AMBLYOPIA
Presenter : Dr Nikhil Agrawal (1st year resident)
Moderator : Dr Ekta Gupta
DHIR HOSPITAL POST GRADUATE INSTITUTE OF OPHTHALMOLOGY
BHIWANI-127021
Email: education@dhirhospital.com
This document discusses various binocular refraction techniques including binocular balancing and binocular best sphere. It describes several methods for achieving binocular balancing such as Humphiss fogging, alternate occlusion testing, duochrome testing with fogging, prism dissociation, and Turville's infinity balance test. The goal of binocular balancing is to achieve equal accommodation between the two eyes rather than just matching visual acuity. Proper binocular balancing is important to reduce asthenopia from an imbalanced refraction.
This document discusses soft toric contact lenses for correcting astigmatism. It defines astigmatism and describes various types. It explains that toric lenses contain a cylindrical component to correct astigmatism unlike standard soft lenses. The document outlines several designs and methods for stabilizing toric soft contact lenses, including prism ballast, dynamic stabilization, and reverse prism designs. It provides steps for fitting toric lenses including diagnosis, trial lenses, and assessing lens rotation to finalize the axis. Examples of toric lens prescriptions and assessments of fit are also summarized.
This document discusses amblyopia, also known as lazy eye. It defines amblyopia as reduced vision in one or both eyes caused by abnormal visual development during childhood. The main causes of amblyopia are strabismus (eye misalignment), refractive error (such as significant nearsightedness, farsightedness or astigmatism), and form deprivation (obstruction of vision in one eye). Early diagnosis and treatment before age 10 is important, as amblyopia can be reversed during the "critical period" of visual development in childhood. Treatment involves correcting refractive errors, patching or blurring the better-seeing eye, and sometimes eye muscle surgery.
The document discusses the Jackson Cross Cylinder (JCC) test, which is used during refraction to detect and refine astigmatism. The JCC is a combination of two cylinders of equal strength but opposite signs, placed at right angles to each other. During the test, the JCC is held in different positions before the eye to see if there is a change in visual acuity. If a position is clearer, it indicates the axis of astigmatism. The test is then used to refine the axis and power of any astigmatic correction.
The document discusses Pentacam corneal topography. Some key points:
- Pentacam uses Scheimpflug imaging to obtain images of the anterior segment and measure the shape of the cornea.
- It provides quantitative indices like simulated keratometry and maps of corneal power, elevation, and irregularity to evaluate corneal shape.
- Pentacam is useful for diagnosing conditions like keratoconus by detecting thinning, steepening, and irregularity. It can also evaluate outcomes of procedures like refractive surgery and intraocular surgery.
- Clinical applications include pre-op screening, surgical planning, contact lens fitting, and determining refraction.
The document summarizes the objectives, methods, results and conclusions of 13 studies conducted by the Pediatric Eye Disease Investigator Group (PEDIG) on various amblyopia treatments. The studies compared treatments such as patching, atropine, Bangerter filters and optical correction alone. They found that most treatments, including shorter daily patching durations, improved visual acuity in amblyopic eyes, though residual amblyopia often remained. Combining treatments did not provide significantly better outcomes than single treatments.
The document summarizes a case study of a 20-year-old male patient with left eye vision loss since childhood due to corneal scarring who was fitted for a prosthetic soft contact lens. Details are provided on the patient's history and examination, differential diagnosis, types and fitting criteria of prosthetic contact lenses, fitting of a medium brown type D prosthetic lens, and fitting assessment showing good coverage, centration, and movement. The plan is for the patient to be fitted with a single purecon prosthetic soft contact lens.
This document discusses various binocular refraction techniques including binocular balancing and binocular best sphere. It describes several methods for achieving binocular balancing such as Humphiss fogging, alternate occlusion testing, duochrome testing with fogging, prism dissociation, and Turville's infinity balance test. The goal of binocular balancing is to achieve equal accommodation between the two eyes rather than just matching visual acuity. Proper binocular balancing is important to reduce asthenopia from an imbalanced refraction.
This document discusses soft toric contact lenses for correcting astigmatism. It defines astigmatism and describes various types. It explains that toric lenses contain a cylindrical component to correct astigmatism unlike standard soft lenses. The document outlines several designs and methods for stabilizing toric soft contact lenses, including prism ballast, dynamic stabilization, and reverse prism designs. It provides steps for fitting toric lenses including diagnosis, trial lenses, and assessing lens rotation to finalize the axis. Examples of toric lens prescriptions and assessments of fit are also summarized.
This document discusses amblyopia, also known as lazy eye. It defines amblyopia as reduced vision in one or both eyes caused by abnormal visual development during childhood. The main causes of amblyopia are strabismus (eye misalignment), refractive error (such as significant nearsightedness, farsightedness or astigmatism), and form deprivation (obstruction of vision in one eye). Early diagnosis and treatment before age 10 is important, as amblyopia can be reversed during the "critical period" of visual development in childhood. Treatment involves correcting refractive errors, patching or blurring the better-seeing eye, and sometimes eye muscle surgery.
The document discusses the Jackson Cross Cylinder (JCC) test, which is used during refraction to detect and refine astigmatism. The JCC is a combination of two cylinders of equal strength but opposite signs, placed at right angles to each other. During the test, the JCC is held in different positions before the eye to see if there is a change in visual acuity. If a position is clearer, it indicates the axis of astigmatism. The test is then used to refine the axis and power of any astigmatic correction.
The document discusses Pentacam corneal topography. Some key points:
- Pentacam uses Scheimpflug imaging to obtain images of the anterior segment and measure the shape of the cornea.
- It provides quantitative indices like simulated keratometry and maps of corneal power, elevation, and irregularity to evaluate corneal shape.
- Pentacam is useful for diagnosing conditions like keratoconus by detecting thinning, steepening, and irregularity. It can also evaluate outcomes of procedures like refractive surgery and intraocular surgery.
- Clinical applications include pre-op screening, surgical planning, contact lens fitting, and determining refraction.
