Download Clinical Examination of Patients with Amblyopia: Course Outline

I.
What amblyopia is not
a. It is not vision loss secondary to organic pathology
b. It is not vision loss secondary to psychological stress
II.
What amblyopia is
a. It is vision loss secondary to:
i. Strabismus
ii. Anisometropia
iii. Large isoametropic prescriptions
III.
Clinical Examination of Patient
a. History
i. The history will not only help you diagnose the problem but also
will help when you design your therapy plan
ii. Ask about activities, especially in school age children
b.
c.
d.
e.
f.
g.
h.
IV.
Visual Acuity
i. Clues that child may be amblyopic
A. Several letters missed on several lines with full chart
B. Letters in the middle of the line missed more frequently
C. Transposition of letter
D. Single letter acuity is improved by 1-2 lines over full chart
ii. Use of non-Snellen charts
A. Teller Cards
B. Cardiff Cards
C. HOTV
D. Lea Symbols
Cover Test
i. Use of appropriate targets
Worth 4-dot and stereopsis testing
Color vision- is not affected with amblyopia
Testing for Eccentric Fixation
i. Visuoscopy
A. Perform in monocular condition
B. Can be performed before or after dilation
C. Is there central fixation and is it steady
ii. Can also utilize After image transfer or Haidinger’s brushes
Retinoscopy/Refraction
i. When to use clyclopentolate
ii. Prescription techniques
Ocular Health assessment
i. Do not make an official diagnosis of amblyopia until ocular health
is fully examined, including dilated fundus examination
You diagnosed amblyopia now what (clinical pearls for designing
therapy plan)
a. Basic outline for therapy
i. Full optical prescription for at least one month (based on
retinoscopy or refraction)
ii. Occlusion/penalization
iii. Anti-suppression therapy (possibly)
iv. Vergence therapy (possibly)
b. What to consider when designing a therapy plan
i. Age of patient
ii. Grade in school (public, private or home schooled)
iii. Visual acuity in amblyopic eye
iv. Extracurricular activities
c.
d.
e.
v. Family dynamics
Atropine vs. Patching
i. Compliance
A. Ways to increase compliance
a. Home calendars
b. Phone calls
ii. Allergic reactions
iii. Systemic side effects
iv. Effectiveness
How often to see the patient
What to consider when discontinuing therapy
i. Vision in amblyopic eye
ii. Length of therapy
iii. Level of compliance
iv. Has there been a change in the mode of therapy
A. Increasing patching or atropine
B. Switching to atropine or patching
v. Sudden cessation versus maintenance therapy