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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