The document summarizes the objectives, methods, results and conclusions of 13 studies conducted by the Pediatric Eye Disease Investigator Group (PEDIG) on various amblyopia treatments. The studies compared treatments such as patching, atropine, Bangerter filters and optical correction alone. They found that most treatments, including shorter daily patching durations, improved visual acuity in amblyopic eyes, though residual amblyopia often remained. Combining treatments did not provide significantly better outcomes than single treatments.
The document summarizes a case study of a 20-year-old male patient with left eye vision loss since childhood due to corneal scarring who was fitted for a prosthetic soft contact lens. Details are provided on the patient's history and examination, differential diagnosis, types and fitting criteria of prosthetic contact lenses, fitting of a medium brown type D prosthetic lens, and fitting assessment showing good coverage, centration, and movement. The plan is for the patient to be fitted with a single purecon prosthetic soft contact lens.
Fitting soft contact lenses requires considering many patient-specific factors to achieve excellent vision and ocular health. A proper fit involves selecting the correct total diameter, base curve, thickness, and material based on the patient's prescription, corneal shape, lifestyle, and health. Trial lenses are used to evaluate fit parameters like coverage, centration, movement, comfort, and vision to optimize on-eye performance while avoiding issues like tightness or looseness that could impact ocular health or vision. The goal is to find a lens that provides optimum vision and good comfort without causing any ocular insult.
Presbyopic Contact Lenses: Bifocals and MultifocalsRabindraAdhikary
This document discusses presbyopic contact lenses and their history, principles, types, designs, fitting considerations, and tips for success. It provides an overview of bifocal contact lens options including simultaneous vision, alternating vision, monovision, multifocal, and non-refractive designs. Key aspects of the fitting process like determining the ideal candidate, measuring important parameters, and troubleshooting vision outcomes are summarized.
This document discusses amblyopia, including its classification, pathophysiology, clinical characteristics, evaluation, and management. It defines amblyopia and outlines its prevalence. Amblyopia can be classified as functional or organic, and further divided into types such as strabismic, anisometropic, and stimulus deprivation amblyopia. Clinical signs may include reduced visual acuity, abnormal fixation, impaired stereopsis, and altered contrast sensitivity. Evaluation involves assessing visual acuity, fixation, binocularity, and refractive error. Management is focused on occlusion therapy to treat the amblyopic eye.
The ROSE K family of lenses were invented by Paul Rose to closely mimic the cone-like shape of the cornea for keratoconus. The lenses use complex geometry that can be customized for each eye. They provide excellent corneal health and high success rates of over 80%. Design features include aspheric optics, aberration control, and flexible edge lifts. Standard lenses do not ideally fit keratoconus, but ROSE K lenses contour to the cone shape with little tear pooling at the base. Types include ROSE K2 for irregular corneas, post-graft, and nipple cones. Fitting involves selecting the base curve, optimizing the peripheral fit, diameter, location, movement, and
Soft toric contact lenses are used to correct astigmatism by having different powers in different meridians. They come in various types depending on the surface curvature (front toric, back toric, bitoric), material (hydrogel, silicone hydrogel), wearing schedule (disposable, extended wear), and color. Silicone hydrogel lenses allow for higher oxygen permeability. Toric lenses are suitable for astigmatism patients wanting colored lenses. Disposable lenses are worn daily to monthly while extended wear lenses can be worn continuously for up to 30 days. Soft toric lenses are indicated for astigmatism over 0.75D when spherical lenses are insufficient or rigid lenses not tolerated.
This case study presents a 27-year old female patient diagnosed with retinitis pigmentosa (RP). RP is a hereditary disorder that primarily affects the rods in the retina. The patient's symptoms include tunnel vision and nyctalopia that have been present since childhood. Examination revealed pale optic discs, bone spicule pigmentation in the periphery, and reduced visual acuity. The patient was prescribed glasses, a stand magnifier, and referred to a low vision rehabilitation center for mobility training and counseling. She was advised to follow up in 6 months and receive genetic counseling due to her family history of consanguinity.
Pediatric Ophthalmic dispensing in different visual problemsRaju Kaiti
Pediatric dispensing, introduction, different from adult dispensing, frame selection, lens selection, special case fitting, Do's and Dont's, Measurements, Down's syndrome, albinism, aphakia, strabismus, syndromes
The FDA classifies soft contact lenses into four groups based on their water content and ionic charge. Group 1 lenses have low water content and are non-ionic, while Group 2 lenses have high water content but are also non-ionic. Group 3 lenses have low water content but are ionic, and Group 4 lenses have high water content and are ionic. This classification system helps differentiate lenses' interactions with care products and their tendencies to accumulate protein deposits from tears.
Accommodative and vergence dysfunctions can cause symptoms like blurred vision, difficulty reading, and asthenopia. Key diagnostic tests include cover test, versions, near point of convergence, and fusional vergence amplitudes. Accommodative issues include insufficiency, fatigue, and infacility. Vergence issues include convergence insufficiency, divergence excess, and basic exophoria. Early treatment is important to prevent amblyopia or learning problems from vergence anomalies.
This document discusses intermittent exotropia, including its theories, presentation, examination, classification, treatment, and surgical management. The key points are:
1. Intermittent exotropia is thought to be caused by an imbalance between convergence and divergence muscles. It typically begins as exophoria in infancy and progresses to intermittent exotropia.
2. Examination includes measuring the deviation at distance and near with and without lenses to classify the type. Non-surgical treatment aims to improve vergence control through patching, lenses, and orthoptics.
3. Surgical treatment is indicated for deviations over 20 prism diopters, worsening control, or failure of conservative therapy.
This document discusses the AC/A ratio, which is the ratio of accommodative convergence to accommodation. It defines the AC/A ratio and notes the normal range is 3-5 prism diopters per diopter of accommodation. Abnormal AC/A ratios can cause strabismus. The document outlines methods to measure the AC/A ratio clinically and discusses its uses in diagnosing different types of strabismus and their management approaches.
