Amblyopia New knowledge and practical approaches ESA 2007 Early morning course May 21, 2007 Daisy Godts CO, Ilse De Veuster MD University Hospital Antwerp

AmblyopiaAmblyopiaNew knowledge and practical approachesNew knowledge and practical approaches

ESA 2007ESA 2007

Early morning courseEarly morning course

May 21, 2007May 21, 2007

Daisy Godts CO, Ilse De Veuster MDUniversity Hospital Antwerp

UZ Antwerp ESA 2007 Daisy UZ Antwerp ESA 2007 Daisy GodtsGodts

AmblyopiaAmblyopia

• Pubmed:

– 5829 amblyopia

– 3051 amblyopia treatment

– 2860 amblyopia therapy

– 490 amblyopia occlusion

– 149 amblyopia patching

– 122 amblyopia atropine

– 70 amblyopia penalization

– 5 amblyopia inverse occlusion


Definition of amblyopiaDefinition of amblyopia

Amblyopia is a diagnosis of exclusion

Because the basis is defective central visual processing,

careful assessment of the retina and optic nerve is

essential

The diagnosis is established by a unilateral or bilateral

reduction of BCVA not entirely attributable to structural

abnormalities of the visual pathways

PPP AAO 2002: Amblyopia



• VA 2 / 3 lines ( < 20/50 3 years of age / <

20/40 5 years of age) / fixation behaviour

• No differences with corrective lenses

• Amblyopia inducing factor present

• Onset : immature visual system

• Prevalence : 2-4% general population

PPP AAO 2002: Amblyopia



• Pattern deprivation

• Strabismus :

– Synchronous stimulus of visual cortex of non corresponding images of two foveas

– Binocular rivalry => suppression

• Optical defocus

– Refractive error removes fine details from the retinal image

– Anisometropia : 100% amblyopia risk : +4D/-6D vs 50% +2,5D/-4D


Pathofysiological mechanismsPathofysiological mechanismsType of amblyopia

Abnormal binocular

interaction

Visual image distortion

Strabismic +

Refractive: Ametropia Anisometropia +

++

Deprivation: Unilateral Bilateral

+ ++

Organic: Unilateral Bilateral

+ ++

Focal Points AAO volume XVIII nr 2, March 2000 : Practical management of amblyopia


ManagementManagement

Two principles

• Optimise clarity of retinal image in the amblyopic

eye: clear visual axis + correction of refractive

errors

• Increase cortical processing of visual input of

amblyopic eye = enhance the neural stimulus to

the visual cortex



• Parent’s explanation !!!!

• Surgery if necessary

• Optical correction : spectacles, contact lenses

• Patching/occlusion

• Atropine/penalization/optical

penalisation/defocus



Response is related to:

• Type of amblyopia

• Initial VA

• Age

• Duration of amblyopia

• Method of treatment

• Compliance


Robbe 8 yearsRobbe 8 years

During screening low VA RE, consulted ophthalmologist:

too late, no treatment anymore. Second opinion

VA RE: 0.1 sc 0.25 +4.25 Logmar

VA LE: 1.0 sc

Cycloplegic refraction RE: +6.75 –0.75 x 150

LE: +4.00 -0.75 x 130

Straight eyes with fusion and moderate stereopsis

Central fixation BE

Anterior and posterior segment: normal

Therapy: +4.75/ +2.00



2 months control

VA RE: 0.3 cc Logmar

VA LE: 1.0 cc

BV: normal

8 hours occlusion LE

2 months control: good compliance


VA LE: 1.0 cc

BV: normal





VA RE: 0.7 cc LogmarVA LE: 1.0 ccBV: normal4 hours occlusion LE


VA RE: 0.8- cc LogmarVA LE: 1.0 ccBV: normal2 hours occlusion LE


Steele A L, Bradfield Y S, Kushner B J, France T D, Struck M C, Gangnon R G . Successful Treatment of Anisometropic Amblyopia with Spectacles Alone. J AAPOS 2006;10:37-43

The mean time to resolution in this study was 5.8 + - 3.9 months with a range of 2 to 15 months

Age at presentation ranged from 0.8 to 7.9 years (mean 4.8, SD 1.7)

We analyzed age, best corrected initial visual acuity in the amblyopic eye, initial stereoacuity, type, and amount of anisometropia to assess which of these presenting characteristics are significantly associated with time to cure.

