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    Amblyopia: Glomarie Hope A. Paquera Danica Ilah M. Sinco

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    Jan Irish
    This document provides information on amblyopia, also known as lazy eye. It defines amblyopia as a reduction in best corrected visual acuity due to suppression of visual input from an eye receiving blurred or conflicting visual information. This disrupts the normal development of visual pathways serving that eye. Amblyopia can be caused by unequal refractive errors between the eyes (anisometropia), misaligned eyes (strabismus), or visual deprivation. Treatment involves correcting refractive errors, patching or penalizing the better eye to encourage use of the amblyopic eye, and sometimes active visual therapy. The goal of treatment is to restore and improve visual acuity through presenting a clear retinal image to the amblyopic eye

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    Amblyopia: Glomarie Hope A. Paquera Danica Ilah M. Sinco

    Uploaded by

    Jan Irish
    123 views39 pages
    This document provides information on amblyopia, also known as lazy eye. It defines amblyopia as a reduction in best corrected visual acuity due to suppression of visual input from an eye receiving blurred or conflicting visual information. This disrupts the normal development of visual pathways serving that eye. Amblyopia can be caused by unequal refractive errors between the eyes (anisometropia), misaligned eyes (strabismus), or visual deprivation. Treatment involves correcting refractive errors, patching or penalizing the better eye to encourage use of the amblyopic eye, and sometimes active visual therapy. The goal of treatment is to restore and improve visual acuity through presenting a clear retinal image to the amblyopic eye

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    This document provides information on amblyopia, also known as lazy eye. It defines amblyopia as a reduction in best corrected visual acuity due to suppression of visual input from an eye receiving blurred or conflicting visual information. This disrupts the normal development of visual pathways serving that eye. Amblyopia can be caused by unequal refractive errors between the eyes (anisometropia), misaligned eyes (strabismus), or visual deprivation. Treatment involves correcting refractive errors, patching or penalizing the better eye to encourage use of the amblyopic eye, and sometimes active visual therapy. The goal of treatment is to restore and improve visual acuity through presenting a clear retinal image to the amblyopic eye

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    123 views39 pages

    Amblyopia: Glomarie Hope A. Paquera Danica Ilah M. Sinco

    Uploaded by

    Jan Irish
    This document provides information on amblyopia, also known as lazy eye. It defines amblyopia as a reduction in best corrected visual acuity due to suppression of visual input from an eye receiving blurred or conflicting visual information. This disrupts the normal development of visual pathways serving that eye. Amblyopia can be caused by unequal refractive errors between the eyes (anisometropia), misaligned eyes (strabismus), or visual deprivation. Treatment involves correcting refractive errors, patching or penalizing the better eye to encourage use of the amblyopic eye, and sometimes active visual therapy. The goal of treatment is to restore and improve visual acuity through presenting a clear retinal image to the amblyopic eye

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    © All Rights Reserved
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    of 39

    AMBLYOPIA

    Reported by:

    Glomarie Hope A. Paquera


    Danica Ilah M. Sinco

    AMBLYOPIA
    Also known as Lazy Eye
    Unilateral/bilateral condition
    Reduction of best corrected visual acuity due to
    cortical suppression of sensory input from an
    eye that is receiving blurred or conflicting visual
    information, leading to disruption of the normal
    development of visual pathways serving that eye

    HOW DOES IT HAPPEN?


    Brain does not full recognize the image from
    amblyopic eye
    Weakening of that eye over time and a reduction
    in its clarity of vision
    Brain may block or suppress the images sent by
    eye and favor the clearer eye.

    CAUSES OF AMBLYOPIA
    Unequal/Poor visual acuity
    Unequal refractive error (anisometropia)
    Bilateral equal high refractive errors
    (isoametropia)
    Uncorrected moderate/high astigmatism
    Strabismus/Misaligned eyes
    Blockage or Deprivation
    Toxic

    CLASSIFICATION OF AMBLYOPIA
    FUNCTIONAL AMBLYOPIA

    Not due to the diseases in the


    eye
    Unilateral/bilateral of the eye
    Reversible
    Examples:
    - refractive amblyopia
    - anisometropic amblyopia
    - meridional amblyopia
    - strabismic amblyopia

    ORGANIC AMBLYOPIA

    Due to lesion in the eye or


    visual pathway
    Unilateral/bilateral of the eye
    Irreversible
    Examples:
    - visual deprivation amblyopia
    - toxic amblyopia

    TYPES OF AMBLYOPIA
    Refractive amblyopia
    Anisometropic amblyopia
    Meridional amblyopia
    Strabismic amblyopia
    Visual deprivation amblyopia
    Toxic amblyopia

    FUNCTIONAL AMBLYOPIA
    TYPE
    Refractive Amblyopia

    Anisometropic Amblyopia
    (second in frequency)

    CAUSES
    Uncorrected isometropia
    Result: a blurred image in both eyes

    Uncorrected anisometropia
    Result: a blurred image in more
    ametropic eye

    Meridional Amblyopia

    Uncorrected high astigmatism


    Result: a blurred and distorted image
    in unilateral or bilateral eyes.

