Amblyopia Simplified

1. AMBLYOPIAAMBLYOPIA
Dr. NITISHDr. NITISH

2. AMBLYOPIAAMBLYOPIA
U/L OR B/L DECREASE OF VISUALU/L OR B/L DECREASE OF VISUAL
FUNCTIONS CAUSED BY FORM VISIONFUNCTIONS CAUSED BY FORM VISION
DEPRIVATION &/OR ABNORMALDEPRIVATION &/OR ABNORMAL
BINOCULAR INTERACTIONS THATBINOCULAR INTERACTIONS THAT
CANNOT BE EXPLAINED BY ACANNOT BE EXPLAINED BY A
DISORDER OF OCULAR MEDIA ORDISORDER OF OCULAR MEDIA OR
VISUAL PATHWAYSVISUAL PATHWAYS
A DIFFERENCE OF 2 LINES ON VISUALA DIFFERENCE OF 2 LINES ON VISUAL
ACUITY CHARTACUITY CHART

3. CLASSIFICATIONCLASSIFICATION
 STRABISMICSTRABISMIC
 ANISOMETROPIC/ ASYMMETRIC/ U/LANISOMETROPIC/ ASYMMETRIC/ U/L
 FORM VISION DEPRIVATIONFORM VISION DEPRIVATION
STIMULUS DEPRIVATION AMBLYOPIA EXANOPSIASTIMULUS DEPRIVATION AMBLYOPIA EXANOPSIA
AMETROPIC AMBLYOPIAAMETROPIC AMBLYOPIA
 NYSTAGMUS RELATEDNYSTAGMUS RELATED
 ORGANICORGANIC
SUBCLINICAL MACULAR DAMAGESUBCLINICAL MACULAR DAMAGE
MALORIENTATION OF CONESMALORIENTATION OF CONES
CONE DEFICIENCY SYNDROMECONE DEFICIENCY SYNDROME

4. STRAIGHT EYE AMBLYOPIASTRAIGHT EYE AMBLYOPIA
ANISOMETROPIC – SUPPRESSIONANISOMETROPIC – SUPPRESSION
BEGINS WHEN ACCOMMODATIONBEGINS WHEN ACCOMMODATION
STARTS BEING ACTIVE 2-3 YRS; VISUALSTARTS BEING ACTIVE 2-3 YRS; VISUAL
MATURATION COMPLETE 6-7YRS.MATURATION COMPLETE 6-7YRS.
RISK FACTORS + 3.5 D SPH, +2.0RISK FACTORS + 3.5 D SPH, +2.0
CYL,INCREASING SIMPLE ASTIGMATISMCYL,INCREASING SIMPLE ASTIGMATISM
, OBLIQUE ASTIGMATISM STRABISMUS, OBLIQUE ASTIGMATISM STRABISMUS
SUPPRESSION / ANISOMETROPICSUPPRESSION / ANISOMETROPIC
AMBLYOPIAAMBLYOPIA

5. AMBLYOPIA WITH SQUINTAMBLYOPIA WITH SQUINT
 AMBLYOPIA EX ANOPSIA – OCULAR MEDIAAMBLYOPIA EX ANOPSIA – OCULAR MEDIA
OPACITIES, CONGENITAL OR TRAUMATICOPACITIES, CONGENITAL OR TRAUMATIC
CATARACT, LEUCOMA, OCCLUSIONCATARACT, LEUCOMA, OCCLUSION
AMBLYOPIAAMBLYOPIA
 DEPTH OF AMBLYOPIA& ITS RECOVERYDEPTH OF AMBLYOPIA& ITS RECOVERY
DEPENDS ONDEPENDS ON
* DEGREE OF VISUAL ACUITY BEFORE* DEGREE OF VISUAL ACUITY BEFORE
INHIBITIONINHIBITION
* PERIOD DURING WHICH EXTINCTION OF* PERIOD DURING WHICH EXTINCTION OF
VISION REMAINED ACTIVEVISION REMAINED ACTIVE
* AGE AT WHICH IT DEVELOPED* AGE AT WHICH IT DEVELOPED

