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Amblyopia PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Amblyopia".

This medical PowerPoint presentation is about amblyopia, also known as lazy eye. Amblyopia is a condition where one eye has weaker vision than the other eye, even with the use of corrective lenses. It occurs when the brain favors one eye over the other during the development of vision in early childhood.

Amblyopia is a common condition, affecting up to 3% of the general population. It is usually diagnosed in children, but can also occur in adults. The condition may be caused by a number of factors, including strabismus (misaligned eyes), unequal refractive errors (differences in the ability of each eye to focus), or deprivation (obstruction of vision in one eye).

Symptoms of amblyopia may include poor depth perception, difficulty seeing three-dimensional objects, and problems with tasks that require both eyes to work together, such as reading or playing sports. Treatment for amblyopia may involve patching the stronger eye to force the weaker eye to work harder, or using special drops to blur the vision in the stronger eye. In some cases, surgery may be necessary to correct misaligned eyes.

Early detection and treatment of amblyopia is important to prevent permanent vision loss. Children should have their vision checked regularly by an eye doctor, and any signs of amblyopia should be addressed as soon as possible.

Tags : amblyopia, lazy eye, Pediatrics, Pediatrics PowerPoint presentation

Published on : Jun 23, 2023 | Views : 2317 | Downloads : 1

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Slide 1-

1 Amblyopia
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2 Unilateral or less commonly, bilateral reduction of best corrected visual acuity that can not be attributed directly to the effect of any structural abnormality of the eye or the posterior visual pathway.
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3 Resulting from one of following: Strabismus - DEVIATION Anisometropia or high bilateral refractive error (Isoametropia) - DEFOCUS Visual deprivation - DEPRIVATION
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4 Prevalence: 2%-4% Commonly unilateral Nearly all amblyopic visual loss is preventable or reversible with timely detection and appropriate intervention. Children with amblyopia or at risk for amblyopia should be identified at a young age when the prognosis for successful treatment is best. Role of screening is important
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5 Amblyopia is primarily a defect of central vision. There is a critical period for sensitivity in developing amblyopia. The time necessary for amblyopia to occur during critical period is shorter for stimulus deprivation than for strabismus or anisometropia.
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6 Neurophysiology: Cells of the primary visual cortex can completely lose their innate ability or show significant functional deficiencies Abnormalities also occur in neurons in the lateral geniculate body Evidence concerning involvement at the retinal level remains inconclusive
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7
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10 Classification: Strabismus Amblyopia :Deviation Anisometropia Amblyopia : Defocuss Amblyopia Due to bilateral high refractive error (isometropic) :Defocuss Deprivation Amblyopia :Deviation
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11 Strabismus Amblyopia The most common form of amblyopia Strabismic amblyopia is thought to result from competitive or inhibitory interaction between neurons carrying the nonfusible inputs from the two eyes. Which leads to domination of cortical vision centers by the fixating eye and chronically reduced responsiveness to the nonfixating eye input.
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12 Anisometropia Amblyopia Second in frequency It develops when unequal refractive error in the two eyes causes the image on the one retina to be chronically defocused. This condition is thought to result: Partly from the direct effect of image blur in the development of visual acuity. Partly from intraocular competition or inhibition
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13
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14 Mild hyperopic or astigmatic anisometropia (1.5D)  mild amblyopia Mild myopia anisometropia (less than -2.5D) usually doesn't cause amblyopia unilateral high myopia (-6D)  sever amblyopia visual loss.
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15 Amblyopia Due to bilateral high refractive error (isometropia) isometropic amblyopia result from large, approximately equal, uncorrected refractive error in both eyes of a young child. Hyperopia exceeding 5D & myopia excess of 10 D  risk bilateral amblyopia