    Strabismic Amblyopia
    (most common)

    Constant strabismus
    Suppression in deviated eye

    ORGANIC AMBLYOPIA
    TYPES
    Visual Deprivation Amblyopia

    Toxic Amblyopia

    CAUSES
    Opacities in ocular media or
    structures
    Examples:
    - cataracts
    - cornea opacities
    - cloudy vitreous in infants

    Drugs, tobacco, alcohol, chemicals,


    nutritional disorders

    SYMPTOMS

    SIGNS

    Blurred vision
    Reduced vision
    Reduced contrast sensitivity

    No obvious sign, unless severe


    abnormality is present
    Rubbing or squinting of eyes
    Misaligning of eyes
    Reduced VA
    Droopy eyelid

    ASSESSMENT OF DEVIATION
    Compare magnitude at distance versus near
    Laterality
    Concomitancy
    Frequency
    The test is
    Cover test
    Hirschberg test
    - uses pen torch
    - corneal reflexes
    Bruckner test
    - uses ophthalmoscope
    - observe the color and brightness of fundus reflexes and compared

    ASSESSMENT OF AMBLYOPIA
    1.) Visual Acuity (VA)
    Degree of amblyopia
    Crowding phenomena
    - Normal Snellen Chart
    * Line Acuity
    - Single Letter Chart
    * Single Letter Acuity

    2.) Neutral Density (ND)


    Depth of amblyopia
    Differentiate between organic
    amblyopia or functional
    amblyopia

    VISUAL ACUITY
    Amblyopes perform better when isolated letters are
    used instead of full chart
    Crowding effect
    - Single letter acuity

    Infant
    -Teller acuity chart

    Preschool-aged children
    -Lea symbols, HOTV or Broken Wheel Cards

    School-aged children
    - Snellen chart or Log MAR chart

    SINGLE LETTER ACUITY


    Advantage
    Directly measures acuity
    especially in children 3-6yrs
    old

    Disadvantage
    Isolated letters can be used,
    which may lead to under
    estimated amblyopia visual
    loss

    CROWDING EFFECT
    Crowding bar, or contour
    interaction bars, allow the
    examiner to test the crowding
    phenomenon with isolated
    optotype.
    Bar surrounding the optotype
    mimic the full of optotype to
    the amblyopia child.

    STRABISMIC AMBLYOPIA
    In strabismic eye, mostly it use other part of area
    instead of fovea area which consist rod
    Image that form will reduce in contrast
    Hence, it also reduce the visual acuity of the eye

    NEUTRAL DENSITY (ND) FILTER


    Strabismic Amblyopia
    - better VA with ND filter
    compared to the normal eye
    - the use of neutral density (ND)
    filter in front of the fixating
    eye enhanced motion in depth
    performance
    - exhibit residual performance
    for motion in depth, and it is
    disparity based
    Anisometropic Amblyopia
    - cannot be diagnosed with
    neutral density filter

    NEUTRAL DENSITY (ND) FILTER


    STRABISMIC AMBLYOPIA

    ANISOMETROPIC AMBLYOPIA

    CONTRAST SENSITIVITY TEST


    Detect functional differences between strabismic
    and anisometropic amblyopes
    Strabismic amblyopes showed abnormalities
    only in the high spatial frequency range
    Anisometropic amblyopes showed an abnormal
    function both in the low and high spatial
    frequency range

    ECCENTRIC FIXATION
    Fixate away from fovea
    - in strabismic amblyopic eye
    Visuscopy
    - detect and assess eccentric fixation
    - explain decreased vision and lead to a more accurate
    measurement of strabismus
    - grid center is temporal to foveal reflex (temporal EF)
    - grid center is nasal to foveal reflex (nasal EF)
    - grid center is superior to foveal reflex (superior EF)
    - grid center is inferior to foveal reflex (inferior EF)

    BINOCULARITY/STEREOACUITY TEST
    Amblyopia reduced VA, it also has reduced
    stereopsis
    Stereo smile for infant
    Preschool random-dot stereogram or randomdot test for preschool children

    REFRACTION
    Commonly can determine anisometropia
    Cycloplegic refraction
    - spasm the ciliary muscle to inactive the
    accommodation by using drug
    Uses 1% cyclopentolate hydrochoride
    Usually more hyperopic or more astigmatic eye
    for the amblyopic eye

