Amblyopia, or lazy eye, is a vision disorder caused by abnormal visual stimulation during early childhood development. It affects 1-6% of children in India. The key causes are strabismus (50% of cases), anisometropia (unequal refractive errors, 17% of cases), or stimulus deprivation (3% of cases). Treatment involves correcting any refractive errors and occlusion therapy, where the better eye is patched for a period each day to encourage use of the weaker eye. Occlusion therapy can improve vision if started before age 7 and continued until vision is equalized in both eyes. Proper follow up is important to monitor progress and taper occlusion over time to prevent relapse. Surgery may
Ever wonder what lazy eye means? What is amblyopia? How do you get it? How do you treat it? This presentation will walk you through this functional vision problem so you can understand what lazy eye is and how you can be successfully treated by your developmental optometrist no matter your age.
Passive Therapy in Management of Amblyopia (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤
Passive Therapy in Management of Amblyopia
. Passive Therapy
The patient experiences a change in visual stimulation without any conscious effort
- Proper refractive correction
- Occlusion
- Penalization
Current Trend in Management of Amblyopia (Amblyopia Therapy)/ Amblyopia Treat...Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
Dear viewers, to download this presentation visit___ https://healthkura.com/lazy-eye-amblyopia/
Current Trend in Management of Amblyopia. Latest as well as old methods of amblyopia management which include active and passive therapies. Amblyopia Therapy/ Amblyopia Treatment
What would be the perfect amblyopia therapy?
Effective
Good compliance
Acceptable to pts. and parent
Quick
Safe
Easy to administer
Cost effective
Well maintained
..............
Summary
Amblyopia occurs due to abnormal visual experience early in life
Proper optical correction alone is necessary for short period of time (6-8 weeks)
before initiation of other therapy
Part time occlusion of better eye is mainstay of treatment since 18th century to till
now
For severe and moderate amblyopia, 6 hrs and 2 hrs of patching is advised
respectively
Atropine is also used in children with poor compliance
Trial of patching can be given in patients as old as 17 yrs
Perceptual learning and pharmacological manipulation have shown areas of
amblyopia treatment beyond the critical period of visual development
Binocular stimulation, software based treatments and other methods do not have
promising result to replace the patching therapy till date
Most of the active therapy methods have good results when used together with
patching therapy
Assessment and Treatment of patients with Amblyopia using interactive binocular computer games
Alexander Foss
Interactive Technologies and Games (ITAG) Conference 2014
Health, Disability and Education
Dates: Thursday 16 October 2014 - Friday 17 October 2014
Location: The Council House, NG1 2DT, Nottingham, UK
Ever wonder what lazy eye means? What is amblyopia? How do you get it? How do you treat it? This presentation will walk you through this functional vision problem so you can understand what lazy eye is and how you can be successfully treated by your developmental optometrist no matter your age.
Passive Therapy in Management of Amblyopia (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤
Passive Therapy in Management of Amblyopia
. Passive Therapy
The patient experiences a change in visual stimulation without any conscious effort
- Proper refractive correction
- Occlusion
- Penalization
Current Trend in Management of Amblyopia (Amblyopia Therapy)/ Amblyopia Treat...Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
Dear viewers, to download this presentation visit___ https://healthkura.com/lazy-eye-amblyopia/
Current Trend in Management of Amblyopia. Latest as well as old methods of amblyopia management which include active and passive therapies. Amblyopia Therapy/ Amblyopia Treatment
What would be the perfect amblyopia therapy?
Effective
Good compliance
Acceptable to pts. and parent
Quick
Safe
Easy to administer
Cost effective
Well maintained
..............
Summary
Amblyopia occurs due to abnormal visual experience early in life
Proper optical correction alone is necessary for short period of time (6-8 weeks)
before initiation of other therapy
Part time occlusion of better eye is mainstay of treatment since 18th century to till
now
For severe and moderate amblyopia, 6 hrs and 2 hrs of patching is advised
respectively
Atropine is also used in children with poor compliance
Trial of patching can be given in patients as old as 17 yrs
Perceptual learning and pharmacological manipulation have shown areas of
amblyopia treatment beyond the critical period of visual development
Binocular stimulation, software based treatments and other methods do not have
promising result to replace the patching therapy till date
Most of the active therapy methods have good results when used together with
patching therapy
Assessment and Treatment of patients with Amblyopia using interactive binocular computer games
Alexander Foss
Interactive Technologies and Games (ITAG) Conference 2014
Health, Disability and Education
Dates: Thursday 16 October 2014 - Friday 17 October 2014
Location: The Council House, NG1 2DT, Nottingham, UK
Lazy Eye, Eye Turns and Other Functional Vision DisordersDominick Maino
This is a presentation that will be given to the GreenParent Network conference attendees of Chicago's Green Family Festival, April 17 & 18, at the Irish American Heritage Center.