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16 Meridonial amblyopia: Uncorrected bilateral astigmatism in early childhood may result in loss of resolving ability limited to chronically blurred meridians.
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17 Deprivation Amblyopia It is usually caused by congenital or early acquired media opacity. This form of amblyopia is the least common but most damaging and difficult to treat. In bilateral cases acuity can be 20/200 or worse.
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18
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19 In children younger than 6 years, dense congenital cataract that occupy the central 3 mm. or more of the lens must be considered capable of causing sever amblyopia. Similar lens opacities acquired after 6 years are generally less harmful.
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20 Small polar cataracts & lamellar cataracts may cause mild to moderate amblyopia or may have no effect on visual development. Occlusion amblyopia is a form of deprivation caused by excessive therapeutic patching.
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21 Diagnosis Characteristics of vision alone cannot be used to reliably differentiate amblyopia from other form of visual loss. The crowding phenomenon is typical for amblyopia but not uniformly demonstrable. Afferent pupillary defect are Characteristic of optic nerve disease but occasiinally appear to be present with amblyopia
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22 Multiple assessment using a variety of tests or performed on different occasions are sometime required to make a final judgment concerning the presence and severity of amblyopia.
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23 Binocular fixation pattern: It is a test for estimating the relative level of vision in the two eyes for children with strabismus who are under the age of about 3. This test is quite sensitive for detecting amblyopia but results can be falsely positive. Showing a strong preference when vision is equal or nearly equal in the two eyes, particularly with small angle strabismic deviations.
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24 The modified Snellen technique directly measures acuity in children 3-6 years old. Often, however, only isolated letters can be used, which may lead to under estimated amblyopia visual loss. Croding bar may help alleviate this problem.
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25 Crowding bar, or contour interaction bars, allow the examinator to test the crowing phenomenon with isolated optotype. Bar surrounding the optotype mimic the full of optotype to the amblyopia child.
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26 Treatment Treatment of amblyopia involves the following steps: Eliminating (if possible) any obstacle to vision such as a cataract Correcting refractive error Forcing use of the poorer eye by limiting use of the better eye.
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27 Cataract removal Cataracts capable of producing amblyopia require surgery without unnecessary delay. Removal of significant congenital lens opacities during the first 2-3 months of life is necessary for optimal recovery of vision. In symmetrical bilateral cases, the interval between operations on the first and second eyes should be no more than 1 week. Acutely developing severe traumatic cataracts in children younger than 6 years should be removed within a few weeks of injury, if possible.
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28 Refractive correction In generally, optical prescription for amblyopic eyes should correct the full refractive error as determined with cyclopagic.
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29 Occlusion and optical degradation Full time occlusion of the sound eye: Defined as occlusion for all or all but one waking hour. It is the most powerful means of treating of amblyopia by enforced use of the defective eye. The patch can either be left in place at night or removed at bedtime. Spectacle-mounted occluser or special opaque contact lenses can be used as an alternative to full-time patching if skin irritation or poor adhesion proves to be a significant problem
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30
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31 Full time patching should generally be used only when constant strabismus eliminates any possibility of useful binocular vision because  full time patching runs a small risk of perturbing binocularity.
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32 Part-time occlusion: Defined as occlusion for 1-6 hours per day. The children undergoing part time occlusion should be kept as visually active as possible when the patch is in place. Compliance with occlusion therapy for amblyopia declines with increasing age.
