This document provides an overview of amblyopia, including: - Amblyopia is diminished vision not caused by eye pathology. It is classified by cause such as strabismic, anisometropic, and deprivation amblyopia. - Treatment involves eliminating vision obstructions, correcting refractive errors, and encouraging vision development in the amblyopic eye through occlusion therapy or penalization of the strong eye. - Occlusion therapy typically uses eye patches while penalization uses blurring techniques. Regular follow-up is important during treatment, especially for younger children. The goal is to achieve maximum possible vision in the amblyopic eye.

1. Amblyopia and it’s
management
Tukezban Huseynova, MD
Specialist in Strabismus and Refractive Cornea,
Briz-L Eye Clinic, Baku, Azerbaijan
Tukezban@gmail.com

2.  Amblyopia is derived from Greek and
means “dullness of vision.”

3.  Amblyopia is a condition of diminished visual
form sense which is not a result of any clinically
demonstrable anomaly of the visual pathway and
which is not relieved by the elimination of any defect
which constitutes a dioptric obstacle to the formation
of the foveal image.

4. Classification
 Stimulus deprivation amblyopia: this may be unilateral
or bilateral and may be
- complete, where no light enters the eye
- partial, where there is some passage of light into the eye.
 Strabismic amblyopia: which is the result of manifest strabismus
and is caused by constant unilateral strabismus in childhood.

5. Classification
 Anisometropic amblyopia: significant difference in the refractive
errors of the two eyes where one eye has the visual advantage at all
distances.
 Meridional amblyopia: is the result of uncorrected astigmatism
where one or both eyes are predominantly astigmatic.
 Ametropic amblyopia: is the result of a high degree of uncorrected
bilateral refractive error.
 Occlusion amblyopia: occur after use of total occlusion or atropine,
particularly before the age of two years. Visual acuity is usually
restored with careful treatment and monitoring.

6. Aetiology
Amblyopia may be unilateral or bilateral and the cause
may be any or a combination of the following factors.
 Light deprivation. There is no stimulus to the retina.
 Form deprivation. The retina receives a defocused image as with
refractive errors.
 Abnormal binocular interaction. Non-fusible images fall on each
fovea, as with strabismus.

7. Eye movements in Amblyopia.
-The amblyopic eye made irregular, jerky movements
- A delay in information processing by amblyopic eyes was
thought to be the cause of increased saccadic movement

8. Visual Deprivation
Amblyopia.

9.  Visual deprivation is caused by occlusion of the visual
axis.
No view

10. Features
- Visual-deprivation amblyopia (VDA) can be
unilateral or bilateral.
- Sensory strabismus often occurs in children with
unilateral vision deprivation.

11. What causes VDA?
 Congenital Cataracts,
 Ptosis,
 Congenital Corneal opacities,
 Vitreous hemorrhage
 Temporary hyphema, or
 Temporary eyelid edema in a very young child

12. Amblyopia is more likely to occur, be more severe,
and be more resistant to treatment when the defect is
UNILATERAL.

13. Strabismic Amblyopia.

14.  Is always unilateral.
 More often in esotropes than in exotropes.
 Assesment of fixation preference
 Amblyopia exists monocular or binocular
Clinical features of Strabismic
Amblyopia

15. Clinical features of Strabismic
Amblyopia
Fixation Preference
 The assessment of fixation preference is used mostly as a more practical
test for visual acuity differences between the two eyes.

16. Clinical features of Strabismic
Amblyopia
Visual Acuity
What degree of reduction in visual acuity
of one eye should be designated as
amblyopia? ??
- A difference of two lines on a visual acuity chart is commonly used as a
diagnostic criterion of amblyopia.
- Every difference in visual acuity produced by amblyopiogenic factors
should be classified as an amblyopia.

17. Clinical features of Strabismic
Amblyopia
Strong fixation preference in
a strabismic infant.
A, A child with right esotropia may not
object to having the deviated eye
covered but protests occlusion of the
dominant left eye.
B, In this patient amblyopia of OD must
be suspected

18. Clinical features of Strabismic
Amblyopia
Fixation pattern of the amblyopic eye.
Bangerter’s classification
1. Central fixation
2. Eccentric fixation ( nonfoveolar:
parafoveolar and parafoveal)
3. No fixation

19. Anisometropic
Amblyopia

20.  Anisometropic amblyopia may occur in
children with hyperopia, myopia, or
astigmatism.

21. Anisohyperopia as small as 1.0 D,
Anisomyopia as small as 2 D, or
Anisoastigmatism as small as 1.5 D
produce
Amblyopia.

22.  The mechanism responsible for the development
of amblyopia in patients with anisometropia is
thought to be similar to that which occurs in those
with strabismic amblyopia.

23. Examination of the Patient with Amblyopia.
 Vision assessment techniques vary depending on
the age and abilities of the individual child. In
preliterate children, techniques that assess visual
behavior are utilized, whereas in older and literate
children, psychophysical (quantitative) recognition
testing of visual acuity is usually possible.

24. Management of
Amblyopia.

25.  The goal of amblyopia treatment is to achieve
the maximum visual acuity and visual function
possible for an individual patient.

26.  Elimination of factors obstructing the visual axis,
such as cataracts and ptosis, is critical for patients
with deprivational amblyopia.
 Other steps include correction of significant
refractive errors, and encouraging use and
development of vision in the amblyopic eye through
occlusion therapy, penalization, or both. These steps
are outlined below.

27. Optical Correction
Correction of significant refractive errors is important to
ensure that a clear image is focused onto the fovea of each eye.

28. Occlusion Therapy
Occlusion is typically accomplished by placement of an
adhesive patch directly over the sound eye or use of a patch
that fits over the spectacle lens.

29. Occlusion Therapy
Patching Regimen
 The daily duration of recommended occlusion remains controversial.
 Amblyopia can be effectively treated with prescribed patching
regimens much less than the full-time or near full-time regimens.
 A randomized clinical trial of prescribed patching regimens of 2
versus 6 hours a day in children between the ages of 3 and 7 with mild to
moderate anisometropic or strabismic amblyopia.

30. Penalization.
 Penalization refers to a series technique used to
temporarily diminish the vision of the sound eye,
thereby encouraging use of the amblyopic eye.
 Penalization can be used as a first-line treatment
or as a back-up treatment in the event that other
therapy fails or compliance is an issue.

31. Penalization.
Pharmologic PenalizationOptical Penalization
(The instillation of cycloplegic
ophthalmic preparations into the
sound eye).
(Optical penalization involves
altering the spectacle or contact lens
correction of the sound eye to
produce image blur, providing
incentive to fixate with the amblyopic
eye).

32. Refractive Surgery
Refractive surgery has been shown to have a potential role in the
treatment of selected children with anisometropic and ametropic
amblyopia.
 Photorefractive keratectomy,
 LASIK (laser-assisted in situ
keratomileusis), and
 Clear lens extraction.

33. Long-term Follow-up.
In general, younger children should be seen more
frequently than older children during the treatment
phase of amblyopia.

34. Thank You.