This document discusses the optics of contact lenses compared to spectacle lenses. It covers topics such as vertex distance, magnification, accommodation, and how contact lenses correct refractive errors like myopia and hyperopia. The key points are:
1) Contact lenses have a closer vertex distance than spectacles, which affects lens power and image size.
2) Contact lenses provide a clearer image with less magnification than spectacles for both myopes and hyperopes.
3) Accommodation requirements are less with contact lenses than spectacles, especially for hyperopes.
4) Contact lenses are generally better than spectacles for refractive errors while spectacles may be better for axial ametropias.
Contact lens fitting in keratoconus copykamal thakur
This document discusses keratoconus and contact lens fitting options for keratoconus patients. It begins by describing the different types and stages of keratoconus cones. It then discusses the various contact lens options including soft lenses, rigid gas permeable lenses, and scleral lenses. For rigid gas permeable lenses, it explains the different fitting philosophies of apical bearing, apical clearance, and three point touch. Specific lens designs like Rose K2 and scleral lenses are also summarized. Key factors for determining the appropriate contact lens are also listed.
This document provides an overview of Duane's retraction syndrome, including:
- It was first described in the late 19th century and studied in more detail by Duane in 1905, giving the syndrome its current name.
- It is a congenital eye movement disorder characterized by limited eye movement, especially abnormal adduction.
- Symptoms often do not appear until childhood and may include a face turn, strabismus, or limited eye movement.
- It is usually unilateral but can be bilateral, and classification systems describe the degree and direction of limited eye movement.
- Surgery is generally only needed for decompensated cases or poor compensation and aims to correct strabismus
This document provides information on contact lens options for managing keratoconus. It discusses various soft lens designs, scleral lenses, corneal lenses, and hybrid lens systems. For corneal lenses, it describes two fitting philosophies - apical bearing and apical clearance. Specific lens designs are also outlined, including Soper, McGuire, NiCone, and ROSE K lenses, which are designed to closely fit the irregular shape of the cornea in keratoconus. The document provides details on parameters like total diameter, base curve radius, optic zone diameter, and materials for fitting these specialized lenses.
Subjective refraction is used to find the best corrective lenses for a patient and requires their cooperation. It involves monocular refraction of each eye separately to determine the cylindrical lens power and axis as well as best spherical lens. This is followed by binocular balancing to ensure clear vision with both eyes open. Techniques like fogging, cross-cylinders, and Maddox rods are used in monocular refraction while techniques like fogging with occlusion, duochrome testing, and prism dissociation are used for binocular balancing. Determining the near vision correction involves estimating accommodation amplitude and adding readers if needed for presbyopia.
This document provides an introduction to binocular single vision (BSV) including its definition, grades, advantages, development, mechanisms, anomalies, and investigations. BSV is the coordinated use of both eyes to see a single image through the process of fusion. It develops in early childhood as the visual axes align and fusional movements are established. Maintaining BSV provides advantages like stereopsis and binocular summation. Investigations of BSV assess fusion, retinal correspondence, suppression, and stereopsis.
This document provides an overview of orthokeratology (orthokeratology), which aims to temporarily reshape the cornea through the overnight use of specialized contact lenses to reduce or eliminate the need for refractive correction. It discusses the history of orthokeratology from its origins in the 1960s using conventional geometry lenses to more modern techniques employing reverse geometry lenses made of high Dk materials. The mechanisms by which orthokeratology reshapes the cornea, patient selection criteria, potential indications and contraindications are described. Advantages include reversibility and potentially slowing myopia progression in children, while disadvantages include its non-permanence and risk of non-compliance.
Management of visual problems of Aging by Ashith Tripathi Ashith Tripathi
This presentation contains headings - Visual performance in the ageing eye
Routine optometric and ocular examination of an older adult:
History
Ocular health examination
Visual acuity measurement
Refraction
Binocular vision
Visual field measurement
Colour vision
Management of vision problems in older adults
Frame requirement
Lens requirements
And special instructions etc.
The keratometer is an instrument used to measure the curvature of the cornea, which provides information such as the radii of curvature, astigmatism level and direction, and presence of distortions. Keratometry is important for contact lens fitting, monitoring keratoconus, and determining intraocular lens power for cataract surgery. There are two main types - single-position keratometers measure two meridians simultaneously while double-position keratometers measure one meridian at a time. The procedure involves aligning and focusing the instrument before taking radius and astigmatism measurements from the scales.
This document provides information on amblyopia, including its definition, epidemiology, pathophysiology, classification, clinical features, diagnosis, and treatment modalities. It defines amblyopia as a reduction in best corrected visual acuity that cannot be attributed to a structural eye abnormality. The main causes are strabismic amblyopia, stimulus deprivation amblyopia, and anisometropic amblyopia. Treatment involves eliminating obstacles to vision, correcting refractive errors, and forcing use of the amblyopic eye through occlusion or penalization of the good eye. Occlusion therapy is the most effective amblyopia treatment.
Amblyopia & its management by sivateja challaSivateja Challa
This document provides information on amblyopia, including its definition, epidemiology, pathophysiology, classification, clinical features, diagnosis, and treatment modalities. It defines amblyopia as a reduction in best corrected visual acuity that cannot be attributed to a structural eye abnormality. The main causes are strabismic amblyopia, stimulus deprivation amblyopia, and anisometropic amblyopia. Treatment involves eliminating obstacles to vision, correcting refractive errors, and forcing use of the amblyopic eye through occlusion or penalization of the good eye. Occlusion therapy is the most effective amblyopia treatment.
Fitting soft contact lenses requires considering many patient-specific factors to achieve excellent vision and ocular health. A proper fit involves selecting the correct total diameter, base curve, thickness, and material based on the patient's prescription, corneal shape, lifestyle, and health. Trial lenses are used to evaluate fit parameters like coverage, centration, movement, comfort, and vision to optimize on-eye performance while avoiding issues like tightness or looseness that could impact ocular health or vision. The goal is to find a lens that provides optimum vision and good comfort without causing any ocular insult.