Worse initial visual acuity was significantly associated with longer time to resolution (P 0.05)

Anisometropia amblyopia : Anisometropia amblyopia : GlassesGlasses


Anisometropic amblyopia : GlassesAnisometropic amblyopia : Glasses

• 3 - 7 years

• Anisometropia : 0,5D SE or 1,5 D astigmatism

• Prescription: hyperopia > 3D full or max –1,5D

• hyperopia < 3 D ( investigator )

• VA 20/40 – 20/250

• VA change : 2,9 lines +- 1,8

• 77% patients improvement of 2 lines

• Resolution of amblyopia ( VA 1 line) = 27%

• Amblyopia resolution ~ base line VA

~ magnitude of anisometropia

PEDIG Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmoly 2006; 113:895.


Aaron 4 yearsAaron 4 years

19/09/06 During screening low VA BE, consulted ophthalmologist: no treatment possible. Second opinion

VA RE: 0.10 sc LEA symbols VA LE: 0.20 sc

Cycloplegic refraction RE: +6.50 –1.75 x 0LE: -1.50 –1.50 x 0

Straight eyesAnterior segment: normalPosterior segment: RE normal, LE myelin vessels

Therapy: contact lenses +6.00 –1.75 x 0-1.50 –1.25 x 0



Posterior segment: RE normal, LE myelin vessels



1 month control:

VA RE: 0.16 ccl LEA symbolsVA LE: 0.40 cclBV: normal

2 months control:

VA RE: 0.25 ccl LEA symbolsVA LE: 0.50 cclNear VA RE: 0.4/1.6 ccl

LE: 0.4/ 0.8 ccl6 hours occlusion LE



1 month control: good compliance to occlusion

VA RE: 0.40 ccl LEA symbols

VA LE: 0.50 ccl

Near VA RE: 0.4/1.0 ccl LE: 0.4/ 0.8 ccl

BV: normal



VA RE: 0.60 ccl LEA symbols

VA LE: 0.60 ccl

Near VA RE: 0.4/1.0 ccl LE: 0.4/ 0.8 ccl



Patching regimensPatching regimens

• 3 - 7 years

• Moderate amblyopia : 20/40 –20/80

• Anisometropic, strabismic and mixed amblyopia

• 2 hours + 1 hour near activity vs 6 hours + 1hr

• Age/base line acuity/ cause of amblyopia : no difference

• Results:

– 5 weeks: 2 hrs 1,84 lines improvement vs 1,92 line

– 4 months : 2,4 lines improvement in both groups

PEDIG A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol 2003; 121: 603


Patching regimensPatching regimens

• 3 - 7 years

• Severe amblyopia : 20/100 –20/400


• Full-time vs 6 hours + 1 hour near activity each

• Age/base line acuity/ cause of amblyopia : no difference

• Results:

– 5 weeks: 6 hrs 3.5 lines improvement vs 3.7 lines in FTO

– 4 months : 6 hrs 4.8 lines improvement vs 4.7 lines in FTO

PEDIG A randomized trial of prescribed patching regimens for treatment of severe amblyopia. Ophthalmology 2003; 110: 2075


Argita 9 yearsArgita 9 years

10/11/06 first ophthalmological examination because poor VA during school examination, Roma gypsies

VA RE: 0.2 sc Logmar VA LE: 0.1 sc Cycloplegic refraction RE: +9.00 –2.00 x 170

LE: +10.00 –2.75 x 10

Straight eyesAnterior and posterior segment: normal

Therapy: +8.00 –2.00 x 170+9.00 –2.75 x 10


Argita 9 yearsArgita 9 years

09/02/07 3 months of full-time spectacle wear

VA RE: 0.6 cc Logmar VA LE: 0.2 cc Micro-esotropia LE central fixation Therapy: 6 hours occlusion RE, control 2 months

17/04/07 good compliance to occlusionVA RE: 0.6 cc Logmar VA LE: 0.25 cc Micro-esotropia LE central fixation

Therapy: more/idem occlusion RE ? Stop occlusion?


