The document discusses the pathophysiology, classification, and management of amblyopia, noting that it is a decreased vision in an otherwise normal eye due to visual deprivation or abnormal binocular interaction during visual development. It describes the different types of amblyopia including strabismic, anisometric, and form vision deprivation and recommends early detection and treatment with refractive correction, occlusion or penalization of the better eye, and visual stimulation activities to improve vision in the amblyopic eye. Prognosis is best for strabismic amblyopia and when treatment begins at a younger age.

1. BY: Dr NIKITA JAISWAL
Ims & sum hospital

2.  Introduction
 Pathophysiology
 Classification
 Management

3.  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.

6.  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

7.  Deprivation of form vision:
•No stimulus reaches the fovea.
complete
•When there is presence of a
defocused image it can be U/L
nd B//L
partial

9.  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.

10. 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 ++ ++

11.  Strabismic amblyopia
 Anisometric amblyopia
 Form vision deprivation

12. • No associated anisometropia
• Associated anisometropia
STRABISMIC
ANISOMETRIC
• Sensory deprivation
• Ametropic amblyopia
• Meridonial amblyopia(astigmatism)
FORM VISION
DEPRIVATION

13.  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.

16.  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

18.  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.

19.  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.

20.  DEPRIVATIONAL AMBLYOPIA

22.  VISUAL ACUITY
 FIXATION
 FIXATION PATTERN
 ASSESSSMENT OF STRABISMUS
 ASSESSMENT OF BINOCULARITY

26.  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.

27. 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

28. 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

29. 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

30. GREATER IMPROVEMENT IN VA IN
CHILDREN WITH SEVERE AMBLYOPIA
WHO PERFORMED NEAR ACTIVITIES
ALONG WITH PATCHING.
NEAR & NON NEAR ACTIVITIES WITH 2 HOURS
PATCHING IN 3-7 YEARS

31. 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

32. 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)

33. 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.

34.  OCCLUSION
 PENALIZATION
 PLEOPTICS
 CAM STIMULATOR
 RED FILTERS
 DRUGS

35.  A competitive advantage is given to the
worse eye over the better eye.
 Total/partial
 Full time/part time

36.  Direct patch of the skin
 Patch over the back surface of spectacles
 Doyne’s occluder
 Pirate patches
 Occlusive contact lens

37. DOYNE OCCLUDER

40.  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.

42.  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.

43.  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

44.  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

45.  Principle: rod domoninated area is used for
eccentric fixation.
 Red filter is use to motivate the patient to use
fovea.

46.  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.