Presbyopic Contact Lenses: Bifocals and MultifocalsRabindraAdhikary
This document discusses presbyopic contact lenses and their history, principles, types, designs, fitting considerations, and tips for success. It provides an overview of bifocal contact lens options including simultaneous vision, alternating vision, monovision, multifocal, and non-refractive designs. Key aspects of the fitting process like determining the ideal candidate, measuring important parameters, and troubleshooting vision outcomes are summarized.
This document discusses amblyopia, including its classification, pathophysiology, clinical characteristics, evaluation, and management. It defines amblyopia and outlines its prevalence. Amblyopia can be classified as functional or organic, and further divided into types such as strabismic, anisometropic, and stimulus deprivation amblyopia. Clinical signs may include reduced visual acuity, abnormal fixation, impaired stereopsis, and altered contrast sensitivity. Evaluation involves assessing visual acuity, fixation, binocularity, and refractive error. Management is focused on occlusion therapy to treat the amblyopic eye.
The ROSE K family of lenses were invented by Paul Rose to closely mimic the cone-like shape of the cornea for keratoconus. The lenses use complex geometry that can be customized for each eye. They provide excellent corneal health and high success rates of over 80%. Design features include aspheric optics, aberration control, and flexible edge lifts. Standard lenses do not ideally fit keratoconus, but ROSE K lenses contour to the cone shape with little tear pooling at the base. Types include ROSE K2 for irregular corneas, post-graft, and nipple cones. Fitting involves selecting the base curve, optimizing the peripheral fit, diameter, location, movement, and
Soft toric contact lenses are used to correct astigmatism by having different powers in different meridians. They come in various types depending on the surface curvature (front toric, back toric, bitoric), material (hydrogel, silicone hydrogel), wearing schedule (disposable, extended wear), and color. Silicone hydrogel lenses allow for higher oxygen permeability. Toric lenses are suitable for astigmatism patients wanting colored lenses. Disposable lenses are worn daily to monthly while extended wear lenses can be worn continuously for up to 30 days. Soft toric lenses are indicated for astigmatism over 0.75D when spherical lenses are insufficient or rigid lenses not tolerated.
This case study presents a 27-year old female patient diagnosed with retinitis pigmentosa (RP). RP is a hereditary disorder that primarily affects the rods in the retina. The patient's symptoms include tunnel vision and nyctalopia that have been present since childhood. Examination revealed pale optic discs, bone spicule pigmentation in the periphery, and reduced visual acuity. The patient was prescribed glasses, a stand magnifier, and referred to a low vision rehabilitation center for mobility training and counseling. She was advised to follow up in 6 months and receive genetic counseling due to her family history of consanguinity.
Pediatric Ophthalmic dispensing in different visual problemsRaju Kaiti
Pediatric dispensing, introduction, different from adult dispensing, frame selection, lens selection, special case fitting, Do's and Dont's, Measurements, Down's syndrome, albinism, aphakia, strabismus, syndromes
The FDA classifies soft contact lenses into four groups based on their water content and ionic charge. Group 1 lenses have low water content and are non-ionic, while Group 2 lenses have high water content but are also non-ionic. Group 3 lenses have low water content but are ionic, and Group 4 lenses have high water content and are ionic. This classification system helps differentiate lenses' interactions with care products and their tendencies to accumulate protein deposits from tears.
Accommodative and vergence dysfunctions can cause symptoms like blurred vision, difficulty reading, and asthenopia. Key diagnostic tests include cover test, versions, near point of convergence, and fusional vergence amplitudes. Accommodative issues include insufficiency, fatigue, and infacility. Vergence issues include convergence insufficiency, divergence excess, and basic exophoria. Early treatment is important to prevent amblyopia or learning problems from vergence anomalies.
This document discusses intermittent exotropia, including its theories, presentation, examination, classification, treatment, and surgical management. The key points are:
1. Intermittent exotropia is thought to be caused by an imbalance between convergence and divergence muscles. It typically begins as exophoria in infancy and progresses to intermittent exotropia.
2. Examination includes measuring the deviation at distance and near with and without lenses to classify the type. Non-surgical treatment aims to improve vergence control through patching, lenses, and orthoptics.
3. Surgical treatment is indicated for deviations over 20 prism diopters, worsening control, or failure of conservative therapy.
This document discusses the AC/A ratio, which is the ratio of accommodative convergence to accommodation. It defines the AC/A ratio and notes the normal range is 3-5 prism diopters per diopter of accommodation. Abnormal AC/A ratios can cause strabismus. The document outlines methods to measure the AC/A ratio clinically and discusses its uses in diagnosing different types of strabismus and their management approaches.
This document discusses the optics of contact lenses compared to spectacle lenses. It covers topics such as vertex distance, magnification, accommodation, and how contact lenses correct refractive errors like myopia and hyperopia. The key points are:
1) Contact lenses have a closer vertex distance than spectacles, which affects lens power and image size.
2) Contact lenses provide a clearer image with less magnification than spectacles for both myopes and hyperopes.
3) Accommodation requirements are less with contact lenses than spectacles, especially for hyperopes.
4) Contact lenses are generally better than spectacles for refractive errors while spectacles may be better for axial ametropias.
Contact lens fitting in keratoconus copykamal thakur
This document discusses keratoconus and contact lens fitting options for keratoconus patients. It begins by describing the different types and stages of keratoconus cones. It then discusses the various contact lens options including soft lenses, rigid gas permeable lenses, and scleral lenses. For rigid gas permeable lenses, it explains the different fitting philosophies of apical bearing, apical clearance, and three point touch. Specific lens designs like Rose K2 and scleral lenses are also summarized. Key factors for determining the appropriate contact lens are also listed.
This document provides an overview of Duane's retraction syndrome, including:
- It was first described in the late 19th century and studied in more detail by Duane in 1905, giving the syndrome its current name.
- It is a congenital eye movement disorder characterized by limited eye movement, especially abnormal adduction.
- Symptoms often do not appear until childhood and may include a face turn, strabismus, or limited eye movement.
- It is usually unilateral but can be bilateral, and classification systems describe the degree and direction of limited eye movement.
