BV 13 - amblyopia treatment
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Monocular goals for amblyopia treatment?
- improve VA
- steady CF
- good pursuit and saccade skills
- good acc: amp, facility and accuracy (improves fusion to break suppression)
Aniso w/o strab features?
- may have binocularity
- central suppression with peripheral fusion
Aniso amb (w/o strab) bino goal?
full binocularity with stereo
strab amb goal?
- full functional cure
- spare eye
- surgery only
- rule out pathology
- full cyclo rx
- rx adaptation
- occlusion + active VT
- accom training
- establish normal BV
- maintenance: VT and/or occlusion
- periodic monitoring for regression
What are the appropriate lenses that are prescribed for amblyopes?
full cyclo rx: clear image to aid fusion, and amblyopia may be due to rx
What is refractive adaptation?
- 1. Prescribe rx
- 2. wait for improvement then plateau
- 3. Prescribe occlusion therapy if amblyopia is still present
improves compliance with patching
Aniso ambs tx?
- Agervi 2013: specs vs spec+filter same VA outcome
- Pedig 2006: full cx 27% resolved amb 7M
Strab amblyopes tx?
Pedig 2012: full cx 40% resolved amb
Aniso - strab - amblyopes tx?
Pedig 2012: full cx 28% resolved amb
Bilateral amb tx?
Pedig 2007: full cx 75% reached 6/7.5 1Y
- which eye?
Which eye is occluded during occlusion therapy?
- Direct: improve monocular oculomotor/accom skills
- Indirect: done as a last resort in amb eye with EF - shown to disrupt EF
- Alternate: to prevent contracture, after acuity returns to normal
What are the light types with occlusion therapy?
- translucent - bangerter filter - will improve VA so filter will need to be changed
What areas can be occlude with occlusion therapy?
- partial: 1- binasal-forces eyes to diverge
- 2- sector - palsies seeing double in certain direction
Duration of occlusion therapy?
- Constant: 8hrs/day - full waking hours
- Intermittent: 2-6hrs.day
What are the direct benefits of direct occlusion?
- breaks down suppression
- strabs: prevents development or reinforcement of AC
What are the goals and type of occlusion therapy for heterphores?
- improve VA
- avoid occlusion strab/amb
- therapy: part time/direct
What are the goals and type of occlusion for intermittent strab?
- Goals: improve VA and avoid occlusion strab/amb
- Tx: part time, direct, total or partial if incomitant
- frequent follow up if bv is poor
What occlusion therapy schedule for a constant mild/mod strab?
- PEDIG: 2H vs 6H same results
- tx: 2H/day with near activities
What occlusion therapy schedule for a constant severe strab?
- PEDIG: 6H vs full day + near activities
- tx: 6H/day + 1hr near activities
What occlusion schedule is best for mod amblyopes?
- PEDIG: rx vs rx+patch
- tx: younger kids rx+patch
What occlusion schedule is best for sev amb?
- PEDIG: rx vs rx+patch
- tx: rx + patch
Adv and disadv of atropine?
- can do on weekend
- reach same VA results as patching
- slower than patching
- CNS side effects
- 1% 1 drop on sat and sun
If still amb after 2H patching and rx?
increase patching to 6H
When would you stop occlusion therapy?
- equal VAs
- no improvement/plateau after 6-8W
- if no improvement + inverse occlusion and EF
Active VT types?
- hand eye
- visual resolution
- foveal tag procedures
VT for direct occlusion amb with infants?
- follow/catch rolling ball with amb eye
- crawling, walking
- handling toys
VT for direct occlusion amb with kids?
- colouring books
- join the dots
- colouring Os in newspaper
- computer/vid games
- foveal tag procedure: haidingers brushes "can you place the brush ontop of the dot- assoc HP with fovea
- pleoptics- bleach out area around fovea with bright light
BV training for ambs?
- if not strab
- break suppression
- train monocular fixation of amb eye under bv conditions- red/green tasks
- extend range of fusion: BI/BO prisms
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