Amblyopia, or lazy eye, is a vision disorder characterized by reduced visual acuity in one or both eyes that persists even after correcting refractive errors. This condition affects a significant percentage of children across various demographics, with its incidence related to factors such as age, cultural background, and prenatal exposure to harmful substances. Various types of amblyopia exist, including strabismic, stimulus deprivation, and anisometropic amblyopia, each requiring different treatment approaches to improve visual outcomes.

1. Amblyopia
By ABDUL SALAM

3. ( Amblyos– Dull, ops—vision)
Amblyopia: (greek word means blunt eye) Also
called as: lazy eye is a disorder of sight.
“Defective visual acuity in one or both eyes,
which persists after correction of the
refractive error & removal of any pathological
obstacle to vision”.
Definition

4. EPIDEMIOLOG
Y
• In developed countries 1-5% of the population
• In india affects 1-4% of children
• Goel et al. found the incidence to be 0.7% in
rural schools than in urban schools 0.5%
• Onset is birth to 7 yrs of age
• SE Factors does not significantly influence the
age of presentation of amblyopia
• Earlier the onset greater the defecit

5. • Four times more frequent in premature
children
• Six times more frequent in children with
delayed
mile stones
• Smoking and use of dugs and alcohol
during pregnancy have been asso with risk
of amblyopia

6. PATHOPHYSIOLOG
Y
Amblyogenic factors
Role of retina
Active cortical
inhibition

7. Amblyogenic
factors
VISUAL
DEPRIVATION
monocula
r
Seen in strabismic ,
anisometropic,
stimulus deprivation
amblyopia
Binocular
Seen in bilateral
cataract, ametropia
and bilateral high
refractive errors
LIGHT DEPRIVATION.
Usually seen in
children with
unilateral or bilateral
complete cataracts.
ABNORMAL
BINOCULAR
INTERACTIO
N
-produces profound
amblyopia due to
competition
amblyopia.
-seen in strabismic,
anisometropic and
unilateral stimulus
deprivation
amblyopia.

8. CRITICAL PERIODS
DEVELOPMENT OF V/A FROM 6/60 TO
6/6 (From birth to age 3-5 years)
PERIOD OF HIGHEST RISK (From few months to
7-8 years)
PERIOD DURING WHICH RECOVERY FROM
AMBLYOPIA CAN BE OBTAINED
(before 8 years)

9. Sensitive Period
The capacity of the visual system to develop amblyopia
is limited by its state of maturity
During immaturity of the visual system the retinocortical
connections are not firmly established and may be
modified by the quantity or quality of the visual input
This phase has been described as the sensitive, critical,
or susceptible period
The human is most sensitive to environmental
manipulation during the first 2 years of life
The human critical period is over by approximately 7 to 9
years of age

10. RETINA IN THE DEVELOPMENT OF
AMBLYOPIA
• Decreased sensitivity of foveal cones in
amblyopia
• The reduced input from rods and cones in
the affected eye causes certain
neurophysiologic changes, transmitted to
the CNS which triggers amblyopia.

11. ACTIVE CORTICAL
INHIBITION
1)A developmental defect of spatial
visual processing occurring in the
visual pathway.
2)Poor transmission from the fovea, optic nerve
to the Striate Cortex of the affected eye.
3) LGB & Striate cortex develop abnormally.
4)Ganglion cells in foveal area are affected;
Shrinkage of LGB Nucleus & Striate cortical
fibres in the amblyopic eye.
5)Loss of binocularly driven cells in LGB &
Striate Cortex

13. CLASSIFICATION &
TYPES
• Strabismic amblyopia.
• Stimulus deprivation or amblyopia of
disuse.
• Anisometropic amblyopia.
• Meridional amblyopia.
• Isoametropic amblyopia .
• Amblyopia secondary to nystagmus.
• Idiopathic amblyopia.
• organic amblyopia.