- Surgery is generally only needed for decompensated cases or poor compensation and aims to correct strabismus
This document provides information on contact lens options for managing keratoconus. It discusses various soft lens designs, scleral lenses, corneal lenses, and hybrid lens systems. For corneal lenses, it describes two fitting philosophies - apical bearing and apical clearance. Specific lens designs are also outlined, including Soper, McGuire, NiCone, and ROSE K lenses, which are designed to closely fit the irregular shape of the cornea in keratoconus. The document provides details on parameters like total diameter, base curve radius, optic zone diameter, and materials for fitting these specialized lenses.
Subjective refraction is used to find the best corrective lenses for a patient and requires their cooperation. It involves monocular refraction of each eye separately to determine the cylindrical lens power and axis as well as best spherical lens. This is followed by binocular balancing to ensure clear vision with both eyes open. Techniques like fogging, cross-cylinders, and Maddox rods are used in monocular refraction while techniques like fogging with occlusion, duochrome testing, and prism dissociation are used for binocular balancing. Determining the near vision correction involves estimating accommodation amplitude and adding readers if needed for presbyopia.
This document provides an introduction to binocular single vision (BSV) including its definition, grades, advantages, development, mechanisms, anomalies, and investigations. BSV is the coordinated use of both eyes to see a single image through the process of fusion. It develops in early childhood as the visual axes align and fusional movements are established. Maintaining BSV provides advantages like stereopsis and binocular summation. Investigations of BSV assess fusion, retinal correspondence, suppression, and stereopsis.
This document provides an overview of orthokeratology (orthokeratology), which aims to temporarily reshape the cornea through the overnight use of specialized contact lenses to reduce or eliminate the need for refractive correction. It discusses the history of orthokeratology from its origins in the 1960s using conventional geometry lenses to more modern techniques employing reverse geometry lenses made of high Dk materials. The mechanisms by which orthokeratology reshapes the cornea, patient selection criteria, potential indications and contraindications are described. Advantages include reversibility and potentially slowing myopia progression in children, while disadvantages include its non-permanence and risk of non-compliance.
Management of visual problems of Aging by Ashith Tripathi Ashith Tripathi
This presentation contains headings - Visual performance in the ageing eye
Routine optometric and ocular examination of an older adult:
History
Ocular health examination
Visual acuity measurement
Refraction
Binocular vision
Visual field measurement
Colour vision
Management of vision problems in older adults
Frame requirement
Lens requirements
And special instructions etc.
The keratometer is an instrument used to measure the curvature of the cornea, which provides information such as the radii of curvature, astigmatism level and direction, and presence of distortions. Keratometry is important for contact lens fitting, monitoring keratoconus, and determining intraocular lens power for cataract surgery. There are two main types - single-position keratometers measure two meridians simultaneously while double-position keratometers measure one meridian at a time. The procedure involves aligning and focusing the instrument before taking radius and astigmatism measurements from the scales.
This document provides information on amblyopia, including its definition, epidemiology, pathophysiology, classification, clinical features, diagnosis, and treatment modalities. It defines amblyopia as a reduction in best corrected visual acuity that cannot be attributed to a structural eye abnormality. The main causes are strabismic amblyopia, stimulus deprivation amblyopia, and anisometropic amblyopia. Treatment involves eliminating obstacles to vision, correcting refractive errors, and forcing use of the amblyopic eye through occlusion or penalization of the good eye. Occlusion therapy is the most effective amblyopia treatment.
Amblyopia & its management by sivateja challaSivateja Challa
This document provides information on amblyopia, including its definition, epidemiology, pathophysiology, classification, clinical features, diagnosis, and treatment modalities. It defines amblyopia as a reduction in best corrected visual acuity that cannot be attributed to a structural eye abnormality. The main causes are strabismic amblyopia, stimulus deprivation amblyopia, and anisometropic amblyopia. Treatment involves eliminating obstacles to vision, correcting refractive errors, and forcing use of the amblyopic eye through occlusion or penalization of the good eye. Occlusion therapy is the most effective amblyopia treatment.
A detailed presentation covering all aspects of amblyopia, a form of cortical visual impairment, defined clinically as a unilateral or bilateral decrease of visual acuity (VA) that cannot be attributed to structural abnormalities of the eye or visual pathway
This document defines and classifies different types of amblyopia, including strabismic amblyopia, stimulus deprivation amblyopia, anisometropic amblyopia, meridional amblyopia, and bilateral ametropic amblyopia. It discusses the pathogenesis and pathophysiology of amblyopia, noting that visual deprivation during early development can cause changes in visual system neurons. The evaluation, diagnosis, and management of amblyopia are also outlined, including prevention through early vision screening, treatment by eliminating causes of visual deprivation and correcting refractive errors, and occlusion therapy to correct ocular dominance.
Amblyopia is a reduction in best corrected visual acuity that cannot be attributed to structural eye abnormalities and results from strabismus, anisometropia, high bilateral refractive error, or visual deprivation. It is primarily a defect in central vision and prevalence is 2-4% in North America. Treatment involves refractive correction, patching or penalizing the better eye to force use of the weaker eye. Prognosis is best when treatment begins early in childhood during the critical period of visual development.
This document provides an overview of amblyopia, including its definition, pathophysiology, classification, clinical characteristics, evaluation, diagnosis, and treatment. Amblyopia is reduced best-corrected visual acuity that cannot be attributed to a structural abnormality and develops due to abnormal visual experience during the visual system's critical period of development early in life. It is classified based on etiology, such as strabismic, refractive, or deprivation amblyopia. Treatment focuses on providing a clear retinal image and correcting ocular dominance through refractive correction and occlusion or penalization therapy, with the goal of improving visual acuity before the end of the critical period.
This document discusses amblyopia, including its classification, etiology, and diagnosis. It defines amblyopia as a decrease in visual acuity caused by pattern vision deprivation or abnormal binocular interaction that cannot be corrected by optical or surgical means. Amblyopia can be functional, resulting from stimulus deprivation, strabismus, refractive errors, or anisometropia, or organic, caused by retinal diseases, nutritional deficiencies, or toxins. The document covers various types of amblyopia in detail and discusses methods for detecting, investigating, and determining the prognosis of amblyopia.
