Flashcards

1
Q

amblyopia

A

reduction in vision (20/30 or worse) in a healthy eye. The reduced vision is a result of changes at the cortical level due to suppression

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2
Q

types of amblyopia

A

form deprivation
refractive amblyopia
strabismic amblyopia

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3
Q

form deprivation amblyopia

A

occurs when there is an obstruction of a clear image to the retina before the age of 6-8 years of age

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4
Q

critical period

A

7-9yo

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5
Q

refractive amblyopia

A

occurs when there is a large amount of anismetropia between the two eyes (anisometropic amblyopia) or a large amount of refractive error is present in both eyes (isometropic amblyopia)

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6
Q

strabismic amblyopia

A

occurs when the visual axes of each eye are misaligned under binocular conditions, resulting in diplopia and confusion due to a lack of fusion. The patient may eventually develop suppression, which occurs when the image from one eye is filtered out at the cortical level.

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7
Q

types of ET

A

infant
acquired
secondary
micro

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8
Q

types of acquired ET

A

accommodative
acute
mechanical

all occur after 6m of age

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9
Q

types of secondary ET

A

sensory

consecutive

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10
Q

infantile ET

A

large angle (40-60), constant ET that occurs prior to 6m of age and is usually idiopathic in nature. Additional associated include DOL (DVD, OIO, Latent nystagmus). Because of the large angle of deviation within the cortical period, non-accommodative infantile ET is often treated with surgery

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11
Q

accommodative ET

A

acquired
secondary to accommodation and is due to either s high amount go uncorrected hyperopia and/or a high AC/A ratio. Initially, the deviation may be intermittent, but it may become constant If not prompts treated. Treatment is typically with corrective lenses (bifocals may be necessary). Prism, VY, and/or surgery may be considered if glasses do not help to avoid suppression, amblyopia, and ARC

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12
Q

treatment for someone with a high AC/A

A

lenses

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13
Q

infantile ET is the same as

A

congenital ET

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14
Q

acute ET

A

acquired
has a sudden onset and is secondary to a neurological problem (CN6 palsy) or a decompensated phoria. Although some cases resolve over time, treatment with patching or surgery may be necessary

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15
Q

mechanical ET

A

acquired

secondary to a physical restriction of an EOM (type 1 Duanes)

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16
Q

neuro vs decompensated phoria

A

test for comitancy

  • comitant=decompensated phoria
  • noncomitant=neuro
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17
Q

things about Duanes

A

left eye
female
adduction=globe retraction and fissure narrowing

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18
Q

sensory ET

A

secondary

occurs after the age of 5 and is a result of reduced VA in one eye from trauma, disease, etc

19
Q

consecutive ET

A

secondary
is iatrogenic and is usually due to overcorrection of an XT during strabismic surgery. Treatment includes prism, VT, lenses

20
Q

micro ET

A 
constant 
unilateral eso
less than 10PD
before age 3
small central suppression scotoma
use 4BO to confirm 
leads to intractable diplopia 
treat with VT or prism
21
Q

best way to check VAs in amblyopia

A

one letter at a time due to the crowding effect

22
Q

W4D

A

evaluates flat fusion ability and the presence of suppression when stereopsis is worse than 40 seconds of arc. The patient wears RG glasses with the red lens over the right eye while viewing a flashlight with 4 dots (1 white, 1 red, 2 green) at distance and near. the right eye will see a white and red dot (2 dots), the left eye will see a white dot and 2 green dots (3 dots)

23
Q

W4D: 2 red dots seen

A

OS suppression

24
Q

W4D: three green dots seen

A

OD suppression

25
Q

W4D: 4 dots

A

flat fusion without suppression

26
Q

W4D: 5 dots seen

A

diplopia

27
Q

W4D and suppressing at distance vs near and light vs dark

A

patients who suppress at distance only and only with the room lights on have a shallow and small suppression scotoma. If the patient also suppresses at near and with the room lights dim, he has a large and deep suppression scotoma

28
Q

spectacle correction and amblyopia

A

according to PEDIG ATS, spec correction alone will resolve amblyopia in 1/3 of patients with moderate anisometropic amblyopia (BCVA 20/40-20/80). A bifocal may be necessary at near in order to decrease the patient’s accommodative demand, particularly if the patient has a high AC/A

29
Q

PEDIG amblyopia treatment guidelines

A

consider adding one treatment at a time

  1. correction of refractive error
  2. occlusion therapy with patching or atropine
  3. structured near activities and/or VT
30
Q

PEDIG: patching ages 3-6: moderate amblyopia

A

2 hr/day

31
Q

PEDIG: patching ages 3-6: severe amblyopia

A

6hr/day

32
Q

PEDIG: atropine ages 3-6: moderate amblyopia

A

2 days/week

33
Q

PEDIG: atropine ages 3-6: severe amblyopia

A

2 days/week

34
Q

when would you use atropine vs patching

A

if the patient is not compliant with patching to patching results in only a minimal improvement in BCVA

35
Q

moderate amblyopia

A

20/40-20/80

36
Q

severe amblyopia

A

20/100-20/400

37
Q

ATS-3

A

treating amblyopia in older children ages 7-17 with moderate and severe amblyopia

38
Q

results of ATS-3

A
  • over 50% of patients had 2 or more lines of improvement in BCVA when treated with patching or atropine
  • almost 50% of patients ages 13-17 who received no prior amblyopia treatment improved with patching or atropine
39
Q

when to d/c amblyopia treatment in older kids

A

if the patient is compliant with treatment and the initial gain in VA stabilizes

40
Q

atropine vs patching: PEDIG

A

demonstrated that atropine and patching result in similar improvements in BCVA for patients with moderate amblyopia. After 6 months, the amblyopic eye was 20/30 or better, and/or improved 3 or more lines from baseline BCVA in approximately 75% of patients in both study groups. the recommended treatment duration is 6 months, with follow up exams every 4-6 weeks

41
Q

adverse effects of atropine

A

increased blood pressure, mental confusion, increased pulse, dryness of mouth and throat, and loss of neuromuscular coordination

  • hot as a hare, dry as a bone, red as a beat, mad as a hatter.
  • RX homatropine 5% if side effects occur
42
Q

epicentral folds

A

most often seen in asian infants and infants with Down syndrome. They are prominent vertical nasal skin folds that may cause the eyes to appear as if they are in esophaguses position when they are actually ortho. they do not increase the risk of strabismus

43
Q

risk factors for strabismus

A 
downs syndrome 
famhx
cerebral palsy 
diabetes 
head trauma

BOARDS2: amblyopia/strabismus (3 decks)

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