15. Amblyopia
‘Organic
Amblyopia’
Irreversible
Structural abnormal
Mac scar, Optic
atrophy
‘Functional
Amblyopia’
Reversible
(when t/t early)
•Strabismic
•Anisometric
•Visual Deprivation

16. STRABISMIC
AMBLYOPIA
• M/C form of amblyopia
• A.K.A amblyopia of arrest
• Seen in unilateral constant squint who
strongly favour one eye for fixation.
• cortical suppression from deviating eye
thought to be due to inhibitory interactions
from neurons carrying non fusable images
which cause visual confusion
• Esotropia more likely to develop
amblyopia as compared to exotropia

17. • 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

18. Strabismic amblyopia
Most common form of amblyopia
Amblyopia is unilateral
Seen in unilateral constant squint who
strongly favour one eye for fixation
Will develop in 100% of pts with constant
untreated acquired esotropia under 3 years
of age resulting in marked decrease in VA
within week(treatment of this type of
amblyopia following acquired esotropia
therefore becomes daytime emergency)
19.7% of congenital cases of esotropia if
untreated

19. Caused by active inhibition within the retinocortical
pathwayof
visual input originating in the fovea of the deviating eye.
Far more often in esotropes than in exotropes because
exotropia is often intermittent at its onset
Also be related to the nasotemporal asymmetry of the
retinocortical projections. In esotropes the fovea of the
deviating eye has to compete with the strong temporal
hemifield of the fellow eye . In exotropia the fovea
competes with the weaker contralateral nasal hemifield
a/k suppression amblyopia
Contd…

20. STIMULUS DEPRIVATION
AMBLYOPIA
• Amblyopia ex anopsia disuse amblyopia.
• Least common but most damaging.
• Cause when the visual axis is
obstructed.
• Monocular congenital or traumatic
cataract, complete ptosis, corneal
opacity & prolonged patching of the
normal eye for treatment of amblyopia.
• Less than 6 yrs – severe amblyopia.
• After 6 yrs – less harmful .

21. • Visual loss resulting from unilateral
deprivation is worse than that produced by
bilateral deprivation of similar degree

22. Conditions exists in
-opacities of the ocular media s/a congenital or
traumatic cataract, corneal opacities , blepharospasm ,
surgical lid closure , or U/L
Complete ptosis
- B/L ptosis is not amblyogenic because the pt
maintains normal VA with a chin elevation

23. ANISOMETROPIC
AMBLYOPIA
• 2nd m.c.c of amblyopia
• develops when unequal refractive errors in the
2 eyes causes the image on 1 retina to be
chronically defocused.
• Most patients with anisometropic amblyopia
have straight eyes and appear “normal,” so the
only way to identify these patients is through
vision screening.
• Hypermetopic anisometropia is more
amblyogenic than myopic
anisometropia

24. • The amount of anisometropia that can induce
amblyopia varies according to the type of
refractive error
• Amount of anisometropia
Hypermetropia > 2D
Myopia > 4D
Astigmatism> 1.25D
However unilateral high hyperopia or myopia
(>6D) causes severe amblyopia

26. MERIDIONAL
AMBLYOPIA
• Resolution of eye is reduced in selective
meridians as a result of un corrected
astigmatism
• Cylinder >1.5D is comsidered amblyogenic
• Doesn’t develop until first year of age

27. ISOMETROPIC
AMBLYOPIA
• Bilateral amblyopia occurring in children
with bilateral uncorrected high
refractive error.
Hyperopia > +5
D. Myopia > -10
D. astigmatism
> 2D
Mechanism – effect of blurred
retinal images alone

28. AMBLYOPIA SECONDARY TO
NYSTAGMUS
• Difficult to establish ascertain whether
nystagmus is the cause or effect of amblyopia
• Bilateral

29. IDIOPATHIC
AMBLYOPIA
• Occurring in apparently normal patients
with a negative history of strabismus & in
the absence of other amblyogenic factors.
• Mech- foveal suppression of amblyogenic
eye d/t transient amblyogenic factor during
infancy

30. Organic ambyophia
Irreversible type which results from some
pathological or anatomical abnormalities of
retina
 Retinal eye disease
-Toxoplasmosis chorioretinitis ,
Retinoblastoma , traumatic retinal lesion
Nutritional amblyopia
-occurs from nutrition deficiencies

31. Toxic amblyopia
-Vision loss d/t damage to the optic nerve fibrosis d/t
effects of exogenous or endogenous poisons
-Types :
Tobacco amblyopia
Ethyl alcohol
amblyopia
Methyl alcohol
amblyopia Quinine
amblyopia
Ethambutol
amblyopia

32. Tobacco amblyopia
-Typically occurs in men in pipe smokers, heavy
drinkers
Ethyl alcohol amblyopia
-Usually in a/w tobacco amblyopia
-May occur in non-smoker but heavy drinkers
suffering from chronic gastritis

