amblyopia treatment past, present and future anne southgate sylvie cringle orthoptic department,...
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Amblyopia Treatment Past, Present and Future
Anne Southgate Sylvie Cringle
Orthoptic Department, HEFT
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Amblyopia – what is it?
• Definition:– Defective visual acuity which persists after
correction of any refractive error and removal of any pathological obstacle to vision.
Also termed ‘lazy eye’
• Types
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Amblyopia Treatment
• Removal of obstacle to vision• Glasses• Occlusion (patching)– Conventional– Inverse
• Stimulation• Atropine penalisation• Optical penalisation
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Early Amblyopia Treatment
• Total to form and light
• Total to form
• Partial to form
• Atropine
• Timing
• Last resort
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Amblyopia Treatment
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Amblyopia Treatment
• Then
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Amblyopia Treatment
• Now
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Amblyopia Treatment
• Then
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Amblyopia Treatment
• Now
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Amblyopia Treatment
• Then and now
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Amblyopia Treatment
Age group: Up to 2 ½ years of age (and/or when vision test cannot be relied on):
Fixation pattern Amount of occlusion Review timeAlternating squint or
Holding fixation}No occlusion indicated Review 6 – 12 weeks
Taking up fixation quickly Observe Review 6-12 weeksTaking up fixation slowly Consider 2 hours occlusion daily Review 4-6 weeks
Not taking up fixation Consider inverse occlusion See separate guidelines (section 10.3)
Age group: 2 ½ years to 5 ½ years of age:
VA Amount of occlusion Review timeVA better than 0.6 LogMAR 2-4 hours Review 6-8 weeks
VA less than 0.6 LogMAR 4-6 hours Review 4-6 weeks
Age group: 5 ½ years of age and upwards:
VA Amount of occlusion Review timeVA better than 0.6 LogMAR 2-4 hours Review 6 weeks
VA less than 0.6 LogMAR Consider up to 6 hours occlusion per day dependant on other clinical
considerations i.e. density of suppression, area of fixation,
behaviour of child, parental views etc
Review 2 weeks
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Amblyopia Treatment
• Atropine
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Amblyopia TreatmentVisit Date VA Test
UsedPrescribed
Daily Occlusion from Last
Visit
Average Actual Daily Occlusion
Total Actual Hours of
Occlusion Since Last
Visit
Prescribed Daily
Occlusion
Reason Occlusion Stopped
Orthoptist
R L
1
2
3
4
5
6
7
8
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Thank you