Treatment of amblyopia > 7 Treatment of amblyopia > 7 yearsyears

• 7 - 10,3 years (36 patients)


• Spectacles + full time occlusion/ total penalisation

• Follow up : 1 year after no further improvement in VA

• VA 20/50- 20/400 start ~ end 20/20 –20/30 for all patients

• Duration : 0,6 yrs aniso / 1,0 yrs strab / 0,8 yrs mix

• BV improved or maintained in 61% of cases

Mintz-Hittner H et al .Succesfull amblyopia therapy initiated after age 7 years. Arch Ophthalmology 2000;118: 1535


Nikki 10 yearsNikki 10 years

Foster child since 1 year, abandoned by her parents

because of drug problems. Had glassed and occlusion long ago

VA RE: 1.0 sc Logmar

VA LE: 0.05 sc0.1 +5.OO –4.00 x 0°

Cycloplegic refraction RE: +2.50

LE: +6.25 –4.00 x 0°

CT: 12êsotropia LE

Central fixation BE


Therapy: Glasses?

Occlusion?



Glasses RE + 1.25 LE + 5.00 –4.00 x 0°Full time occlusion RE

1.5 months: VA RE: 1.0 cc LogmarVA LE: 0.5 cc12ÊTFull time occlusion RE

3 months: VA RE: 1.0 cc LogmarVA LE: 0.6 cc12ÊTFull time occlusion RE



5 months: Occlusion done 7- 8 hours


VA LE: 0.6 cc

12ÊT

4 hours occlusion RE

7 months: VA RE: 1.0 cc Logmar

VA LE: 0.7 cc

10ÊT

Titmus: 4/9

2 hours occlusion RE




VA LE: 0.7 cc

10ÊT’

Titmus 5/9, Lang I: positive

1 hour occlusion RE


VA LE: 0.7 cc

10ÊT’

Titmus: 5/9, Lang I & II: positive

1 hour occlusion RE once a week




VA LE: 0.7 cc

8ÊT

Titmus 6/9, Lang I & II: positive

Stop occlusion RE


VA LE: 0.7 cc

8ÊT

Titmus: 5/9, Lang I & II: positive, TNO 240”



• 10 - 18 years, 66 patients

• VA 20/40 –20/160

• Optimal optical correction > 4 wks


• Daily patching 2 hrs/day ( 1 hour of near visual

activity)

• 2 month follow up

• 18/66 (27%) VA improvement with 2 or more lines

• 10-14 years vs 14–18 years: no difference

PEDIG A prospective, pilot study of treatment of amblyopia in children 10 to < 18 years old. Am J Ophthalmol 2004;137: 581-583.



• 7 - 17 years, 507 patients

• 2 groups: younger group 7-12 years, older group 13-17 years

• VA 20/40 – 20/400


• Optimal optical correction alone or + 2-6h patching+atropine

• 24 weeks follow-up (6 weeks controls)

• Younger group: 53% improvement (patching+atropine)

25% improvement (optical correction)

• Older group: 25% improvement (patching)

23% improvement (optical correction)

• No diplopia

PEDIG Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 2005; 123: 437-447


Thomas 4 yearsThomas 4 years

Second opinion: glasses +4.00/+5.75 since age 2 year

occlusion 4h RE/day poor compliance

AV RE: 0.7 cc Snellen E

AV LE: 0.2 cc


LE: +6.50 –1.00 x 150

Partial accommodative esotropia LE

Therapy: LE +6.00 –1.00 x 150

Occlusion RE at school



3 months: Very poor compliance to occlusion


AV LE: 0.2 cc

= partial accommodative ET LE

Therapy: Atropine 0.50 % RE, plano glass RE

6 months: AV RE: 0.2 sc/atropine Snellen E

AV LE: 0.8 cc

Therapy: RE + 4.00 Stop atropine RE, 1 h alternate occlusion



8 months: Good compliance to occlusion


AV LE: 0.8 cc


Therapy: 1 h alternate occlusion



AV LE: 0.8 cc

Therapy: 2h occlusion RE





AV LE: 0.8 cc

near VA RE: 1.0 cc LEA

VA LE: 0.8 cc


Therapy: 2 h occlusion RE

26 months: Poor compliance to occlusion

AV RE: 1.0 cc Logmar

AV LE: 0.6 cc

Therapy: Atropine 0.5 % RE 2X week



32 months: No atropine used, occlusion 2 h RE

AV RE: 1.0 cc Logmar

AV LE: 1.0 = cc

near VA RE: 1.0 cc LEA numbers

VA LE: 0.8+ cc


Therapy: 2 h occlusion RE 2-3 times a week


Atropine vs patchingAtropine vs patching

• 3-7 years, 419 patients

• VA 20/40 – 20/100


• Occlusion > 6 hours vs atropine daily

• Results:

– 5 wks : 2,22 lines improvement occlusion vs 1,37

atropine

– 16 wks: 2,94 vs 2,42

– 6 months: 3,16 vs 2,84

• Patching = more rapid and possible slightly better VA

• Atropine easier administration and lower cost PEDIG. A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch 2002; 120: 268


Atropine vs patchingAtropine vs patching

• 3-7 years, 419 children

• VA 20/40 - 20/100


• VA 6 months: 0,25 ( 20/30-2) atropine daily vs 0,21 (20/30)

occlusion (6h - FTO)

Age, depth of amblyopia, cause of amblyopia: no difference

Atropine as effective in VA 20/100 as when 20/40

Occlusion faster improvement especially when VA 20/80-

20/100 and when FTO or nearly FTO

PEDIG. A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia and other factors. Ophthalmology 2003; 110: 1632-1638.


Atropine vs patching : Atropine vs patching : 2 y follow-2 y follow-upup

• Follow-up 18 months after 6-months randomised trial

• 419 children age < 7 years

• Initial VA 20/40 to 20/100

• After 2 years: VA increased from baseline 3.7 lines

(occlusion 6h-FTO) and 3.6 lines (atropine daily)

• In both groups mean amblyopic VA was 20/32, 1.8 lines

worse than the sound eye (20/20)

Atropine or patching produced similar improvement of

moderate amblyopia in children age 3-7 yearsPEDIG Two-year follow-up of a 6 month randomized tral of atropine versus patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2005: 123: 149-157.


Glen 4 yearsGlen 4 years

10/11/04 first ophthalmological examination because poor VA during school examination

VA RE: 0.2 sc Snellen E VA LE: 1.0 sc Cycloplegic refraction RE: +1.75

LE: +1.75 –0.50 x 100

Esotropia RE, poor fixation possible eccentricAnterior and posterior segment: normal

Therapy: orthoptic consult



07/06/05 second opinion, low VA RE, no therapy done, consulted ophthalmologist did not know what to do

VA RE: 0.01 sc Snellen E VA LE: 1.0 sc

Cycloplegic refraction RE: +1.75 –0.50 x 105LE: +1.25 –0.25 x 100

Esotropia RE, no central fixation Anterior and posterior segment: normal

Therapy: 4 hours occlusion LE, control 4-5 weeks



15/11/05 Poor compliance to occlusion, max 1 hour

VA RE: 0.05 sc Snellen E

VA LE: 1.0 sc


LE: +1.21 –0.25 x 100

Esotropia RE, poor fixation

Unstable fixation RE

Therapy: Atropine 0.5% LE + occlusion LE

Control 4 weeks



19/10/06 atropine used beginning last year, sometimes

occlusion done

VA RE: 0.1 sc Snellen E

VA LE: 1.0 sc

Esotropia RE, poor fixation

Central unstable fixation RE

Therapy: Full time occlusion (day and night)

6 weeks control



07/12/06 Good compliance

VA RE: 0.5 sc Snellen E VA LE: 1.0 sc Therapy: Full time occlusion, 6 weeks control

11/01/07 good compliance

VA RE: 0.8 sc Snellen EVA LE: 1.0 scTherapy: 6 hours occlusion, 8 weeks control

22/03/07 Good compliance

VA RE: 0.8 sc Snellen E VA LE: 1.0 sc

Therapy: 3 hours occlusion, 2 months control


Compliance : occlusionCompliance : occlusion

• Poor parental fluency in the national language

• Low level of education

• Poor acuity at the start of treatment

An educational program primarily aimed at the child

improved compliance and reduced the number of

children who did not comply with occlusion at all

SE Loudon, M Fronius, CWN Looman, M Awan, B Simonsz, PJ van der Maas, HJ Simonsz: Predictors and a remedy for noncompliance with amblyopia therapy in children measured with the occlusion dose monitor.Invest Ophthalmol Vis Sci. 2006 Oct;47(10):4393-400.