Active Vision Therapy in Management of Amblyopia (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
In the request of my viewers, I have compiled my works here in a website. Visit this website (healthkura.com) to freely download this presentation along with other tons of presentations. Some useful links are given here.____Remember___healthkura.com
Active Vision Therapy in Management of Amblyopia
- Pleoptics
- Near activities
- Active stimulation therapy using CAM vision stimulator
- Syntonic phototherapy
- Role of perceptual learning
- Binocular stimulation
- Software-based active treatments
- Exposure to dark
- Pharmacological Therapy
Lazy Eye, Eye Turns and Other Functional Vision DisordersDominick Maino
This is a presentation that will be given to the GreenParent Network conference attendees of Chicago's Green Family Festival, April 17 & 18, at the Irish American Heritage Center.
Active Vision Therapy in Management of Amblyopia (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/lazy-eye-amblyopia/❤❤
In the request of my viewers, I have compiled my works here in a website. Visit this website (healthkura.com) to freely download this presentation along with other tons of presentations. Some useful links are given here.____Remember___healthkura.com
Active Vision Therapy in Management of Amblyopia
- Pleoptics
- Near activities
- Active stimulation therapy using CAM vision stimulator
- Syntonic phototherapy
- Role of perceptual learning
- Binocular stimulation
- Software-based active treatments
- Exposure to dark
- Pharmacological Therapy
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
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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2. Reduction in visual acuity that cannot be attributed to structural abnormality of eye.
Prevalance in India – 1% to 6%
Any child with visual acuity in either eye of 6/12 or worse at age of three to five years , or
6/9 or worse at age of six years or older is diagnosed as ambylopia.
In addition to reduction in visual acuity , there is a reduction in contrast sensitivity ,
stereopsis,etc.
3. RISK FACTORS :
Ambylopia is 4 times more common in infants who are premature , 6 times
more common in children with developmental delay or children who have
a first degree relative with ambylopia.
Smoking and substance abuse during pregnancy are also contributory
factors.
Onset : Birth to 7 years
Earlier the onset - greater is the deficit.
4. PATHOPHYSIOLOGY
Concept by Hubel and Wiesel
Visual system is not fully developed at birth.
Normal eye Anatomical organization
Bilateral / unilateral
Visual Functional organization
Experience
Eye in stage of dramatic
developmental plasticity
5. Concept of critical period
Sensitive to Abnormal visual stimuli
Stimulus deprivation
Strabismus
AMBYLOPIA
Anisometropia
0
To
9 years
6. Ambylopia is a developmental cortical disorder of visual pathway due to
abnormal visual stimulus reaching binocular cortical cells.
Ambylogenic factors
Visual
Deprivation
Light
Deprivation
Abnormal
Binocular
Interaction
7. Defect of spatial visual processing occurring in visual pathway
Poor transmission from the fovea, optic nerve to striate cortex of affected
eye
LGB and Striate cortex develop abnormally
Ganglion cells in foveal area are affected ; shrinkage of LGB, striate cortex
fibers in ambylopic eye
Reduction / Suppression of binocularly driven ocular dominance columns.
10. Strabismus
Most common form of ambylopia (50%).
Seen in unilateral constant squint.
Esotropia more than exotropia.
Does not develop in alternating or intermittent strabismus.
Severity of ambylopia does not correlate with angle of strabismus.
11. Anisometropic ambylopia
2nd most common cause of ambylopia (17% cases).
Unequal refractive errors in both eyes ( image on one retina
to be chronically defocussed)
Straight eyes and appear ‘ normal `
- hence importance of preschool vision screening.
Hypermetropic anisometropia is more ambylogenic than
myopic.
> 2D in hypermtropes, >4D in myopes and > 1.25D in
astigmatism.
12. Stimulus deprivation Ambylopia ( ambylopia ex anopsia)
Least common but most damaging (<3% cases ).
When the visual axis is obstructed.
Congenital or traumatic cataract, complete ptosis , corneal
opacity and prolonged patching of the normal eye for
treatment of ambylopia.
< 6 years- severe
ambylopia
After 6 years- less
harmful
13. Meriodonal ambylopia
Resolution of eye is reduced in selective meridians as a result
of uncorrected astigmatism.
Cylinder > 1.5 D is considered ambylogenic.
Doesn’t develop until first year of age.
14. Isoametropic ambylopia
Bilateral ambylopia occurring in children with bilateral
uncorrected high refractive error.
