AMBLYOPIA

AMBLYOPIA

Definition, Classification, Diagnosis, & Management

Multiple Choice

What is Amblyopia?

• Central Suppression

• Facultative Suppression

• Absolute Suppression

• Unilateral Suppression

Multiple Choice

What is the criteria to diagnose Amblyopia?

• Difference in visual acuity between the eyes

• Difference in visual field between the eyes

• Difference in color vision of two plates, between the eyes

• Difference in visual acuity of two lines between the eyes

Scenario 1

• A 1 year old child is brought with c/o constant inward deviation of the left eye noticed since 4 months of age.

• Cycloplegic refraction:

  –OD: +2.00DS

  –OS: +2.00 DS

• •Fixation Assessment – resists occlusion of right eye.

Multiple Choice

Will you correct the refractive error?

• Yes

• No

• Will wait for another 6 months

• None of the above

Scenario 2

• A 4 year old child is referred from the school vision screening program for further management.

• Visual Acuity: OD: 6/18, N6, OS: 6/9, N6

• Cover Test: Ortho at distance & near

• Cycloplegic refraction:

  –OD: +1.50/-4.00X180

  –OS: +1.50/-0.50X180

Multiple Choice

What type of amblyopia is this?

• Anisometric amblyopia

• Strabismic amblyopia

• Isometric amblyopia

• Combined mechanism amblyopia

• Meridonial amblyopia

Multiple Choice

Will you correct the refractive error?

• Yes

• No

• Will wait for another 6 months

• None of the above

Multiple Choice

What type of amblyopia is scenario 1

• Anisometric amblyopia

• Strabismic amblyopia

• Combined mechanism amblyopia

• Isometric amblyopia

• Meridonial amblyopia

Multiple Choice

Given the following refractive error, what type of amblyopia does this patient potentially have?

–OD: +5.25 – 2.75 x 180

–OS: +4.00 – 2.50 x 180

• Amblyopia OD secondary to anisometropic hyperopia

• Amblyopia OU secondary to high astigmatism OU

• Amblyopia OD>OS secondary to anisometropic hyperopia and high astigmatism OU

• Amblyopia OD>OS secondary to anisometropic hyperopia and high hyperopia and high astigmatism OU

Multiple Choice

Which of the following examples will potentially have amblyopia secondary to strabismus?

• 12pd Intermittent Left Exotropia at Distance and Near

• 20pd Constant Alternating Esotropia at Distance and Near

• 20pd Intermittent Alternating Exotropia at Dist and 10pd Exophoria at Near

• 16pd Constant Right Esotropia at Distance and Near

Scenario 3:

This was the Bruckner reflex of four different boys.

Open Ended

Identify THE REFRACTIVE ERRORS IN:

A, B, C, and D

Multiple Choice

Predict VA for 3 PD Nasal EF

• 20/50

• 20/60

• 20/80

• 20/100

CASE:

• VISIT 1:

• 5y/o female 

• C/o: Failed school screening; Mom reports occasional squinting

  Birth, developmental, and educational hx – all unremarkable

Findings:

• DVAsc: OD: 20/60 OS: 20/100 Lea S-line 

• PERRLA –APD 

• EOMs: Full 

  
  

  
  

• CTsc: 2 EP, 4 EP’ 

• Stereo: RDS: 250”   WC: 100” 

• •SLE: unremarkable 

Findings Continued:

• Cycloplegic Refraction:

  
  

  OD: +3.00-3.25x180 (20/40) OS: +4.50-3.50x180 (20/80)

  
  

• Final RX:

• OD: +1.50-3.25x180  

• OS: +3.00-3.50x180

  
  

  
  

Multiple Choice

What is the Diagnosis?

• Strabismic Amblyopia

• Meridonial Amblyopia

• Anisometropic Amblyopia

• Combination of Strabismic and Meridonial Amblyopia

• Combination of Anisometropic and Meridonial Amblyopia

Multiple Choice

How do you manage this patient?

• Full time Occlusion only

• Part time Occlusion only

• Part time Occlusion with spectacle correction

• Part time Occlusion with both spectacle correction and active games

Visit 2:

• The patient returns after 3 months

• VA improves OD: 20/30 OS:20/60 

• Stereo WC: 70”

Multiple Choice

What is your advice now?

• Stop Occlusion

• Continue the same treatment

• Start tapering the Occlusion

• Shift to Penalization

Multiple Choice

A patient came in for their first eye exam and has been diagnosed with anisometropic refractive amblyopia OS (VA: 20/60).

You prescribed the patient glasses and the patient returns for their 3 month follow up and their vision improves to 20/50.

What would your next step be?

• Have the patient continue wearing the glasses full time and have them return in 3 months

• Begin patching OD for 2 hours/day, 7 days/week

• Begin Atropine 1%, 1 day break for OD on the weekends

• Begin patching OD for 6 hours/day, 7 days/week

Multiple Choice

Your amblyopic patient has completed patching therapy.

They have been patching OS 2 hours/day, 7 days/week and the vision is OD: 20/20 and OS: 20/20

What is your next step?

• Discontinue patching and have the patient return in 1 year for a comprehensive exam

• Discontinue patching and have the patient return in 3 months for a follow-up

• Taper patching to OS 2 hours/day, 4 days/week and have them return in 3 months

Multiple Choice

Your amblyopic patient has completed patching therapy.

They have been patching OS 2 hours/day, 7 days/week and the vision is OD: 20/20 and OS: 20/20

What is your next step?

• Discontinue patching and have the patient return in 1 year for a comprehensive exam

• Discontinue patching and have the patient return in 3 months for a follow-up

• Taper patching to OS 2 hours/day, 4 days/week and have them return in 3 months