Amblyopia, commonly known as lazy eye, is a condition where vision is reduced in one or both eyes and cannot be corrected by glasses or contact lenses. It is caused by abnormal visual development during childhood. There are several types of amblyopia including stimulus deprivation, strabismic, anisometric, and isometric amblyopia. Treatment involves patching or blurring the stronger eye to encourage use of the weaker eye, along with refractive correction if needed. Therapy is most effective when started early in childhood.

1. Amblyopia
Surendra sah
2nd
January, 2015
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Definition
 Amblyopia means “Dullness of vision”
(Ambly = dull + ops = vision)
 A condition of visual acuity not correctable
by refractive means and not attributable to
obvious structural and/or pathological
ocular anomalies

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 Visual Acuity
 Difference of 2 lines on a visual acuity
chart is commonly used as diagnostic
criteria for amblyopia
 OD: 20
/100
20
/30
 OS: 20
/20

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I am
suppressed

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Classifications
 Stimulus deprivation amblyopia
 Strabismic amblyopia
 Anisometric amblyopia
 Isometric amblyopia
 Occlusion amblyopia
 Secondary due to nystagmus
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Stimulus deprivation amblyopia
 Severe ptosis
 Corneal opacity
 Congenital Cataract
 Vitreous opacity
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Strabismic amblyopia
 Due to unilateral squint it develops as an
adaptation to avoid diplopia
 Most commonly seen in esotropia
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Clinical tests for Strabismic
amblyopia
 Fixation Preference
 Child strongly and repeatedly
objects to having the fixating eye
covered
 Free alteration safely assess that
amblyopia is absent

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Anisometric amblyopia
 Significant difference in
refractive error between
two eyes
 Hypermetropia is more
intense than myopia
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Isometric amblyopia
 Secondary to approximately equal high
refractive errors in both eyes
 Hypermetropia is more intense than myopia
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Occlusion amblyopia
 Prolonged occlusion therapy of
preferred eye
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Secondary to Nystagmus
 Latent or manifest nystagmus may decrease
vision
 In micronystagmus horizontal oscillation of
the eye is present

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Clinical Features
 Visual acuity decreased
 Crowding phenomenon
 Decreased contrast sensitivity
 Decreased accommodation
 Decreased visual field

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Crowding phenomenon
 Amblyopes can discriminate smaller visual
acuity symbols when presented singly
E O

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Investigations
 History
 Visual acuity testing
 Fixation evaluation
 Perfect refraction
 Eye disease evaluation
 Visual field testing
 Neutral density filter
 Test of retinal function
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Fixation evaluation
 Central fixation
 Eccentric fixation
 No fixation
Foveal Para foveal Macular Peripheral
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Neutral Density Filter
 Reduce vision in eyes with central retinal
lesions and glaucoma
 Kodak Wratten Filter No.96

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Amblyopia Therapy
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Amblyopia Therapy
1. Removal of ocular pathology
2. Full refractive correction
3. Occlusion therapy / Penalization therapy
4. CAM vision stimulator
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Cont………
5. Auxiliary therapy for eccentric fixation
6. Prescription of appropriate maintenance
programme
7. Periodic visit
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Occlusion Therapy
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 Attach with spectacle
 Occlusion with black cloth
 Attach with skin
 Opaque contact lens

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Types
 According the area of visual field occluded
 According which eye occluded
 According the effect of light transmission
 According the occlusion time
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 Degree of amblyopia
 Age of the patient
Required time

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Maintenance therapy
 Patching for 1-3 hours per day
 Penalization with atropine 1 or 2 day per
week.
 This may require periodic monitoring until
age 8-10 years

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Risk of Occlusion Therapy
 Full time occlusion requires close
monitoring, especially in the younger child
 The first follow up visit after initial
treatment should occur within 1 week
 Part time occlusion method allows for less
frequent observation

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Reality
 Poor cooperation
 Underlying organic defect
 Started too late
 Grossly unequal eyes (unilateral high myopia -
unilateral aphakia)
 Latent nystagmus

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Children with sensitive skin
 Tincture of benzoin is applied before
occlusion

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Penalization therapy
 Near
Good eye : Atropine 1% + full correction
Amblyopic eye : +3.00Dsph over correction
 Distance
Good eye : Atropine 1% + +3.00Dsph add
Amblyopic eye : full refractive correction
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Cont………
 Total
Good eye : Atropine 1% + plano lens
Amblyopic eye : full refractive correction
Good eye : Atropine 1%
Amblyopic eye : Pilocarpine 2%
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CAM Vision Stimulator
 Campbell and coworkers in 1978
 Stimulation by slowly rotating high
contrast, square wave grating for 7 min.

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Auxiliary therapy for eccentric
fixation
 Pleoptics
 Inverse prism therapy
 Red filter therapy

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Pleoptics
 Patch amblyopic eye for 1-2 months
 Bangerter’s method
 Pleoptophore
-Bleaching phase
-Stimulating phase
 Cupper’s method
 Ethyscope

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Inverse prism therapy
 Occlude the normal eye totally
 Place an inverse prism before
amblyopic eye
 Shifts the principal visual direction to the
fovea

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Red filter therapy
 Occlude the normal eye totally
 Kodak Wratten Filter No. 92 (640nm) is
placed before amblyopic eye

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Thank
you…