33. Methyl alcohol amblyopia
-It is typically acute usually resulting in optic atrophy &
permanent blindness
Quinine amblyopia
-May occur even with small doses of the drugs in
susceptible individuals
Ethambutol amblyopia
-caused d/t anti-tubercular drugs

34. Clinical
characteristics

35. CLINICAL
CHARACTERISTICS
• Decreased visual acuity
• Decreased stereoacity
• Fixation reflex
• Crowding phenomenon
• Effect of neutral density
filter
• Contrast sensitivity
• Fixation pattern

36. VISUAL
ACUITY
• Two line difference between amblyopic and normal
eye
• For B/L amblyopia the VA should be less than 20/40 in
each
eye
• But in children there will be difficulty in
assesing VA Infants-fixation preference
preverbal children-preferential looking test,OKN
test,VEP 2-3 yrs- E charts,pictoral charts
>3 yrs-snellens charts,HOTV charts

38. PREFERENTIAL LOOKING
TEST

39. STEREOACUIT
Y
• Presence of amblyopia can be detected by
defective performance on various
stereograms
• Two pencil test is a clinically useful test and
can be applied even when VA recording is
unreliable or not possible
• Can also be easured by titmus fly test,random
dot
stereogram

42. FIXATION
REFLEX
• useful tool to assess VA in children <5yrs of age
• Central steady and maintained (CSM) fixation implies
good
VA
Affixation  <3/60
unsteady fixation  3/60 to 6/60
Central but not maintained 6/60 to 6/18
Central but strong preference for other eye  6/18
to 6/9 Alternate fixation  6/6

44. CROWDING
PHENOMENON
• Amblyopia pts exhibit better VA for single
optotypes than for letters placed in a row
• Although not specific for amblyopia,it may be
pronounced in amblyopic eye compared to
better eye
• Single line acuity improves more than line
acuity during treatment
• So it is important to record both single letter
and line visual acuity every time as it is
prognostic indicator

45. • Vision testing with single optotypes is likely to
over estimate VA in pts with amblyopia
• More accurate assesment 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

46. 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.
• Hence it can be used to differentiate the two.

48. CONTRAST
SENSITIVITY
• Reduction in contrast
sensitivity more
for higher
frequencies
• Improves during
amblyopia
therapy and
useful to monitor
the progress
• Contrast threshold
becomes normal in
strabismic
amblyopia
when luminance
levels
were reduced,
while the
deficit persists in
anisometropic
pelli robson contrast
sensitivity chart

49. FIXATION
PATTERN
• Bangerter’s classification of fixation
patterns in amblyopia
I. Central fixation
II. Eccentric fixation (nonfoveolar)-
common type
III. No fixation
• Patients with eccentric fixation appear to be
looking to the side,not directly at the fixation
target. They have poor smooth pursuits,so they do
not accurately follow a moving target.
• Can be tested in old coperative children by
visuoscope

51. OTHER
FEATURES
• VEP Reduction in amplitude and
slightly prolonged latency
• Afferent pupillary defect may be seen
• Normalisation of VA in dim light
occasionally
• Occasionally latent nystagmus

52. Visualfield
Monocular VF are usually recorded as normal in
strabismic amblyopia . Although there is obviously
a relative defect in the fovea it is difficult to
demonstrate it on a target screen or goldmann
perimeter
This clearly differentiates strabismic
amblyopia from organic amblyopia in which
a scotoma involving the fovea area can be
plotted

53. CLINICAL EVALUATION &
DIAGNOSIS
• Thorough clinical history
• Binocular red reflex test
• Binocularity/stereo acuity testig
• Evaluation of visual acuity and fixation pattern
• Binocular alingnment and ocular motility
• External examination
• Pupillary examinaion
• Thorough ocular examination including fundus
examination.
• Cycloplegic retinoscopy/Refraction
• Neutral density filter and testing for crowding
phenomenon.

54. Pupillary Responses
An afferent pupillary defect of amblyopic eyes has
been reported by several authors(9% to 93%)
(Dole´nek)
On Pupillographic measurements on the eyes of
amblyopic children it was found that on average
the pupil of the amblyopic eye was 0.5 mm larger
than the pupil of the normal eye in the natural
state and
0.3 mm larger in miosis induced by a light stimulus
(Dole’nek &
Kru¨ger).

