px with amblyopia

Question 1

what are the clinical characteristics of amblyopia

Answer 1

no symptoms
px may rub eyes/ close an eye

Question 2

signs of amblyopia

Answer 2

• decrease in va
• fixation preference 0 child may prefer to use one ye over the other
• eccentric fixation
  unsteady fixation
  poor accomodation
• poor depth perception
• squinting /shutting an eye
• head tilting

Question 3

what is MBLYOPIA

Answer 3

• DEVELOPMENTAL DISORDER OF THE VISUAL SYSTENM CHARACTERISED BY A DECREASE IN VISION IN THE AFFEECTED EYE AND A DISRUPTION OF bINOCULAR FUCNTIONAL VISION

Question 4

what causes amblyopia

Answer 4

reduced vision in 1 eye caused by abnormal visual development early in life. The weaker or lazy - eye often wanders inwards or outward.

Question 5

what are the types of amblyopia

Answer 5

refractive
strabismic
deprivation
reverse

Question 6

what is cause of unilateral amblyopia

Answer 6

constant strabismus
anismometropia
visual deprivation( catarcats,ptosis, opaque cornea, prolonged uncontrolled patching , prolonged unilateral cycloplegia)

-

Question 7

what causes bilateral amblyopia

Answer 7

cataracts of equal density
high uncorrected hypermmetropia
high uncorrected astigmatism
nystagmus

Question 8

strabismic amblyopia

Answer 8

result of manifest strabismus

Question 9

aniesemetropic amblyopia

Answer 9

result of significant difference in the refractive errors of the 2 eyes / where one eye will have th visual advantage of all distances

Question 10

ametropic amblyopia

Answer 10

result of high degree of uncorrected bilateral refractive error

Question 11

meridional amblyopia

Answer 11

uncorrected astigmatism

Question 12

stimulus deprivation

Answer 12

lack of adequate stimuli is n early life
may be uni/bi/complete/partial

Question 13

when should treatment start and stop

Answer 13

treat as early as possible Babies can be patched –need to be careful not to induce iatrogenic amblyopia due to occlusion

• Continue treatment until no improvement in visual acuity after 2 consecutive review visits (at least 6 weeks apart)
• Treatment of amblyopia DOES NOT have to stop at age 8 years

Question 14

Refractive correction

Answer 14

• correct ametropia
  FT wear
• process can take up to 16 weeks or longer
• Review refractive correction frequently (over 12 –16 weeks).
• Anisometropic amblyopes

Question 15

what is strabismic amblyopia

Answer 15

caused by active suprression
to get rid of cdiplopia and confusion

-may be complicated by eccentric fixation
by anomalous retinal correspondence

Question 16

how much patching

Answer 16

10mins- 8-10hrs

Answer 17

Opaque and total occlusion is the standard (alternative occlusion can use attenuating filters –
Bangerterfoils/filters) but these vary in their attenuation.

Answer 18

2 hours of patching (with near activities) as effective as 6 hours for moderate amblyopia (mean
of 6/18 ~ 4 line difference) – strabismic, anisometropic or combination.
* 6 hours of patching as effective as full-time patching in severe amblyopia (mean 6/48~ 7 line
difference).

Answer 19

Recurrence can occur if treatment stopped (25% of successful treatment can recur after
stopping) –weaning off treatment (patching) may lessen recurrence rate.
* Shorter patching duration may help compliance rather than full time occlusion.
* Review every 6 weeks (6weeks for optimal affect). If no improvement check compliance.
* If no improvement after 6 weeks consider referral or reconsider potential.

Question 20

orthoptic management for amblyopia

Answer 20

Orthoptic treatment
* Seen both by orthoptist and optometrist.
* Give full prescription
* Monitor vision and prescription every 3months
* Possible prism given or patching given – dependent on case
* Checks fusional reserves
* If strabismic problem – surgery available to tighten or loosen muscle.

Question 21

referral

Answer 21

Amblyopia
Routine to be seen within 4-6 weeks of referral. Give full prescription in the meantime.
squint/strabismus Routine to be seen within 4-6 weeks of referral. Give full prescription in the meantime.
reduced vision Routine – follow prescribing guidelines.

Question 22

moderate amblyopia

severe amblyopia

Answer 22

6/12-6/30

6/30-6/120

Question 23

patching

Answer 23

4hrs for all type of amblyopia
no additional benefit beyond 400hrs

Question 24

atropine 1% weekends

Answer 24

1% weekends , review 1 week to check acuity in dominant eye
monitor closely for iatrogenic by checking best corrected acuity in dominant eye at each follow up visit

Question 25

how does penalisation work?

Answer 25

atropine/ointment /drops
prevent accomodation of fellow wy w
encourages amblyopic eye to fixate at near

side effectsects ( photophobia/ eye pain HA/skin irritation/facial flushing )

Question 26

when is occlusion therapy stopped

Answer 26

• when px vision has improved and remained stable over 3 consecutive visits
• once the patch has been stopped Childs vision monitored to ensure it not reduce again. in some children it will recess this can be rectified by reintroducing the patch for a short period of time
• px has been compliant and has worn the patch. but here ahas not been significant improvement of vision

-poor compliance