Dixon Woods M et al. Why is compliance with occlusion therapy for amblyopia so hard? A qualitative study. Arch Dis Child 2006; 91: 491


• Semi structured interviews ( n = 28 ) of parents of a child prescribed

patching ( 2 to 8 years : mean duration of patching: 3 months to 5

years)

• Problems with patching

– Begin of treatment/ extreme emotional reactions of child/ low VA ~ struggle with everyday life activities

– Social impact : risk of teasing

– Strain relationship child – parent

– Time consuming



• Strategies to support patching

– Explanation : need for patching

– Rewarding the effort with VA increase at follow

up/ attention and praise/ game / no big deal

– Normalisation strategies : toy with patch /other

children with patch

– Customising the patch :figures on the patch etc

– Establishing routine :structure and routine

– Support of others : teachers, day care workers

Dixon Woods M et al. Why is compliance with occlusion therapy for amblyopia so hard? A qualitative study. Arch Dis Child 2006; 91: 491


Jef 4.5 yearsJef 4.5 years

Since 1.5 years glasses + occlusion RE during school

hours, no VA improvement, good compliance

VA RE: 1.0 sc 1.0 cc (+1.00) E linear

VA LE: 0.1 sc 0.1 cc (+3.00)

Cycloplegic refraction RE: +2.50

LE: +4.50

Partial accommodative esotropia LE

Parafoveal fixation LE




Therapy: Inverse occlusion?



1 month full time inverse occlusion LE

VA RE: 0.9 cc Linear EVA LE: <0.05 cc

Total fixation loss LE

R/ Full time occlusion RE, no bilateral fixation

1 month: VA RE: 0.6 cc Linear E

VA LE: 0.2+ cc

Central unsteady fixation LE

R/ Full time occlusion RE



Central fixation RE Central unsteady fixation LE


Jef 5 yearsJef 5 years

3 months: Full time occlusion done

VA RE: 0.5 cc E linear

VA LE: 0.4 cc

Central fixation LE

ET RE

R/ Alternate occlusion

4 months: Alternate occlusion done

VA RE: 0.8- cc E linear

VA LE: 0.6- cc

ET LE

Central fixation

R/ 6 hours occlusion RE


Jef 5 yearsJef 5 years

6 months: 6 hours occlusion done


VA LE: 0.6 cc

Central fixation LE

ET LE


8 months: 6 hours occlusion done


VA LE: 0.8 cc

ET LE

Central fixation



Inverse occlusionInverse occlusion1. Pigassou-Albouy R. Treatment of eccentric fixation. Inverse

prism and occlusion. J Fr Ophtalmol. 1988;11(8-9):597-600. Review. French. No abstract available.

2. Koskela PU, Hyvarinen L. Contrast sensitivity in amblyopia. III. Effect of occlusion. Acta Ophthalmol (Copenh). 1986 Aug;64(4):386-90.

3. Blassmann K, Neuhann T. Treatment of amblyopia with soft occlusion lenses (author's transl). Klin Monatsbl Augenheilkd. 1978 May;172(5):766-70. German.

4. Andree G. The influence of inverse occlusion on fixation and function of amblyopic eyes. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1966 Aug 15;170(3):257-64. German. No abstract available.

5. Postic G. Influence of inverse and direct occlusion on the amblyopic eye with excentric fixation. Bull Mem Soc Fr Ophtalmol. 1966;79:305-66. French. No abstract available.


Celine 8 yearsCeline 8 years

During screening at school 1 year ago low VA LE, glasses

(-1.00 –0.50 x 110/-5.00 –3.00 x 145), no occlusion,

second opinion

VA RE: 0.8 cc Logmar VA LE: 0.3 cc

Cycloplegic refraction RE: -1.50LE: -4.75 –2.75 x 150

Straight eyes with peripheral fusion and central suppression

LE, poor stereopsis

Central fixation BE




6 weeks 4 hours occlusion RE

Good compliance

VA RE: 0.8 cc LogmarVA LE: 0.6=/0.7= cc

Near VA RE: 1.0 cc LEA numbers LE: 0.8 cc

BV: normal2 hours occlusion RE



3 months 1-2 hours occlusion RE

VA RE: 0.9 cc LogmarVA LE: 08= cc


CT: straight eyesCentral and peripheral fusionGood stereopsisStop occlusion



Control 1 year

VA RE: 0.9 –2.50 LogmarVA LE: 08= –5.50 –2.75 x 150


CT: straight eyesCentral and peripheral fusion

Good stereopsis


Cessation of treatmentCessation of treatment

Bhola et al. Recurrence of Amblyopia After Occlusion Therapy. Ophthalmology 2006;Vol 113, 11: 2097-2100

• < 10 years (retrospective)


• > 8 hours patching daily

• 27% recurrence of amblyopia after 1 year ( 179 / 653)

by 2 logMAR levels

• Recurrence inversely correlated with patient age

• Important risk of recurrence when amblyopia therapy

is decreased before the age of 10 years



PEDIG. Risk of Amblyopia Recurrence After Cessation of Treatment J AAPOS 2004;8: 420-428.