55. Prognostic Factors in
Amblyopia
Positive factor Negative factor
functional organic
Central fixation Eccentric fixation
Random dot stereopsis No random dot
stereopsis
Short duration Long duration
Young patient, motivated Older patient, un-
motivated
Degree of prognosis
Strabismic > Anisometropic myopia >
Anisometropic hypermetropia

57. TREATMENT
MODALITIES
Treatment of amblyopia involves following
steps:-
1)eliminate any obstacles to vision , such as
cataract.
2) correct any significant error.
3)force use of the poorer eye by limiting use
of the better eye.

58. Strategies to treat amblyopia
Eliminate cause of visual deprivation & provision of
clear retinal image in amblyopic eye.
Correction of ocular dominance
Perceptual training
Recommended treatment
should be based on:-
Patient’s
age
Visual acuity
Compliance with

59. • Refractive correction
• Occlusion therapy
• Penalisation
• Drug therapy
• Pleoptics
• Cam stimulator
• Surgery to treat the cause of
amblyopia

60. CATARACT
REMOVAL
• Removal of congenital lens opacity- first 4 -6 week of
life.
• If symmetrical b/l cases- interval b/w 1st & 2nd
eye should not be not more than 1-2 weeks.
• Developing severe traumatic cataract in children
less than
6 yrs removed within few weeks of injury.

61. REFRACTIVE ERROR
CORRECTION
• Improves VA in 25-33% of patients with
anisometropic amblyopia and also in strabismic
amblyopia
• Cycloplegic refraction followed by adequate
optical correction
• ATS 5 concluded that amblyopia improved with
optical correction in 77% and resolved in 27%
• Chen et al (AJO 2007) concluded that penalisation
and occlusion is required only if the child
doesn’t improve with glasses for four months
• In general eye glasses are well tolerated by
children
especially when there is improvement in visual
function

63. OCCLUSION
THERAPY
• Occlusion of the sound eye is the most
effective treatment for amblyopia
treatment
• When fixation is central, simple &
effective.
• When fixation is eccentric, <7yrs central
fixation will be recovered.
• Older the child harder to regain central
fixation.
• Success rate 30-92%
• MOAprevent fixating eye taking part in act
of vision and removes inhibitory stimulus

64. Mode of action
Prevent fixating eye taking part in act of vision and removes
inhibitory stimulus that arises from stimulation from fixating
eye (non-amblyopic eye)
Occlusion goals
• Differential diagnosis
• Improvement of amblyopia
• Elimination of suppression
• Awareness or elimination of diplopia
• Disruption of
anomalous
corresponde
nce.

65. Types of
occlusion
• Total or partial
• Conventional or inverse
• Full time or part time
• Patching is most commonly
prescribed,however contravercy exists
concerning how much treatment is necessary
• Most data on response according to daily
dosage of patching are retrospective and
uncontrolled

66. TOTAL VS PARTIAL
OCCLUSION
total partial
•All light is prevented from •Does not cut off the total
entering eye.
•Employed in amblyopic
eyes
light entering eye
•Degrades the vision of
with acuity less than 6/24
•Occlusion using elastoplast,
normal eye such that
amblyopic eye gets better
gauze pad, tape, doynes
rubber occluder.
vision and preference
•Occlusion using cellophane,
transparent nail polish, or a
higher plus lens.

67. Partial /translucent
occlusion
Total occlusion
Given in
nystagmus
Amblyopia
treatment

68. CONVENTIONAL VS INVERSE
OCCLUSION
Conventional Inverse
•Occlusion of sound eye •Occlusion of
amblyopic eye so that
eccentric fixation
becomes less fixed

69. Additional
points
Inverse occlusion is prescribed whenever
occlusion is needed but direct occlusion is
intolerable to the patient.
Given only if the patient is strongly resistant to
direct occlusion.
For example:- A strabismic patient with deep
amblyopia may not be able to perform needed visual
tasks with amblyopic eye . So 1st inverse occlusion is
started & changed to direct occlusion once more
central fixation and improved visual acuity are
obtained


70. FULL TIME VS PART
TIME
Full time Part time
Removed only while
going to bed at night
Short time each day
during close work or
watching television.
Choice of initial Rx In relapses after Rx and also
for
maintanence

71. Occlusion in Constant
strabismus
Earlier, full time occlusion followed by a day of rest was
advocated. This allows constant strabismus to regress to
anomalous strabismic visual processing on free day.
Nowadays, full time occlusion is prescribed initially.
When intermittency is achieved in open space ,part-
time occlusion is given allowing some reinforcement of
binocular skills in normal activities.