Amblyopia, commonly known as lazy eye, refers to reduced vision in one or both eyes that is not correctable by glasses and is not caused by any organic eye disease. It is caused by abnormal visual development in early childhood due to strabismus, anisometropia, media opacities, or form deprivation. Diagnosis involves assessing visual acuity, refractive error, eye alignment and binocularity. Treatment focuses on improving vision in the amblyopic eye through patching or atropine drops in the good eye, with the goal of treatment being before age 7 for best results. Surgery may be needed to treat underlying causes such as strabismus or cataracts.
Visual Axis Deprivation Amblyopia results from prolonged obstruction of the visual axis in one eye during childhood. It is the least common but most severe type of amblyopia. Prolonged monocular conditions like congenital cataract, ptosis, or corneal opacity before age 6 can cause severe visual loss. Treatment involves removing any obstructions, refractive correction, and occluding the good eye to encourage use of the amblyopic eye. Amblyopia affects 1-5% of the population in developed countries and 1-4% in India. Earlier onset and longer duration of obstruction lead to greater visual impairment.
Amblyopia is a condition of reduced vision in one or both eyes that is not caused by structural eye problems. It occurs during early childhood development when there is inadequate visual stimulation to one or both eyes. Common causes include strabismus, significant refractive error differences between the eyes, form deprivation, and abnormal binocular interaction. Treatment involves correcting any refractive errors and using occlusion therapy or drugs to blur vision in the non-amblyopic eye, forcing use of the amblyopic eye. Occlusion therapy is the most common treatment but requires compliance to achieve results. Other options include penalization, visual stimulation, and drugs, but occlusion remains the standard first approach. Success depends on early diagnosis and treatment before age 7.
This document provides information on the diagnosis and treatment of childhood amblyopia. It defines amblyopia as reduced best corrected visual acuity caused by form vision deprivation or abnormal binocular interaction without an organic cause. Key points include:
- Amblyopia affects 1-5% of the population and has a critical period between ages 4 months to 5 years.
- Diagnosis is usually made through routine screening between ages 3-5 years. Treatment involves refractive correction, occlusion therapy using adhesive skin patches, and sometimes supplemental medications like levodopa.
- The goal of treatment is to eliminate eccentric fixation and develop foveal fixation in the amblyopic eye. Full-time occlusion of the non-amb
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.
AMBLYOPIA CLASSIFICATION-SQUINT.ppt classification of ambylopia pptVinodhini92
This document discusses amblyopia, including its definition, classification, causes, assessment, and management. It defines amblyopia as reduced vision in an eye that cannot be corrected by glasses or contact lenses. The main types of amblyopia are strabismic, anisometropic, ametropic, stimulus deprivation, and meridional amblyopia. Assessment involves tests like cover testing, while management consists of optical correction, occlusion or penalization of the good eye, and visual stimulation techniques for the amblyopic eye. The goal is to improve vision in the amblyopic eye through treatment during childhood.
Amblyopia, commonly known as a "lazy eye", is a reduction in vision that occurs in one or both eyes due to abnormal visual development during childhood. There are several causes of amblyopia including unequal refractive errors between the eyes (anisometropia), misaligned eyes (strabismus), visual deprivation from conditions like cataracts, and high amounts of uncorrected refractive errors. Amblyopia is assessed through visual acuity tests, refractive error checks, and examinations for eye alignment and movement. Treatment involves correcting any refractive errors, wearing an eye patch over the strong eye to encourage use of the weak eye, atropine eye drops to blur vision in the strong eye, or active visual stimulation therapies
Dr. Shashidhar Patil presented on amblyopia (lazy eye) at a symposium moderated by Dr. Arvind L. Tenagi. Amblyopia is a common vision problem in children caused by abnormal visual development that results in decreased vision in one or both eyes. It can be prevented or reversed with early intervention before age 8. Treatment involves prescribing corrective lenses, removing any obstructions to vision, and occluding the better eye to force use of the amblyopic eye. Occlusion therapy works best when started early and continued consistently over time with good parental cooperation.
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1. AMBLYOPIA
Presenter : Dr Nikhil Agrawal (1st year resident)
Moderator : Dr Ekta Gupta
DHIR HOSPITAL AND POSTGRADUATE INSTITUTE OF OPHTHALMOLOGY
2. DEFINITION
• Amblyopia (lazy eye) has been described as unilateral or bilateral reduction in
BCVA caused by vision deprivation , abnormal binocular interaction , without a
visible organic cause .
• Most common cause of preventable uniocular vision loss in children .
• The visual loss is correctable, if appropriate measures are applied at appropriate
time .
3.
4. Epidemiology
• Onset – Birth to 7 yrs
• Socio-economic factors does not significantly matter .
• Earlier the onset the greater the deficit .
• 4 times more frequent in premature children .
• 6 times more frequent in children with delayed milestones .
• Other risks are Retinopathy of Prematurity, malnutrition, maternal smoking, use of
drugs and/or alcohol , albinism, Down syndrome, neurological problems like
hydrocephaly and cerebral palsy..
6. Significant electrophysiological and anatomical
abnormalities are seen in the striate cortex and
lateral geniculate nucleus (LGN). The
neurophysiology reveals that the deprived eye
shows a marked shrinkage of its input stripes
(ocular dominance columns) and a
corresponding expansion of the non deprived
eye.
7. Pathophysiology
• Critical period-The period of development of visual acuity (1 month to 3-5 years of
age).
• Sensitive period-The period during which deprivation is effective in causing
amblyopia (a few months to 7 or 8 years of age) .
• Plastic period -The period during which recovery from amblyopia can be obtained
(time of deprivation to the teenage years or even into the adult years)
• Bilateral stimulus deprivation in critical period disrupts the development of fixation
reflex and nystagmus appears as a result of this.
