AMBLYOPIA
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Lavanya Madabushi
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96 Slides • 16 Questions
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AMBLYOPIA
Definition, Classification, Diagnosis, & Management
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Multiple Choice
What is Amblyopia?
Central Suppression
Facultative Suppression
Absolute Suppression
Unilateral Suppression
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Multiple Choice
What is the criteria to diagnose Amblyopia?
Difference in visual acuity between the eyes
Difference in visual field between the eyes
Difference in color vision of two plates, between the eyes
Difference in visual acuity of two lines between the eyes
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Scenario 1
A 1 year old child is brought with c/o constant inward deviation of the left eye noticed since 4 months of age.
Cycloplegic refraction:
–OD: +2.00DS
–OS: +2.00 DS
•Fixation Assessment – resists occlusion of right eye.
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Multiple Choice
Will you correct the refractive error?
Yes
No
Will wait for another 6 months
None of the above
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Scenario 2
A 4 year old child is referred from the school vision screening program for further management.
Visual Acuity: OD: 6/18, N6, OS: 6/9, N6
Cover Test: Ortho at distance & near
Cycloplegic refraction:
–OD: +1.50/-4.00X180
–OS: +1.50/-0.50X180
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Multiple Choice
What type of amblyopia is this?
Anisometric amblyopia
Strabismic amblyopia
Isometric amblyopia
Combined mechanism amblyopia
Meridonial amblyopia
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Multiple Choice
Will you correct the refractive error?
Yes
No
Will wait for another 6 months
None of the above
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Multiple Choice
What type of amblyopia is scenario 1
Anisometric amblyopia
Strabismic amblyopia
Combined mechanism amblyopia
Isometric amblyopia
Meridonial amblyopia
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Multiple Choice
Given the following refractive error, what type of amblyopia does this patient potentially have?
–OD: +5.25 – 2.75 x 180
–OS: +4.00 – 2.50 x 180
Amblyopia OD secondary to anisometropic hyperopia
Amblyopia OU secondary to high astigmatism OU
Amblyopia OD>OS secondary to anisometropic hyperopia and high astigmatism OU
Amblyopia OD>OS secondary to anisometropic hyperopia and high hyperopia and high astigmatism OU
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Multiple Choice
Which of the following examples will potentially have amblyopia secondary to strabismus?
12pd Intermittent Left Exotropia at Distance and Near
20pd Constant Alternating Esotropia at Distance and Near
20pd Intermittent Alternating Exotropia at Dist and 10pd Exophoria at Near
16pd Constant Right Esotropia at Distance and Near
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Scenario 3:
This was the Bruckner reflex of four different boys.
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Open Ended
Identify THE REFRACTIVE ERRORS IN:
A, B, C, and D
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Multiple Choice
Predict VA for 3 PD Nasal EF
20/50
20/60
20/80
20/100
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CASE:
VISIT 1:
5y/o female
C/o: Failed school screening; Mom reports occasional squinting
Birth, developmental, and educational hx – all unremarkable
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Findings:
DVAsc: OD: 20/60 OS: 20/100 Lea S-line
PERRLA –APD
EOMs: Full
CTsc: 2 EP, 4 EP’
Stereo: RDS: 250” WC: 100”
•SLE: unremarkable
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Findings Continued:
Cycloplegic Refraction:
OD: +3.00-3.25x180 (20/40) OS: +4.50-3.50x180 (20/80)
Final RX:
OD: +1.50-3.25x180
OS: +3.00-3.50x180
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Multiple Choice
What is the Diagnosis?
Strabismic Amblyopia
Meridonial Amblyopia
Anisometropic Amblyopia
Combination of Strabismic and Meridonial Amblyopia
Combination of Anisometropic and Meridonial Amblyopia
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Multiple Choice
How do you manage this patient?
Full time Occlusion only
Part time Occlusion only
Part time Occlusion with spectacle correction
Part time Occlusion with both spectacle correction and active games
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Visit 2:
The patient returns after 3 months
VA improves OD: 20/30 OS:20/60
Stereo WC: 70”
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Multiple Choice
What is your advice now?
Stop Occlusion
Continue the same treatment
Start tapering the Occlusion
Shift to Penalization
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Multiple Choice
A patient came in for their first eye exam and has been diagnosed with anisometropic refractive amblyopia OS (VA: 20/60).
You prescribed the patient glasses and the patient returns for their 3 month follow up and their vision improves to 20/50.
What would your next step be?
Have the patient continue wearing the glasses full time and have them return in 3 months
Begin patching OD for 2 hours/day, 7 days/week
Begin Atropine 1%, 1 day break for OD on the weekends
Begin patching OD for 6 hours/day, 7 days/week
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Multiple Choice
Your amblyopic patient has completed patching therapy.
They have been patching OS 2 hours/day, 7 days/week and the vision is OD: 20/20 and OS: 20/20
What is your next step?
Discontinue patching and have the patient return in 1 year for a comprehensive exam
Discontinue patching and have the patient return in 3 months for a follow-up
Taper patching to OS 2 hours/day, 4 days/week and have them return in 3 months
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Multiple Choice
Your amblyopic patient has completed patching therapy.
They have been patching OS 2 hours/day, 7 days/week and the vision is OD: 20/20 and OS: 20/20
What is your next step?
Discontinue patching and have the patient return in 1 year for a comprehensive exam
Discontinue patching and have the patient return in 3 months for a follow-up
Taper patching to OS 2 hours/day, 4 days/week and have them return in 3 months
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Definition, Classification, Diagnosis, & Management
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