6. CLINICAL FEATURESCLINICAL FEATURES
 DECREASED VISUAL ACUITY- RECOGNITIONDECREASED VISUAL ACUITY- RECOGNITION
 DECREASED GRATING ACUITY- RESOLUTIONDECREASED GRATING ACUITY- RESOLUTION
 DECREASED VERNIER ACUITY- HYPERACUITYDECREASED VERNIER ACUITY- HYPERACUITY
 DECREASED / LOST STEREOACUITY- HYPERACUITYDECREASED / LOST STEREOACUITY- HYPERACUITY
 DECREASED CONTRAST SENSITIVITY- NEURALDECREASED CONTRAST SENSITIVITY- NEURAL
 DECREASED BRIGHTNESS PERCEPTION- 6 TIMESDECREASED BRIGHTNESS PERCEPTION- 6 TIMES
LONGERLONGER
 ABNORMAL CONTOUR INTERACTION- LINEAR ACUITYABNORMAL CONTOUR INTERACTION- LINEAR ACUITY
 INCREASED PERCEPTION & REACTION TIMESINCREASED PERCEPTION & REACTION TIMES
 NASOTEMPORAL ASYMMETRIES IN RESOLUTION OFNASOTEMPORAL ASYMMETRIES IN RESOLUTION OF
VERTICAL GRATINGSVERTICAL GRATINGS
 MOTILITY DEFECTS IN PURSUIT, SACCADES &MOTILITY DEFECTS IN PURSUIT, SACCADES &
FIXATIONFIXATION

7. CROWDING PHENOMENONCROWDING PHENOMENON
VISUAL ACUITY WITH ISOLATEDVISUAL ACUITY WITH ISOLATED
SYMBOLS IN A UNIFORMSYMBOLS IN A UNIFORM
BACKGROUND BETTER THAN THOSEBACKGROUND BETTER THAN THOSE
PRESENTED IN A ROWPRESENTED IN A ROW
CRITICAL AREA OF SEPARATION 1.9CRITICAL AREA OF SEPARATION 1.9
TO 3.8 MIN OF ARCTO 3.8 MIN OF ARC
IMPORTANT IN PROGNOSISIMPORTANT IN PROGNOSIS

8. CLASSIFICATION OF FIXATIONCLASSIFICATION OF FIXATION
CENTRAL/FOVEOLARCENTRAL/FOVEOLAR
ECCENTRIC / PARAFOVEOLARECCENTRIC / PARAFOVEOLAR
NO FIXATION / ARRATICNO FIXATION / ARRATIC
PARAMACULAR 2 - 4PARAMACULAR 2 - 4°°
CENTROCAECALCENTROCAECAL
PARACENTRALPARACENTRAL

9. DIAGNOSIS OF ECCENTRICDIAGNOSIS OF ECCENTRIC
FIXATIONFIXATION
VISUOSCOPEVISUOSCOPE
EUTHYSCOPEEUTHYSCOPE
BANGERTER PLEOTOPHORE,BANGERTER PLEOTOPHORE,
LOCALISER,CENTROPHORE,LOCALISER,CENTROPHORE,
SEPARATION TRAINERSEPARATION TRAINER
FUNDUS PICTUREFUNDUS PICTURE
COVER TESTCOVER TEST
CORNEAL REFLEX TESTCORNEAL REFLEX TEST

10. TESTS FOR VISUAL FUNCTIONTESTS FOR VISUAL FUNCTION
ELECTRORETINOGRAPHYELECTRORETINOGRAPHY
ELECTROENCEPHALOGRAPHYELECTROENCEPHALOGRAPHY
VISUALLY EVOKED RESPONSEVISUALLY EVOKED RESPONSE

11. OCCLUSIONOCCLUSION
OCCLUSION OF THE SOUND EYEOCCLUSION OF THE SOUND EYE
METHODS – ATTACHING OCCLUDERMETHODS – ATTACHING OCCLUDER
TO SPECTACLES, PASTING DARKTO SPECTACLES, PASTING DARK
PAPER , MATERIALS THAT FASTEN TOPAPER , MATERIALS THAT FASTEN TO
SKIN, SNEAK OR SLOWLYSKIN, SNEAK OR SLOWLY
INCREASING OCCLUSIONINCREASING OCCLUSION
INVERSE OCCLUSION – IN SQUINTINVERSE OCCLUSION – IN SQUINT
WITH ECCENTRIC FIXATION . AFTER 5WITH ECCENTRIC FIXATION . AFTER 5
YRS OF AGEYRS OF AGE