8. TYPES
Functional Amblyopia Organic Amblyopia
Potentially reversible Irreversible
Refers to obligatory psychical suppression of the
retinal image.
Refers to partial loss of vision caused by undetectable
organic lesions in the eye or in the visual pathway.
Types: Strabismic, Anisometropic, Ametropic,
Meridional, Stimulus, Deprivation
Types: Nutritional, Toxic, d/t retinal diseases,
Idiopathic
Usually seen in childhood Can cause visual acuity defect at any age
10. STRABISMIC AMBLYOPIA
• Seen in patients with unilateral constant squint who strongly favour one eye for
fixation from birth to 6 years of age.
• Seen far more often in esotropes than the exotropes.
• Types –
Cong. Esotropia
Cong. Exotropia
Accommodative Esotropia
Acquired constant tropia in childhood
Monofixation Syndrome (small angle tropia )
11. STRABISMIC AMBLYOPIA
• Does not develop in alternating or intermittent strabismus as there are periods of
normal binocular interaction that preserve the integrity of visual system .
• Severity of amblyopia does not correlate with angle of strabismus.
12. VISUAL DEPRIVATION AMBLYOPIA
• Disuse amblyopia.
• Caused by those conditions wherein one eye is prevented from seeing early in life.
• Most common cause is congenital , developmental , traumatic cataract , but
complete ptosis, corneal opacity and vitreous hemorrhage may also implicated.
• Occlusion amblyopia- type of deprivational amblyopia caused by excessive
therapeutic patching.
• Visual loss resulting from unilateral deprivation is worse than that produced by
bilateral deprivation of similar degree.
13. ANISOMETROPIC AMBLYOPIA
• Refers to the amblyopia occurring in an eye having higher degree of refractive
error than the fellow eye.
• Most patients have straight eyes and appear normal , so the only way to identify
these patients is through vision screening.
• Amblyopia is more common and is of higher degree in patients with
anisohypermetropia than in those with anisomyopia.
• Potentially Amblyopiogenic Refractive Errors :
14. ISOMETROPIC AMBLYOPIA
• • Bilateral amblyopia occurring in children with bilateral uncorrected high
refractive error.
• Mechanism – effect of blurred retinal images alone.
• Potentially Amblyopiogenic Refractive Errors :
15. CLINICAL CHARACTERISTICS
• Decreased visual acuity
• Decreased stereopsis
• Fixation reflex
• Crowding phenomenon
• Effect of neutral density filter
• Contrast sensitivity
• Fixation pattern
• VEP - Reduction in amplitude and slightly prolonged latency
• Afferent pupillary defect may be seen
• Occasionally latent nystagmus
16. VISUAL ACUITY
• Two line difference between amblyopic and
normal eye
• For B/L amblyopia the VA should be less than
6/12 in each eye
• VA in children-
Infants - Fixation preference preverbal
Children-preferential looking test , OKN test , VEP
2-3 yrs - E charts , pictorial charts
>3 yrs – Snellen’s charts , HOTV charts
Lea’s padels
OKN TEST
18. FIXATION REFLEX
• Useful tool to assess VA in
children <5yrs of age
• Central steady and maintained
(CSM) fixation implies good VA .
19. CROWDING PHENOMENON
• Amblyopia patients exhibit better VA for single optotypes than for letters placed in
a row .
• Vision testing with single optotypes is likely to over estimate VA in pts with
amblyopia
• More accurate assessment of mono ocular VA is obtained with the presentation of
line of optotypes or single optotype with crowding bars that surround the
optotype being identified .
20. NEUTRAL DENSITY FILTER
• A neutral density filter reduces overall luminance without inducing a color change.
• Decreased luminance of the visual target results in diminished central acuity in
normal eyes.
• Decreased illumination of visual targets has less of an effect on amblyopic eyes
because they are not using central acuity
• It was found that neutral filters profoundly reduce vision in eyes with organic
amblyopia whereas vision of eyes with functional amblyopia was not reduced and
occasionally even slightly improved.
21. Amblyopia is a Diagnosis of Exclusion.
Following three factors are essential to diagnose amblyopia.
1. Evidence of reduced visual acuity - usually unilateral but may be bilateral.
2. Presence of amblyopgenic factors .
3. No cause for visual loss on examination.
Specific emphasis should be given on Bruckner’s test – Studies suggest an accuracy
of 84% in amblyopia detection in patients with strabismus or prescription difference
of 3D or more .
22. CLINICAL EVALUATION & DIAGNOSIS
• Thorough clinical history
• Evaluation of visual acuity and fixation
pattern
• Stereo-acuity testing
• Binocular alingnment and ocular
motility
• Thorough ocular examination including
fundus examination.
• Cycloplegic retinoscopy/Refraction
• Bruckner’s test
• Neutral density filter and testing for
crowding phenomenon.
Hirschberg corneal reflex test
23. Grading of Severity
• On the basis of visual acuity :
Mild amblyopia -6/9 to 6/12
Moderate amblyopia – 6/12 to 6/36
Severe amblyopia – worse than 6/36
24. TREATMENT
• Eliminate any obstacles to vision , such as cataract.
• Correct any significant refractive error.
• Increase use of the poorer eye by limiting use of the better eye.
25. TREATMENT
• Refractive correction
• Occlusion therapy
• Penalisation
• Drug therapy
• Pleoptics
• Cam stimulator
• Surgery to treat the cause of amblyopia
26. Cataract Sx
• As early as possible in unilateral cases .
• In bilateral cases , interval between 1st and 2nd eye sx should not be more than 1-2
weeks .
• Proper correction should be given in the form of contact lens after cataract sx .
• Near correction is more important in children .
27. REFRACTIVE ERROR CORRECTION
• Cycloplegic refraction followed by adequate optical correction
• ATS-5 concluded that amblyopia improved with optical correction in 77% and
resolved in 27%
• ATS-7Treatment of binocular refractive amblyopia with glasses improves binocular
VA.
• Chen et al (AJO 2007) concluded that penalisation and occlusion is required only if
the child doesn’t improve with glasses for four months .
• LASIK in children has been shown to improve VA but regression can occur .
