BV 13 - amblyopia treatment

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Author:
sookylala
ID:
290603
Filename:
BV 13 - amblyopia treatment
Updated:
2014-12-04 06:18:47
Tags:
amblyopia
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Description:
amblyopia
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  1. 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)
  2. Aniso w/o strab features?
    • may have binocularity
    • central suppression with peripheral fusion
  3. Aniso amb (w/o strab) bino goal?
    full binocularity with stereo
  4. strab amb goal?
    • full functional cure
    • spare eye
    • surgery only
  5. Conventional treatment?
    • rule out pathology
    • full cyclo rx
    • rx adaptation
    • occlusion + active VT
    • pleoptics
    • accom training
    • establish normal BV
    • maintenance: VT and/or occlusion
    • periodic monitoring for regression
  6. 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
  7. 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
  8. Aniso ambs tx?
    • Agervi 2013: specs vs spec+filter same VA outcome
    • Pedig 2006: full cx 27% resolved amb 7M
  9. Strab amblyopes tx?
    Pedig 2012: full cx 40% resolved amb
  10. Aniso - strab - amblyopes tx?
    Pedig 2012: full cx 28% resolved amb
  11. Bilateral amb tx?
    Pedig 2007: full cx 75% reached 6/7.5 1Y
  12. Occlusion features?
    • which eye?
    • light?
    • Area?
    • duration?
  13. 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
  14. What are the light types with occlusion therapy?
    • opaque
    • translucent - bangerter filter - will improve VA so filter will need to be changed
  15. What areas can be occlude with occlusion therapy?
    • Total
    • partial: 1- binasal-forces eyes to diverge
    • 2- sector - palsies seeing double in certain direction
  16. Duration of occlusion therapy?
    • Constant: 8hrs/day - full waking hours
    • Intermittent: 2-6hrs.day
  17. What are the direct benefits of direct occlusion?
    • breaks down suppression
    • strabs: prevents development or reinforcement of AC
  18. What are the goals and type of occlusion therapy for heterphores?
    • improve VA
    • avoid occlusion strab/amb
    • therapy: part time/direct
  19. 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
  20. What occlusion therapy schedule for a constant mild/mod strab?
    • <6/30
    • PEDIG: 2H vs 6H same results
    • tx: 2H/day with near activities
  21. What occlusion therapy schedule for a constant severe strab?
    • >6/30
    • PEDIG: 6H vs full day + near activities
    • tx: 6H/day + 1hr near activities
  22. What occlusion schedule is best for mod amblyopes?
    • <6/30
    • PEDIG: rx vs rx+patch
    • tx: younger kids rx+patch
  23. What occlusion schedule is best for sev amb?
    • >6/30?
    • PEDIG: rx vs rx+patch
    • tx: rx + patch
  24. 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
  25. If still amb after 2H patching and rx?
    increase patching to 6H
  26. When would you stop occlusion therapy?
    • equal VAs
    • no improvement/plateau after 6-8W
    • if no improvement + inverse occlusion and EF
  27. Active VT types?
    • hand eye
    • visual resolution
    • foveal tag procedures
  28. VT for direct occlusion amb with infants?
    • follow/catch rolling ball with amb eye
    • crawling, walking
    • handling toys
  29. VT for direct occlusion amb with kids?
    • colouring books
    • join the dots
    • colouring Os in newspaper
    • computer/vid games
  30. EF tx?
    • 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
  31. 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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