72. Points on Occlusion
The presence (or absence) of amblyopia and its fixation
pattern determine which eye to patch.
The frequency of strabismus determines the amount of
time that the eye is patched
Alternate occlusion
When equal visual acuity is present in each eye, (e.g :-
a constant alternate esotropia) , full time occlusion is
alternated daily between two eyes.
The purpose of full time occlusion for strabismics with
no amblyopia is
to eliminate suppression and possibly disrupt
anomalous correspondence.

73. Types of
occluders
• Adhesive skin patches made of
micropore
• Commercially available opticlude
• Spectacle occluder
• Contact lens occluder
OPAQUE CONTACT LENS

74. • Patche
s
• Micropore tape with soft tissue paper
• Spectacle patch / frost glass • Doyne’s occluder

75. Contact lens
occluder
Bandage occluder
Patches
Microp
ore
Spectacle
occluder

76. Tie-on occluder Clip-on occluder
Occlusion lens Occlusion filter

77. Bitemporal
occlusion
Binasal
occlusion
Sector
occlusion

78. Paediatric eye disease investigator group(PEDIG) has
conducted several amblyopia treatment trials
(amblyopia treatment study or ATS) over the past
several years. Results have shown that
• Spectacles alone are powerful treatment for
amblyopia; patching is superior to spectacles
• Initiating fewer hours of prescribed patching
seems to be
as effective as traditional treatment
• Patching is effective in older children particularly
if they have not been treated earlier
• Atropine is as effective as patching
• Weekend atropine is as effective as daily atropine

79. How much
patching??
The amblyopia treatment study have helped to
define the role of full time patching vs part
time patching
• In patients aged 3-7 years with severe
amblyopia
(VA B/W 6/30 to 6/120) full time patching
produced similar effect to that of six hours
patching per day
• 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

80. Treatment of amblyopia in 7-17
yrs
• For 7-13 yrs age group 2-6 hours of
patching can improve VA only if
previously treated
• For 13-17 yrs age group 2-6 hous of
patching improved VA even if not
treated previously
• Long term results from these studies
are still pending

81. HOW TO GO ABOUT
OCCLUSION
• Motivation of child and parents.
• 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.
• May take 3-6 months.
• If there is no improvement. Then treatment is
stopped. Also other causes to be ruled out.
• Maintainence treatment is continued atleast upto
9 yrs of
age with part time occlusion and exercises

82. Rx schedule for initial
occlusion
Age in yrs Period of
occlusion(day
s) Direct :
inverse
Follow up after
every
Upto 2 2 :1 15 days
3 3 : 1 15 days
4 4 : 1 1 month
5 5 : 1 1 month
6 & older 6 : 1 1 month

83. • Follow up-depending on age,severiy of
amblyopia and compliance
• To look for-VA, fixation pattern and
occlusion amblyopia
• When to stop occlusion
VA equals in both eyes
alternation of
fixation
• When VA is stable
patching may be
decreased slowly
• Because amblyopia recurres in large no. of
patients maintanence therapy or tapering of
therapy should be strongly considered.

84. Disadvantages of
occlusion
• Occlusion amblyopia
• Non compliance
• Psychological distress
• Appearance of constant
deviation
• Allergic skin rash
• Diplopia
• Cosmetically inacceptable

85. Prognostic
considerations
• Younger the age better the prognosis
• Type of amblyopia myopic anisometropia>
hyperopic anisometropia> strabismic
amblyopia> stimulus deprivation
• Pretreatment
VA
• Type of
occlusion
• Type of fixation
• Near exercises
• Patient compliance and parent
education
• Presence of astigmatism
• Method of treatment termination
• Previous treatment
• Refractive correction

86. Occlusion
amblyopia
When normal or preferred eye is occluded, visual acuity may
decrease & occlusion amblyopia may occur in the occluded
eye.
The younger the child ,faster is the acuity loss & become
profound and permanent.Esp:- full time occlusion when
given to infant <2yrs (critical developmental yrs)
Alternate patching is given to prevent this & shorter period
of direct occlusion for younger children
For the remedy of skin reactions d/t patch that is in contact with skin
, hypoallergenic patch (Opticlude) can be used.
Tincture benzoin may be applied to the skin before applying patch.
This forms a protective layer & increase adhesiveness.