• < 8 years


• >2 hours patching daily or > 1 drop atropine weekly

• VA <20/40 at enrollment, improvement of 3 logMAR

levels

• 24% recurrence of amblyopia after 52 weeks ( 35 /

145) by 2 logMAR levels

• Occlusion (n = 112) : 25 % recurrence

• Atropine (n = 33) : 21% recurrence



PEDIG. Risk of Amblyopia Recurrence After Cessation of Treatment J AAPOS 2004;8: 420-428.

• 2 h daily stop: low recurrence risk (14%)

• 6-8 h patching stop: high recurrence risk (42%)

• Patching hours should be weaned before treatment is

stopped



PEDIG. Factors Associated with Recurrence of Amblyopia on Cessation of Patching. Ophthalmology 2007

• < 8 years (prospective)


• 6-8 hours patching daily, stopped abruptly/weaned

• Risk of recurrence higher when:

• Better VA at the time of cessation

• More lines of improvement

• History of recurrence

• Orthotropia or good stereoacuity no protective effect


• 3-7 years


• VA 20/40 – 20/100

• Atropine, 6h patching or both

• Follow-up 2 years

• 14% new strabismus, 3% > 8 (atropine = occlusion)

• Microtropia (1-8 ): 36% resolution, 14% increase > 8

• Heterotropia > 8 : 20% resolution, 64% increase > 8

Adverse effects of treatment : Adverse effects of treatment : risk of strabismusrisk of strabismus

PEDIG. The Effect of Amblyopia Therapy on Ocular Alignment. J AAPOS 2005, Vol 9, 6: 542-545.


• 3-7 years (419 patients)


• VA 20/40 – 20/100

• Atropine daily versus 6h-FTO occlusion

• 6 months : VA decrease 2 lines 17 patients in atropine

group, 3 patients in patching group

• 2 years: all patients normal VA (20/20) in both groups

Adverse effects of treatment : Adverse effects of treatment : VA sound eye decreaseVA sound eye decrease

PEDIG. Two-year follow-up of a 6 month randomized tral of atropine versus patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2005: 123: 149-157.


• Mean age : 4 years

• Follow up : 54 weeks

• No difference between no treatment / only spectacles/ glasses + occlusion

• VA 6/9 – 6/36 no strabismus

Adverse effects of treatment : Adverse effects of treatment : stereo acuitystereo acuity

.Richardson SR et al. Stereoacuity in Unilateral Visual Impairment Detected at Preschool Screening: Outcomes from a Randomized Controlled Trial Invest Ophthalmol Vis Sci. 2005;46:150–154


Adverse effects of treatment : Adverse effects of treatment : no successno success anisometropic amblyopiaanisometropic amblyopia

Hussein M AW et al. Risk Factors for Treatment Failure of Anisometropic Amblyopia . J AAPOS 2004; 8:429-434.

• 3-8 years

• 104 children with anisometropic amblyopia

• VA < 20/50, 3 lines interocular difference

• Anisometropia 1D

• Relative failure = failure of VA to improve 3

lines

• Functional failure = final VA < 20/40


Adverse effects of treatment : Adverse effects of treatment : no successno success anisometropic amblyopiaanisometropic amblyopia

Hussein M AW et al. Risk Factors for Treatment Failure of Anisometropic Amblyopia . J AAPOS 2004; 8:429-434.

• Risk of functional failure

• Age above 6 years

• An initial visual acuity of 20/200 or worse

• Risk of relative failure

• Poor treatment compliance

• Astigmatism of 1,5D

• No risk

• Degree of anisometropia

• Type of refractive error

• Concurrent strabismus


Do we change our habbitsDo we change our habbits

Questionaire to 380 pediatric ophthalmologists

• 39% no modification

• 33% rare adjustments

• 12% adapted amount of patching hours

Wygnanski-Jaffe T. The Effect on Pediatric Ophthalmologists of the Randomized Trial of Patching Regimens for Treatment of Moderate Amblyopia. J AAPOS 2005;9:208-211.




Hope to see you in Antwerp !

Documents

Amblyopia New knowledge and practical approaches ESA 2007 Early morning course May 21, 2007 Daisy Godts CO, Ilse De Veuster MD University Hospital Antwerp