Packet 2 Amblyopia Flashcards
4 classifications of Amblyopia
- strabismic
- anisometropic
- isoametropic
- deprivation (image degradation)
how does strabismic occur
foveal line of sight fails to intersect object of fixation
-confusion and diplopia lead to suppression and then cortical spatial changes
1/3 of amblyopia in clinics is
anisometropic amblyopia
some facts for anisometropic amblyopia
- dissimilar retinal image clarity, contrast, and size (vs. form)
- unequal input -> ABI -> suppression
- eye with higher ametropia becomes amblyopic
- always unilateral
- as aniso increases, generally more severe amblyopia
what are some necessary characteristics of strabismus
- frequency
- laterality
- fixation distance
is there a relationship between depth of amblyopia and size of strab?
no relationship
100% of people had amblyopia when their hyperopia was greater than
3.50 D
100% of people had amblyopia when their myopia is greater than
6.50 D
50% had amblyopia when their hyperopia is greater than
2.50 D
50% had amblyopia when their myopia was greater than
4.50 D
what are some characteristics of isometropia amblyopia
- from uncorrected high bilateral refractive error
- ret images have equal clarity/ size but blurred
- bilaterally reduced VA (same +/- one line)
- BCVA usually 20/30- 20/60 and similar b/w eyes
amount of hyperopic aniso that is amblyogenic
> or = 1.00 D
amount of myopia aniso that is amblyogenic
> or = 3.00 D
amount of astigmatism aniso that is amblyogenic
> or = 1.50D
amount of isometropic hyperopia that is amblyogenic
> or = 4.00 D
amount of isometropic myopia that is amblyogenic
> or = 6.00 D
amount of isometropic astigmatism that is amblyogenic
> or = 2.00 D
what are some things that can cause deprivation amblyopia
- any physical obstruction to line of site:
- visual axis media opacity (like a cataract), significant ptosis, prolonged occlusion
what are some characteristics of deprivation amblyopia?
- unilateral or bilateral (unilateral is worse)
- VA loss often severe (>20/200 typically)
- less common but hard to treat
what are the 2 amblyogenic mechanisms
- form deprivation
2. abnormal binocular interaction
what is form deprivation mechanism?
- inadequate stimulation of fovea
- lack of clear image- neural connections for form/shape not stimulated
- primary effect is cortical, basic retinal receptor processes normal
- spatial frequency channels present, but require higher contrast to be activated
what is abnormal binocular interaction mechanism?
- ABI caused by unequal or conflicting input to 2 eyes
- competitive, inhibitory effect leading to suppression
what mechanism for strabismus?
ABI
what mechanism for anisometropia?
both ABI and form deprivation
what mechanism for isoametropia?
form deprivation
what mechanism for deprivation (unilateral)?
ABI and form deprivation
what mechanism for deprivation (bilateral)?
form deprivation
in amblyopia, when is the most critical period
most sensitive birth to 2-3 years, then decreased until about 6 years
which one is more powerful: ABI or form deprivation alone
ABI
cut off for shallow amblyopia
20/20 - 20/32
cut off for moderate amblyopia
20/40 - 20/80
cut off for deep/severe amblyopia
20/100 or worse
amblyopic eye behaviors
- response slow and irregular
- wide range of acuity errors
- letters read out of order or skipped
- miscalls not necessarily confusion letters
- letters on ends easier than in middle
- isolated letter > single ling > full chart
- variability makes repeated testing poor
amblyopic eye defects: behavioral responses related to:
- contour interaction effects
- spatial distortion and uncertainty
- reduced contrast sensitivity function
- eccentric fixation
- reduced accommodation
- poor saccades
- fixation instability
some characteristics of ETDRS charts
- 10 sloan letters
- equal number of letters per line
- logMAR progression (geometric progression of letter size)
- improved testing for worse VA levels
- standardized contour interaction effects
how do you measure VAs in people with latent nystagmus?
- high plus (like >+5.00) over fellow eye
- polarized testing conditions