BY: Dr NIKITA JAISWAL

Ims & sum hospital

 Introduction

 Pathophysiology

 Classification

 Management
 Amblyopia: (greek word means blunt eye)
Also called as: lazy eye is a disorder of sight.

Results in decreased vision in an eye that

otherwise appears normal.
 As binocular or uniocular decrease in {BCVA}
due to pattern visual deprivation or binocular
interaction during visual immaturity for which
there is no obvious ocular pathology or visual
pathway defect
 Deprivation of form vision:

•No stimulus reaches the fovea.

complete

•When there is presence of a

partial defocused image it can be U/L
nd B//L
 Single letter acuity is better than linear acuity

seen in strabismic amblyopia
 Phenomenon of crowding
 Because of abnormal contour interaction
 Abnormal eye movement

o Contrast sensitivity :
o In stabismic amblyopia it improves on decreased
illumination.
characteristics strabismic anisometric

Angular VA better ++++ ++

than linear VA
Contrast better on dec. + -
illuminance
Better performance in ++ +++
mesopic conditions
Vernier acuity less ++++ _
affected than
resolution acuity
Naso temporal OKN +++ _
asymmetry
VEP abnormalities ++ ++
 Strabismic amblyopia

 Anisometric amblyopia

 Form vision deprivation

 • No associated anisometropia
STRABISMIC • Associated anisometropia

ANISOMETRIC

• Sensory deprivation
FORM VISION • Ametropic amblyopia
DEPRIVATION • Meridonial amblyopia(astigmatism)
 Most common form of amblyopia.
 Strabismic amblyopia develops in the deviating
eye.
 Constant,non alternating,heterotropias are the
type most likely to cause significant amblyopia.
 It is thought to result from compeititive or
inhibitory interaction between neurons
carrying non fusible input from 2 eyes.
 Dissimilar refractive errors in the 2 eyes cause
the image on 1 retina to b echronically
defocused.
 More prevalent than strabismic amblyopia.
 Levels of anisometropia
• >1.50D of anisohyperopia
• 2.00D of anisoastigmatism
• 3.00D of anisomyopia
 B/L dec. in VA results from large,approx.
equal, uncorrected ref errors.

 Hyperopia exceeding 4.00-5.00D.

 Myopia exceeding 5.00-6.00D.

 Uncorrected B/L astigmatism in early
childhood may result in loss of resolving ability
limited to the chronically blurred meridians .
 The degree of cylinder is unknown

 Most ophthalmologists recommend correction

when there is > 2.00-3.00 D of cylinder.
 DEPRIVATIONAL AMBLYOPIA
 VISUAL ACUITY

 FIXATION

 FIXATION PATTERN

 ASSESSSMENT OF STRABISMUS

 ASSESSMENT OF BINOCULARITY
 EARLY DETECTION:
 +nce of nystagmus, roving
movement,abnormal head posture
Asymmetrical fundal glow (bruckner’s
reflex)
Observation of delayed visual milestones.
 Correction of refractive errors:
 Removal of any media opacities.

 Providing the worse eye a compeititive

advantage over the better eye by occluding
the better eye.
 Strict vigilance & monitoring of therapy.
 Occlusion in moderate
amblyopia in children bet 3-7
yrs

At 5 wks improvement of
2.2 lines,improvement
directly related to no of
hours of patching(lesser
baseline VA)
At 6 months, improvement of
3.1 lines irrespective of hours of
patching in pts with baseline
VA between 20/40 & 20/100
 Occlusion vs. Atropine penalization for 6
months in children betw 3-7 yrs

Similar improvement of VA in
both groups of about 3.7 lines
after 2 yrs starting of therapy.

After 2 yrs the amblyopic eye VA remained about 2

lines worse than the VA in the sound eye in both the
groups
 2 hrs & 6 hrs occlusion in
moderate amblyopia in 3-7 yrs

Similar improvement of VA in both groups

2 hrs + 1 hr near work equal a 6 hrs

occular regimen
 NEAR & NON NEAR ACTIVITIES WITH 2 HOURS
PATCHING IN 3-7 YEARS

GREATER IMPROVEMENT IN VA IN
CHILDREN WITH SEVERE AMBLYOPIA
WHO PERFORMED NEAR ACTIVITIES
ALONG WITH PATCHING.
 Evaluation of 2 hours of patching with near
vision activities vs. Spectacles alone for
strabismic & anisometropic amblopia in 3-7 yrs.

Significant difference between

the improvement in VA in the 2
groups at 5 wks.

After a period of refractive adaptation,2

hrs of daily patching with 1 hr of near
visual activities improves VA in mod to
severe amblyopia
 Evaluation of spectacles alone as T/T for
anisometropic amblyopia in children between
3 & 7 years

33-50% pts showed resolution of amblyopia: rest

required occlusion after 2 months.
(plateau with spectacles alone)
 EVALUATION OF amblyopia between 7-17 yrs

•Optical correction suffices in 25 % cases

•Children bet.7 & 12 yrs improved with patching
irrespective of previous t/t for amblyopia.
•Pts betwn 13& 17 yrs improved with patching only if there
was no h/0 of previous T/T
•Results of long term sustenance of the improvement of VA
in older amblopes require further studies.
 OCCLUSION

 PENALIZATION

 PLEOPTICS

 CAM STIMULATOR

 RED FILTERS

 DRUGS
 A competitive advantage is given to the
worse eye over the better eye.

 Total/partial
 Full time/part time
 Direct patch of the skin

 Patch over the back surface of spectacles

 Doyne’s occluder

 Pirate patches

 Occlusive contact lens

DOYNE OCCLUDER
 Refers to partial exclusion of light & form
perception.

 Refractive correction of the glasses that is being

dispensed should be accurate.

 The glasses should be worn properly.

 Selective fogging of the better eye by means of
glasses/cycloplegics.
 Pharmological penalization is more acceptable
cosmetically.
 It can be for distance or near penalization
 Dist: good eye for near & the amblyopic eye for
dist

 Total: fogging for near as well as distance.

 Principle: establish foveal superiority over the
retinal periphery & to bleach out the ecccentric
point of fixation.

 Fovea is re-educated to assume the straight head

position.

 Time taking procedure

 Age : more than 5 yrs children who are intelligent

& coopoerative.
 Not more than 7 yrs
 Principle: visual area of brain respond to a
stimuli of a particular spatial frequency & can
be stimulated to evoke visual function in
amblyopic eye.
 Contains: 7 rotating light & dark coloured disc
which have diff width
 Rotated for 7 mins at the rate of 1rotatn/min

 It is of historical use
 Principle: rod domoninated area is used for
eccentric fixation.

 Red filter is use to motivate the patient to use

fovea.
 Younger the child better the prognosis.

 Deprivation amb. Carries poor prognosis.

 Strabismic amblyopia has best prog.

 Presence of eccentric fixation worsens the prog.

 Occlusion is the better tha other methods.