12. RED FILTER TREATMENTRED FILTER TREATMENT
TOTAL OCCLUSION SOUND EYE WITHTOTAL OCCLUSION SOUND EYE WITH
RED FILTER KODAK GELATINERED FILTER KODAK GELATINE
WRATTEN FILTER , WAVE LENGTHWRATTEN FILTER , WAVE LENGTH
600-640600-640µ ON GLASS BEFOREµ ON GLASS BEFORE
AMBLYOPIC EYEAMBLYOPIC EYE
CUTS OUT WHITE LIGHTCUTS OUT WHITE LIGHT
RED LIGHT INCAPABLE OFRED LIGHT INCAPABLE OF
STIMULATING ECCENTRIC FIXATIONSTIMULATING ECCENTRIC FIXATION

13. PRISMSPRISMS
OCCLUSION OF THE SOUND EYE WITHOCCLUSION OF THE SOUND EYE WITH
PRISM FOR THE AMBLYOPIC EYEPRISM FOR THE AMBLYOPIC EYE

14. PLEOPTICSPLEOPTICS
BANGERTER 1940BANGERTER 1940
PLEOPTOPHORE , MODIFIEDPLEOPTOPHORE , MODIFIED
GULLSTRAND OPHTHALMOSCOPEGULLSTRAND OPHTHALMOSCOPE
ECCENTRIC FIXATION DAZZLED WITHECCENTRIC FIXATION DAZZLED WITH
BRIGHT LIGHT, FOVEA PROTECTEDBRIGHT LIGHT, FOVEA PROTECTED
WITH A DISC FOLLOWED BYWITH A DISC FOLLOWED BY
INTERMITTENT STIMULATION OFINTERMITTENT STIMULATION OF
MACULAMACULA

15. EUTHYMOSCOPEEUTHYMOSCOPE
CUPPERS AT GEISSENCUPPERS AT GEISSEN
NEGATIVE AFTER IMAGE IS EVOKEDNEGATIVE AFTER IMAGE IS EVOKED
AND ENHANCED BY FLICKERINGAND ENHANCED BY FLICKERING
ROOM ILLUMINATIONROOM ILLUMINATION
CLEAR SPOT IN THE CENTRE OFCLEAR SPOT IN THE CENTRE OF
AFTER IMAGE CORELATES WITHAFTER IMAGE CORELATES WITH
FOVEA WHICH HAS REGAINEDFOVEA WHICH HAS REGAINED
FUNCTIONAL SUPREMACYFUNCTIONAL SUPREMACY
HAIDINGER BRUSHESHAIDINGER BRUSHES

16. PENALISATION METHODPENALISATION METHOD
1 % ATROPINE OINTMENT FOR SOUND1 % ATROPINE OINTMENT FOR SOUND
EYE + MIOTICS IN AMBLYOPICEYE + MIOTICS IN AMBLYOPIC
HYPERMETROPIC EYEHYPERMETROPIC EYE

17. CAMBRIDGE STIMULATORCAMBRIDGE STIMULATOR
TREATMENTTREATMENT
7 MINUTES A DAY OCCLUSION OF7 MINUTES A DAY OCCLUSION OF
SOUND EYE & SIMULTANEOUSSOUND EYE & SIMULTANEOUS
STIMULATION OF AMBLYOPIC EYESTIMULATION OF AMBLYOPIC EYE
WITH SLOWLYY ROTATING HIGHWITH SLOWLYY ROTATING HIGH
CONTRAST GRATING OF HIGHCONTRAST GRATING OF HIGH
SPATIAL FREQUENCYSPATIAL FREQUENCY

18. ADJUNCT TO OCCLUSIONADJUNCT TO OCCLUSION
LEVO DOPA CARBIDOPA 4:1 IN DOSESLEVO DOPA CARBIDOPA 4:1 IN DOSES
OF 2/ 0.5 MG / KG BODY WT FOR 3OF 2/ 0.5 MG / KG BODY WT FOR 3
WEEKS BELOW 12 YEARSWEEKS BELOW 12 YEARS