REFRACTIVE

AMBLYOPIA
I Wayan Ardy Paribrajaka (1871122001)
PROGRAM PENDIDIKAN DOKTER SPESIALIS-1
PROGRAM STUDI SPESIALIS ILMU KESEHATAN MATA
FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANA
RSUP SANGLAH
DEFINITION
Amblyopia ~ visual IMPAIRMENT, which cannot be corrected,
occur in one or both eyes, can not be related to structural
abnormalities in the eye

Refractive amblyopia ~ decreased visual acuity that occurs due

to the difference in refraction between one or both eyes so that
the shadow falls incorrectly on the retina.

Refractive amblyopia ~ visual impairment that is permanent so

that it can have a major impact on the quality of life (QoL) of
sufferers.
EPIDEMILOGY
MYOPIA
• The prevalence of myopia in the USA ~ 20-50% of
the population, in contrast to some regions in
Asia, i.e. by 80-90%.
• In Asia, the highest rates are found in children
(18.5%)
 Refractive
• Close viewing amblyopia is the
activities such as most type
reading, of amblyopia ~ more than 90% of all
writing,
use a computer, and play video games related to
types of
increased amblyopia.
prevalence of myopia.
 Anisometropia is around 1% -11%

 Isoametropic amblyopia is only about 1% -2% (the least frequently

encountered refractive amblyopia).

 CLASSIFICATION a refractive abnormality in the eye where
A refractive
the shadow disorder
focused when
in fronta of the retina,
beam when of the
lighteyeisis not
traveling
accommodated.
• Refractive abnormalities caused by a beam of parallel to the
light that is not refracted at one focus point, unaccommodated eye, then
however at several focal points on several refracted forming a shadow
corneal meridians and lenses. miopia e.c.the
behind relatively
retina. long axis of the eyeball or
strength-excessive refraction media.
• Classified by shape and type.
• The shape  regular and irregular
astigmatism. • mild myopia (<-3.00 D),
• Refractive
The type  hypermetropia hypermetrop
simplex, myopia • moderate (-3.00 D to -6.00
Amblyopia
simplex, composite y
hypermetropia, D),
composite myopia, and mixtus astigmatism. • highproportional
Astigmatism
It is directly myopia
> (> -6.00
2.00 D D).
to thea risk
age.
factors of anisometropia
Hypermetropia exceeding 4.00-5.00 D  a
risk factor of isoametropia.
astigmatism Myopia more than 5.00-6.00 D  a risk
factor
of amblyopia isoametropia
CLASSIFICATION
caused by differences in refraction in both
unilateral eyes so that the shadows that are formed
become more blurred on the wrong one eye.

A combination of defects  blurred in one eye and the

anisometropia
interocular inhibition process referred to strabismus.

The further the difference in refractive abnormalities in the

Refractive two eyes, the greater the risk of amblyopia anisometropia
Amblyopia

rare.

regarding both eyes experienced a sharp

isoametropia
decrease in vision.

bilateral,

This is purely caused by Blurred shadows

produced by the retina in both eyes.
PATOPHYSIOLOGY
corneal curvature and lens, refractive index changes in
refractive media, and abnormalities in the length of the axis
of the eyeball

parallel beam impulses do not fall right on the retina till form an
unfocused shadow

If the shadow is blurred in one eye or shadow is different in both

eyes, the visual transmission cannot develop well, then it can even
get worse.