Hyperopia> +5 D
Myopia >-10D
Astigmatism > 2D
Mechanism – effect of blurred retinal images alone
15. Work up of ambylopic patient ( AIOS guidelines)
16. CHARACTERISTIC FEATURES
A difference in BCVA of two snellen lines(or > 1log unit ) between the two
eyes.
Crowding phenomenon ( Spatial interference Effect): Single optotypes are
seen better than when presented in a row.
Less degradation of VA and often improvement in the same with Neutral
density filter.
Diminished contrast sensitivity
Colour vision – normal; may be affected in severe ambylopia with BCVA <
6/36
17. TREATMENT
A ) Why treat ambylopia?
B) Approach to treatment
C) Specific treatment strategies
18. Why treat ambylopia?
1. Potentially reversible if treated in the right way at the right time.
2. Improvement in stereopsis.
3. Better outcomes post strabismus surgery may be anticipated although
this has not been proved.
19. Approach to treatment
Correct first : Refractive error or cause of stimulus deprivation such as
cataract, corneal opacities,etc.
Carry out specific treatment strategies for ambylopia.
20. Specific treatment Strategies for ambylopia
Optical correction
Patching or occlusion therapy
Pharmacological penalization
Optical penalization (translucent or opaque lenses and filters)
Dichoptic stimulation
Active Vision Therapy
Surgery.
21. OPTICAL CORRECTION
Correction of refractive errors (if any) is the first step in treatment of
amblyopia.
Refractive correction alone improve visual acuity in many cases (ATS 5).
Proper optical correction should be prescribed, after performing a
cycloplegic refraction in children.(ATS 7 : 3-10 years)
22. OCCLUSION THERAPY
There are various methods of occlusion therapy being practiced, some of them being
application of opaque patch over the skin directly, application of opaque patch over the
glasses, application of rubber patch on glasses, pirate patch, occlusion contact lenses.
Materials
Elastoplast : thicker, better occlusion
Opticlude : thinner but less allergenic
Occlusion therapy may be administered either full time (all waking hours) or part time (2-
6 hours, either continuous or split patching).
23.
24. Traditionally, full-time patching is supposed to increase the visual acuity faster as
compared to part-time patching;, however, recent studies have shown both to have
equivalent final outcomes. (ATS 2)
Full-time patching may be a better mode of therapy in preschool children though it
carries more risk of occlusion amblyopia than part-time patching.
Part-time occlusion is better accepted by school going children. It is recommended that
the caregivers/parents fix the number of hours at a single stretch of time so that there is
no variation in proper administration of a pattern of part-time occlusion.
The mode and schedule of occlusion therapy should be individualized.
25. Pharmacological penalization
Atropine ointment 1% is the recommend agent in the dosage of twice a week in the
better eye (ATS 4 : daily = weekend); however, the dosing schedule may be as per the
discretion of the treating ophthalmologist. (ATS 1)
Atropine drops may be associated with systemic absorption and adverse effects, hence
should not be used. Non desirable effects include reduced vision of better eye (similar to
occlusion amblyopia), photosensitivity, allergy, and anticholinergic side effects. (ATS 9:
atropine e/d Vs patching)
It may be used, when despite the best efforts and explanation about the occlusion
therapy, there is noncompliance or nontransient, nonresolving allergic issues associated
with patching.
26. Optical penalization
The results have not been promising in treatment of amblyopia.
Translucent filters, ground glass, or stick on tapes on glasses alone are not
effective in treatment of amblyopia, however they can be used for
maintenance and weaning off of the occlusion therapy.
27. Surgery
Operative procedure to clear media opacity like cataracts, subluxated lens,
nonclearing vitreous hemorrhage, and corneal opacity,. which can hamper
the amblyopia treatment need to be taken up as early as possible.
Refractive surgery to correct anisometropia, in anisomteropic amblyopia is
not advocated by the panel in general, however it may be of limited use in
certain cases.
28. ACTIVE VISION THERAPY
The child should be encouraged to use the amblyopic eye for visually
demanding tasks in the form of reading/writing, drawing, watching
television/video games, along with occlusion of better/normal eye.
This not only increases compliance as it acts as an encouragement to the
child but may help as an adjuvant to occlusion.
Minimum 1 hour daily activity should be prescribed along with occlusion
therapy.(ATS 12)
29. Recent studies have tested the use of binocular I-pad games in the treatment of
amblyopia.(ATS 18)
The principle of binocular therapies was that high contrast images were presented to the
amblyopic eye and low contrast images to the fellow eye to achieve binocularity.
It was found that with the use of red-green glasses, when children played the ‘falling
blocks’ game, improvement in visual acuity was not as good as 2 hours of patching.