    EXTERNAL AND INTERNAL OCULAR


    EXAMINATION OF THE EYE
    Determine either it is visual deprivation
    amblyopia or afferent pupillary defect are
    characteristic of optic nerve disease but
    occasionally appear to be present with
    amblyopia
    To rule out ocular pathology
    These examination consist of assessment
    - physiological function
    - anatomical status

    MANAGEMENT
    Goal of Treatment
    Passive Therapy
    Optical correction
    Occlusion
    Penalization
    Active Therapy
    CAM visual stimulator
    Intermittent photic stimulation (IPS)
    Pleoptics

    GOAL OF TREATMENT
    To restore and improves visual acuity by two
    strategies:
    1.)Present CLEAR retinal image to the amblyopic eye
    Eliminate causes of visual deprivation
    Correcting visually important refractive errors
    2.) Make the child use the amblyopic eye
    Recommended treatment should be based on
    - pxs age, VA, compliance with previous treatment
    and physical, social and psychological status

    CHOICES OF TREATMENT
    The choices of treatment of amblyopia are used
    alone or in combination to achieve goal of
    treatment
    1.)Passive Therapy
    - the patient experiences a change in visual
    stimulation without any conscious effort
    Proper refractive correction
    Occlusion
    Penalization

    PROPER REFRACTIVE CORRECTION


    Purpose
    - to provide sharp images and providing
    OPTIMAL environment for amblyopia therapy
    Give the proper optical correction alone
    - short period of time (6-8weeks) before
    initiation of other therapy

    OCCLUSION
    Purpose
    - cover good eye to stimulate amblyopic
    Enable the amblyopic eye to enhance neural
    input to the visual cortex
    Decreasing inhibition better eye

    OCCLUSION CAN BE CLASSIFIED IN SEVERAL


    WAYS
    Ways of Patching
    - adhesive patch
    - spectacles occlude
    - opaque contact lens
    Type
    - direct occlusion: to stimualte amblyopic eye
    - inverse occlusion: to weaken eccentric fixation
    Duration
    - full time occlusion: for deprivational amblyopia
    - part time occlusion: to help preseve fusion

    Partial patching form


    Allow appreciation of form but diminish acuity
    - ie. Translucent material (bangerter foil)
    - foil is cut to size and positioned on inner lens
    surface
    Or occlusion covering part of spectacles
    - ie. Lower half of spectacles
    - to promote use of the amblyopic eye for near work

    TYPE
    Direct occlusion
    - patch the good eye
    - stimulate amblyopic eye
    Indication for
    - deprivation amblyopia
    - anisometropic amblyopia

    Inverse occlusion
    - for amblyopia associated with EF = strabismic
    ambyopia
    - patching the amblyopic eye
    *to weaken eccentric fixation of amblyopic eye
    If children under 5 yrs old
    - Direct full time occlusion may risk reverse amblyopia
    - Do direct occlusion alternate with inverse occlusion
    - ie.: for 3 yrs old children, may need 3 days direct and 1
    day indirect occlusion consider 1 cycle and repeated
    period of time

    Duration
    - based on binocular vision status, age, performance need
    Full time occlusion
    - 24hrs a day/waking hours
    - for children over 7yrs over plastic age
    - when there is no binocular vision
    - strabismic amblyopia
    *alternate strabismus
    *constant strabismus
    - also anisometropic amblyopia with poor binoculat
    vision
    - shows more rapid development

    Part time occlusion


    - for specific periods/prescribed activities
    When binocularity is present
    -anisometropic amblyopia
    *to help preserve fusion
    *prevent occluded eye become amblyopic if
    doing full time occlusion
    Children under 4 yrs
    - 2hrs per day
    - prevent deprivation amblyopia in good eye

    Occlusion is maintained until there has been no


    further improvement for the last 5-6 weeks
    Frequent check are necessary to monitor ocular
    health, binocular status and each eyes acuity

    PENALIZATION
    Drug penalization
    - 1gtt of 1% atropine instilled daily to good eye
    - provide sufficient blur to force the child
    *use amblyopic eye at near
    *good eye at distance
    Has cosmetic advanteges and does not totally
    disrupt binocular vision
    Effective method of treatment
    - for mild to moderate amblyopia in children

    PENALIZATION
    Optical penalization
    - children who do not tolerate patching
    - fog the good eye (non-amblyopic eye) +3.00D
    - amblyopic eye use for distance and good eye for
    near
    - not practically applicable
    *do near work most of time compared to
    distance

    ACTIVE THERAPY
    Is designed to improve visual performance by
    the patients conscious involvement in a
    sequence of a specific, controlled visual task that
    provide feedback
    CAM visual stimulator
    Intermittent photic stimulation
    pleoptic

    SURGERY
    If amblyopia is due to:
    Cataract cataract surgery
    Nonclearing vitreous opacities vitrectomy
    Corneal opacities corneal graft
    Blepharoptosis tarsal tuck

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