lack of light impulses are transmitted via n. opticus to the primary visual
cortex (occipital lobe) for higher visual coordination.
CLINICAL FEATURES
Related to the refractive disorders occurred (myopia, hypermetropia, and or
astigmatism).
These clinical symptoms can occur in one eye or both eyes
HYPERMETROPY
ASTIGMATISM
Myopi Sufferer will see more
a
clearly at close range and
see blur when looking far
away,
sufferers usually have the
habit of squinting to
prevent aberration spheres
or to get the pinhole effect
blurred vision at close range
then slowly blurred
Shaded-appearing at a long
objects,
distance,
distortion shadow,
sensitivity and
to increased light,
and
sometimes followed by headache.
the presence of accommodation
spasms.
These can disrupt various activities, such
as driving, and activities that require
coordination between the eyes and hands
DIAGNOSIS
TRIAL FRAME & TRIAL LENS
AUTOREFRACTOMETRY
RETINOSCOPY
HOTV CARD LEA SYMBOL
MANAGEMENT
•Occlusion therapy is conducted by
• If the refractive abnormality closingcan a healthy eye for early,
be identified stimulate
therapy
thenofthe
choice the use of amblyopia
therapy and prevention can be done eyes 
(correction of glasses, patching.
evaluation and
• the use of glassesprevention,
with the right optimally.
patching, follow-up.
correction is first line of pharmacological • Patching starts after the diagnosis
amblyopia therapy. • Screening
therapy, surgery),in children• with risk factors
of amblyopia
Atropine for Penalization
amblyopia
is established or after
can be conducted with an examination,
a trial of amblyopia
(cycloplegyc Binocular
agent) therapy
 with a
• First, some patients will not need Red Reflex or Bruckner Test.
correctionantagonistic
cholinergic glasses. agent is
additional therapy if only using
• Atropine for been
Treatment of dripped on the healthy eye,
glasses that have corrected
Myopia sharp
(ATOM) mentions that • This inspection carried • •causing
no sharp
out increase
dilating
in a room in poor
vision
effect
with onbythe
using
to improve eyesight.
atropine eyes drops with a lighting, the examinerpupils glassesand
directs with the bestinto
decreases
funduscopy correction
power 
the
Parents or caregivers PATCHING
accommodation for of
twoglasses
hours every day,
• small
Second, • a Bangerter
dose,
few 0.01%,
patients Filters
who more a translucent
need middle of filter
bothattached
patients' to thetolens
eyes see theslowly
reflex of and
onthe
effectivehealthy
to eyes. myopia
prevent must understand the stimulate amblyopia eyes to work
occlusion and penalization light reflected by the •patient's
If patching
retina,
for
approximately
two hours every day
• will
This filter is intended importance
of 0.1% as maintenance of using
therapythis in near vision.
progression
therapy than
start the dose
therapy at a distance of 45after
to 70
• Blur
initial
cm.
no caused
amblyopia therapy,
improveby vision  patching
atropine causestime
andearly
within 0.5%.
both patching or atropine.patching in children so
improved/better
thecaneyebetoincreased
be hyperopiato sixsohours
thatper
it
vision  it can improve
• The effectiveness of this filter that they
as can
the motivate
main therapy for amblyopia compared with
• This examination doescannot not
day.require dilated
see objects pupils
clearly.
compliance and expected output
2 hours of patching per day children to continue
 Both using
have similar determine
value in the sharp vision
because it will be difficult resulting
results it.
increment. fundal reflex • Sharpening patients' vision should
be monitored every 6-12 weeks
depending on the severity of
amblyopia and the patient's age.
COMPLICATION

Sharp vision in healthy eyes

decreases by more 9% of
children who received reverse amblyopia
atropine eye drops during
treatment
6 months

Sharp vision in healthy

Sharp vision in healthy
eyes decreases by more
eyes decreases by about
than 1% of children who
two rows of letters on
have received patching
Snellen cards
therapy 6 hours
CONCLUSSION
periodic visual
examination is
Its management is
needed
inseparable
A good
determining the
anamnesis can
The need of triggered risk
certainly
initial factors. They
occur in one or directs the
evaluation of includes prevention,
both eyes, examination
Amblyopia is a refractive therapy of choice
and the
sharp amblyopia- (correction of
diagnosis of
decrement in tended children glasses, patching,
refractive
visual function by a pharmacological
amblyopia.
comprehensive therapy, surgery), as
eye well as evaluation
examination and follow-up.
THANK YOU