Also, no improvement was seen in visual acuity or stereopsis with Dig Rush iPad game
at the end of 8 weeks.
30. Medical therapy
Medical therapy in the form of levodopa- carbidopa or citicoline(cytidine
diphosphate choline) is not recommended as a standalone treatment.
Citicoline acts as a neuroprotectant in degenerative diseases as it
prevents nerve cell damage and impacts the brain- remodelling activity. It
also increases the level of neurotransmitters such as dopamine. For the
same reason, its role has been studied in amblyopia.
Safe for short term use (90 days) ; safety for long term use is not known.
Side effects include Insomnia , Headache along with constipation, nausea
,and chest pain.
The degree of benefit on using these to complement occlusion therapy is
questionable and they are not recommended for routine use.
31. DICHOPTIC STIMULATION THERAPY
Dichoptic stimulation therapy is found to be promising especially for mild to moderate
amblyopia and is under evaluation for more evidence before it can be used as an
alternative to occlusion.
These include transcranial magnetic stimulation (TMS), which utilizes magnetic
induction to generate weak electrical currents in targeted cortical areas and
transcranial direct current stimulation (tDCS) that involves a small (1–2 mA)
current passed between two head mounted electrodes.
The delivery of repeated pulses of TMS can induce lasting increases or
decreases in neural excitability depending on the pattern and frequency of
stimulation . tDCS can also induce increases and decreases in excitability
depending on the direction of current flow .
32. • PLANNING THE AMBYLOPIA THERAPY
It is important to note the grade of amblyopia, type of amblyopia, and age of the patient
before planning the treatment.
All children irrespective of age should be offered treatment, more so in case of refractive
amblyopia as even older children and young adults have been found to have benefit of
treatment in certain cases. (ATS 3 – upto 17 years)
Proper and careful refractive correction is essential in all types of amblyopia treatment.
In case of large anisometropia or refractive error, contact lenses may be the choice of
refractive rehabilitation.
Spectacle or optical adaptation time of approximately two to four weeks should be given
to establish baseline best corrected visual acuity before starting the patching.
33. However, patching can be started along with prescription of glasses if amblyopia is
dense or repeated visits are difficult.
All children undergoing amblyopia therapy need to reassessed and re-refracted under
proper cycloplegia at repeated intervals. For children less than 3 years of age, refraction
needs to be repeated at least once every 6 monthly, while for older children it should be
done on a yearly basis.
Dichoptics and optical penalization may be used in mild amblyopia or in cases of
maintenance of amblyopia therapy, e.g., in cases where the patient has completed the
amblyopia therapy and is waiting for strabismus surgery or in cases where the
ophthalmologist fears recurrence of amblyopia.
34. Occlusion therapy should be initiated in all forms of amblyopia.
Regular follow up should be done, generally once every 4-6 weeks for children on full-
time occlusion and 6-8 weeks for children on part-time occlusion.
Infants should be followed up every 15 days.
Occlusion therapy is continued till the vision in both eyes equalizes or no further
improvement is seen over two visits at least one month apart despite good compliance.
After successful treatment of amblyopia with patching, maintenance patching or weaning
of patching should be done in view of possible recurrence of amblyopia.
35. Tapering/weaning of occlusion therapy entails reducing the number of days of occlusion,
e.g., 6:1 patching pattern is reduced to 5:1, then 4:1 and so forth, on each visit 4-6
weeks apart (for full-time occlusion) or full-time occlusion may be shifted to a part-time
occlusion of 6 hours daily and then tapered off as a part-time occlusion.
Part-time occlusion can be tapered from 6 hours daily to 4 hours daily on two
consecutive visits 8-10 weeks apart, then 2 hours daily for next two follow-up 8-10 weeks
apart.
Children should be followed up 6-12 monthly even after full recovery of amblyopia till the
age of 9 years.
36. If squint is present, surgical correction should preferably be planned when the vision is
equal in both eyes or the maximum possible visual acuity is achieved in the amblyopic
eye after therapy.
In bilateral and symmetrical amblyopia (ametropic or visual deprivation), the need for
occlusion is to be assessed based on other factors like presence of constant strabismus,
significantly smaller size of the eye, and unilateral significant astigmatism.
In cases where there is no significant difference in both the eyes, only optical correction
is required and alternate patching does not play a role.
37. In cases of amblyopia, resistant to occlusion therapy, addition of active vision therapy or
medical therapy such as levodopa-carbidopa may be tried.
The cases where there is no improvement after institution of amblyopia therapy for 2-3
consecutive visits, the diagnosis of amblyopia needs to be reconsidered, and a re-look
into the refractive status or revision of diagnosis may be needed.