• LASIK is alternate surgical modality for adult anisometropic amblyopia .
28.
29. OCCLUSION THERAPY
• Occlusion of the sound eye is the most effective treatment for amblyopia
treatment
• When fixation is eccentric, <7yrs central fixation will be recovered.
• Older the child harder to regain central fixation.
• MOA- prevents fixating eye taking part in vision and removes inhibitory stimulus
that arises from stimulation from fixating eye.
30. OCCLUSION THERAPY
Total Occlusion Partial occlusion
All light is prevented from entering eye. Does not cut off the total light entering eye
Employed in amblyopic eyes with acuity less than
6/24
Degrades the vision of normal eye such that
amblyopic eye gets better vision and preference
Occlusion using elastoplast, gauze pad, tape, doynes
rubber occlude.
Occlusion using cellophane, or a higher plus lens
• There is poor binocular outcome from patching as it primarily involves
monocular mechanism .
31. Types of Occluders
• Adhesive skin patches made of micropore
• Commercially available opticlude
• Spectacle occluder
• Contact lens occlude
32. Amblyopia Treatment Study
Pediatric eye disease investigator group(PEDIG) has conducted several amblyopia
treatment trials (amblyopia treatment study or ATS) . Results have shown that
• A Randomized Trial of Atropine Versus Patching for Treatment of Moderate Amblyopia in
Children - ATS 1 :There was substantial improvement in amblyopic eye visual acuity with
both treatments .Improvement was more rapid in the patching group.
• A Randomized Trial Comparing Part-time Versus Full-time Patching for Severe Amblyopia
- ATS 2A: In patients aged 3-7 years with severe amblyopia (VA 6/30 to 6/120) full time
patching produced similar effect to that of six hours patching per day .
• A Randomized Trial Comparing Part-time Versus Minimal-time Patching for Moderate
Amblyopia - ATS 2B :In patients aged 3-7 years with moderate amblyopia (VA better than
6/30) 2 hours patching produced similar effect to that of six hours patching per day .
33. Amblyopia Treatment Study
• Prospective Study of Recidivism After Cessation of Amblyopia Treatment - ATS 2C :
Most recurrences occur within 3 months – early follow-up is critical . It suggests
weaning is beneficial .
• An Evaluation of Treatment of Amblyopia in Children 7-<18 Years Old – ATS3
:Amblyopic vision improves in 7 to < 13 year old children but not 13 to < 18 year
olds who have been treated previously. All amblyopic eyes have remaining visual
deficit.
• A Randomized Trial of Atropine Regimens for Treatment of Moderate Amblyopia in
Children – ATS4 :Weekend atropine appears to be as effective as daily atropine in
treating moderate amblyopia in children 3 to < 7 years of age . The magnitude of
the visual acuity improvement was similar to that seen for 2-hour and 6-hour
prescribed patching regimens for moderate amblyopia.
34. OCCLUSION THERAPY
• Active vision exercises by amblyopic eye like dotting O’s and encircling E’s in a
newspaper, joining dots,reading comics and story books.
• In case of vision improvement, occlusion is continued till amblyopic eye has not
only developed equal vision but also equal preference of fixation.
• Maintenance treatment is continued atleast upto 9 yrs of age with part time
occlusion and exercises .
• When VA is stable , patching may be decreased slowly because amblyopia recurred
in large no. of patients .
• If no improvement in vision for 3 months , patching is discontinued .
35. Full Time Patching
• Recommended for :
-Severe Amblyopia
-Older age group
-Failure of part time occlusion
-Non compliant patient
36. PENALISATION
• Therapeutic technique performed by optically defocussing the eye with better
vision by using cycloplegia or altering the eye glass lens.
• INDICATIONS
No compliance for occlusion.
Mild degrees of amblyopia.
Maintainence after occlusion.
Anisometropic amblyopia
37. Methods of Penalization
1. Near penalization: fixing eye is atropinized & fully corrected for distance,
amblyopic eye is overcorrected with +2 to +3D .
2. Distance penalization : fixing eye is atropinized & overcorrected, amblyopic eye
is fully corrected.
3. Total : fixing eye is atropinized & undercorrected by 4 to 5 D, amblyopic eye is
fully corrected.
38. PLEOPTICS
• Involves active stimulation of fovea to
overcome eccentric fixation.
• The peripheral retina including the
eccentrically fixing area around the
fovea is dazzled.
• After lights are turned off, fovea
functions better because the
surrounding retinal area is in a state
of hypofunction .
39. CAM STIMULATOR
• Slowly rotating high contrast square wave grating of different spatial frequencies
• Principle – rotating gratings provide specific stimulation for cortical neurons
• The visual improvement was found to be better in emmetropes and
hypermetropes .
• Not used these days.
40. PHARMACOLOGICAL THERAPY
• • LEVADOPA is the only most extensively studied drug in western and Indian
population
• Precursor of dopamine known to influence visual system at retina and cortical
level
• Advantages - Augments conventional occlusion , Speeds up recovery of visual
functions , Improves compliance , Reduces cost and duration of treatment.
• Catecholamine based medical treatment citicholine has been demonstrated to
improve VA in amblyopic eyes.
41. SURGERY
• Anisometropia refractive surgeries .
• Surgical therapy for strabismus generally should occur after amblyopia is reversed.
• Disadvantages of prior surgery
Difficulty in telling if amblyopia is present because there is no longer a strabismus
to assess fixation preference
Higher potential to being lost to follow-up.
The improved cosmesis gives the parents a false sense of security about the vision
improving.
42. Newer Modalities
• Aim at binocular development along with
VA improvement .
• Involves :
- Perceptual Learning
-Dichoptic Training
43. RECURRENCE
• When amblyopia treatment is discontinued after fully or partially successful
completion, approximately half of patients show some dgree of recurrence,
• Maintenance therapy:
• Patching for 1-3 hours per day
• Optical penalization with spectacles
• Pharmacologic penalization with atropine 1 or 2 day per week.
• This may require periodic monitoring until age 8-10.