Download I. Definition of Amblyopia

Current Trends in Treating Amblyopia
Definition of Amblyopia
I.
Case report: 9-year-old boy was told “too late for any lazy eye treatment”.
When does critical period end?
A.
B.
Definition of amblyopia
Classification of Amblyopia
II.
A.
Types of amblyopia:
1. Strabismic amblyopia
2. Refractive amblyopia
3. Stimulus deprivation amblyopia
B.
Mild, moderate, and severe amblyopia
Diagnosis of Amblyopia
III.
A.
Amblyopia is not decreased visual acuity
B.
Find a reason/reasons to cause amblyopia
C.
Potentially amblyogenic refractive errors
1. Anisometropia: hyperopia, myopia, astigmatism
2. Isometropia: hyperopia, myopia, astigmatism
D.
Rule out ocular pathology
1. Optic nerve anomalies
2. Case report: a patient with constant left esotropia, decreased VA
(OS), and Optic nerve hypoplasia (OS)
Treatment of Amblyopia
IV.
A.
Treatment sequential
1. Rx correction: cyclopentolate refraction
2. Initiate amblyopia treatment after Rx correction until VA is stable
3. Follow-up every 1 to 3 months and progress evaluation
4. End of Amblyopia Treatment
B.
Treatment Options
1. Patching
2. Atropine
3. Bangerter filter
4. Over plus good eye
Recent Amblyopia Treatment Studies
V.
A.
Spectacle correction
B.
Patching vs. glasses
C.
Dose of patching
D.
Patching vs. Atropine
1. Mechanism of atropine in amblyopia treatment
2. Pros and cons of atropine treatment
E.
Atropine daily vs. weekend
F.
Amblyopia in older children
G. Amblyopia
in adults
Amblyopia Treatment Prognosis
VI.
Patient age: age when amblyogenic factor starts and age when treatment
initiates
A.
B.
Initial visual acuity
C.
Types of amblyopia
D.
Depth of amblyopia
E.
Patient compliance
Amblyopia Recurrence
VII.
25% of successfully treated amblyopes (aged 3-8) have a recurrence
within the first year of treatment.
A.
Amblyopia recurrence is rare in children 7-12 year old after discontinuing
treatment other than spectacle wear, only 7%.
B.
C.
VIII.
A.
Consider to taper patching in young children.
What Should We do if VA Has no Improvement or Worse
Check patient compliance
B.
Check glasses prescription
C.
Does patient look over the glasses?
D.
Patching the wrong eye
E.
Recheck Refraction/ cyclopentolate refraction
Bilateral Amblyopia
IX.
A.
Is alternating patching necessary to treat bilateral amblyopia?
B.
The effectiveness of refractive correction on bilateral amblyopia
Vision Therapy in Amblyopia Treatment
X.
A.
Study results: near activities vs. far activities
Effect of vision therapy on accommodation, pursuit, saccades and other
binocular vision functions
B.
C.
When should we consider vision therapy?
Case Discussion
XI.
5-year-old boy with hyperopic anisometropia and intermittent esotropia:
how to prescribe?
A.
A patient with anisometropic amblyopia and optic nerve hypoplasia in the
fellow eye: is the fellow eye normal?
B.
A patient with high magnitude of myopic anisometropia: how to correct the
high magnitude of anisometropia?
C.
2 hour patching or longer hour for moderate amblyopia? Is 2 hour patching
always the golden standard for any moderate amblyopia?
D.
Clinical Pearl in Amblyopia Treatment
XII.
A.
Communication and communication!
B.
Strategies for non-compliant patients
C.
Constant struggling during amblyopia treatment
D.
Rewarding in the end: significant impacts on patients’ life quality