87. Strabismic diplopia
Occurs d/t extended period of total occlusion without
resolution of strabismus esp in older patients & those with
anomalous correspondence.
In pts <10 yrs, suppression may regain in few weeks after
discontinuation of occlusion even after experiencing
diplopia for several months when occluder is removed.
 d/t tendency of suppression to
lessen with age
 Difficulty in achieving BSV in long
duration strabismus

88. Deviation
changes
Appears to be expected progression of strabismic
syndrome such as accommodative esotropia or
essential esotropia.
Dissociated vertical deviation may appear or
previously measured primary vertical deviation
may increase in size.
Exodeviations may increase in size with full time or
part time occlusion & later become stable.
Some esotropic deviations continue to increase in
size( without increase in hyperopia) with time & after
months they stabilize at a given angle.

89. Occlusion removal & Maintenance
occlusion treatment
Occluder is not removed until comfortable ,efficient
binocularity has been obtained, and patient is capable of
maintaining binocular vision in open space without
regressions.
Most errors are made in removing the occluder too
soon. Regressions from non strabismus to strabismus
may occur in a relatively short time (1 to 3 months).esp.
intermittent or constant strabismus
Once the vision has been equalized, the maintenance
occlusion should be continued till the amblyogenic ,
i.e up to at least 9 years of age.

90. TREATMENT OF ANISOMETROPIC
AMBLYOPIA

91. TREATMENT OF STRABISMIC
AMBLYOPIA

92. PENALISATIO
N
• 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

93. • Advantages cheap,better compliance
• DisadvantagesS/E of drugs
risk of occlusion amblyopia
systemic absorption
• Unless penalisation decreases the VA of
dominant eye below the amblyopic eye this
form of treatment is not adviced

94. Methods of
penalisation
a. Near penalization: fixing eye is
atropinized & fully corrected for distance,
amblyopic eye is overcorrected with +2 to
+3D .
b. Distance penalization : fixing eye is
atropinized & overcorrected, amblyopic eye
is fully corrected.
c. Total : fixing eye is atropinized &
undercorrected by 4 to 5 D, amblyopic eye is
fully corrected.

95. PLEOPTIC
S
• Involves active stimulation of fovea to
overcome eccentric
fixation & improves Va.
• 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
• ONLY INDICATION IS coperative and
intelligent child older than 6yrs having
eccentric fixation

96. PLEOTOPHOR
E

97. 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
than those in strabismus amblyopia
• Not used these days

99. 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

100. • Catecholamine based medical treatment
citicholine has been demonstrated to improve
VA in amblyopic eyes

101. SURGER
Y
By reducing anisometropia refractive
surgeries has reported to
• Improve spectacle tolerance
• facilitate amblyopia thearpy
• Enhance binocular vision
Also used for children who has finished
amblyopia therapy and cannot comply with
spectacles or contact lens

102. Surgical therapy for strabismus generally
should occur after amblyopia is reversed.
• Disadvantages to surgical therapy prior to
correction of amblyopia include
difficulty in telling if amblyopia is present
because there is no longer a strabismus to
assess fixation preference and higher
potential to being lost to follow-up, as the
child cosmetically looks better.
The improved cosmesis gives the parents a
false sense of security about the vision
improving

103. RECURRENC
E
• Chances are high until child is visually
mature.
• Careful monitoring every month upto 1 year,
every 2 months upto 2 years and 4- 6 months
upto visual maturity is required.
• Maintainence occlusion to be given

104. SCREENIN
G
• AAO recommends screening by the age of 3
yrs and thereafter every 2yrs
• Includes visual acuity, corneal reflex test,
refraction, fixation preference and stereo
acuity
• AAP suggests that vision screening should
begin at birth and continue as a part of child
regular medical check up
• All new born infants should be screened in
nursery with the use of red reflex
• Infants at risk should undergo detailed
evaluation

105. Severe amblyopia can be eliminated as a public
health problem
• The goal can be achieved by
 improvements in public awareness
better screening protocols at the level of
primary health care provider
 full access to medical care for at risk
patients

106. THANK