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33 Penalization: A cycloplegic agent (usually atropine 1% or homatropine ) once daily to the better eye This form of treatment has recently been demonstrated to be as effective as patching for mild to moderate amblyopia.
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E.B.M. Evidence Based Medicine Prospective, randomised PEDIG, MOTAS & COCHRANE Eminence Based Medicine Hopkins: weekend atropine Scott [Iowa]: only full time
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PEDIG P E Diatric ophthalmology Investigator Group North American Community based Ophthalmology and optometry
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MOTAS Monitored Occlusion Treatment of Amblyopia Study England Alistair Fielder
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PEDIG: Amblyopia 6/30 - 6/120 6 h/d vs. all [or all -1] waking hours Ages 3-7 Can do reliable HOTV 1h/d near activity 4mo: 4+ line improvement both groups Age / severity of amblyopia NOT relevant to outcome!
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PEDIG:Amblyopia 6/12- 6/24 2h vs. 6h/d opaque occluder Ages 3-7 Can do reliable HOTV 1h/d near activity 4mo: same 2.4 line improvement Age / severity of amblyopia NOT relevant to outcome!
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PEDIG:Amblyopia 6/12 - 6/24 Daily atropine vs. patch 6h/d 6mo: no difference Patch: faster response 2y: amblyopic eye 1.8 lines worse in each group Improvement @ 2y: 3.6 vs. 3.7 lines
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PEDIG:Recurrence of amblyopia after stopping treatment ≥ 3 lines acuity improvement 25%: ≥ 2 lines loss @ 12mo 42% after stopping 6h/d 14% if 6h/d tapered to 2h/d before stopping
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MOTAS investigators:Recurrence of amblyopia after stopping treatment Factors affecting the stability of visual function following cessation of occlusion therapy for amblyopia. Graefe 6/2007 Tacagni DJ, … Fielder AR
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MOTAS investigators:Recurrence of amblyopia after stopping treatment 1 y follow-up from treatment cessation: children with "mixed" amblyopia (both anisometropia and strabismus) had significantly (p=0.03) greater deterioration in VA (0.11+/-0.11 log units) than children with only anisometropia (0.02+/-0.08 log units) or only strabismus (0.05+/-0.10 log units).
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PEDIG:Amblyopia 6/12 - 6/24 Daily vs. weekend atropine Same results Daily slightly easier to do 1/80: occlusion amblyopia
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PEDIG:Amblyopia 6/12 - 6/120 in 7-17yo Glasses vs. glasses plus 7-12: plus = patch 2-6h/d & daily atropine Acuity improves by ≥ 2 lines 13-17: plus = patch 2-6h/d Some have improved acuity 12mo later: 20% have regressed
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PEDIG:Glasses alone 6/12 to 6/75 27% cured Another 50% ≥ 2 lines better Took up to 7 mo
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MOTASGLASSES ALONE‘REFRACTIVE ADAPTATION’ VA in 65 newly diagnosed children with difft causes of amblyopia at 6w intervals for 18w VA improved significantly (p,0.001) from 0.67 to 0.43 logMAR: a mean improvement of 0.24 independent of amblyopia type (p = 0.29) and age (p = 0.38) Br J Ophthalmol 2004;88:1552-1556.
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MOTASREFRACTIVE ADAPTATION FOLLOWED BY OCCLUSION Prescribed dose 6h/d Compliance <50% [2.8h]. Only 10% used it ≥ 5.5 h/d 0.1 [1 chart line] VA improvement per 120h of occlusion Total doses >200h: residual amblyopia <0.2 log >75% of deficit corrected IOVS 2004
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MOTASREFRACTIVE ADAPTATION FOLLOWED BY OCCLUSION % of amblyopia deficit corrected
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MOTAS:ELECTRONIC PATCH #1 18w of glasses, then patch prescribed 6h , 12h/d 6h/d: received 4.2 [± 0.5] h/d 12h/d: received 6.2 [± 1.1] h/d p=0.06 <3h/d: worse outcome
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MOTAS:ELECTRONIC PATCH #2 6h/d prescribed Best acuity after 150 - 250 h 2 line gain: 4y: needs 170h 6y: needs 236h
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ELECTRONIC PATCH #3 Graefe 3/2003 Simonsz HJ et al. Compliance : % of electronically registered time c.f. prescribed time. Satisfactory acuity increase ratio between acuity of the amblyopic eye and acuity of the good eye > 0.75 acuity of the amblyopic eye > 0.5 on E or Landolt-C, or 3 LogMAR lines of increase in acuity.
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Results: Graefe 3/2003 Simonsz HJ et al. Measured compliance ~ 80% in 8/14 children with satisfactory acuity increase 34% in 6 children with unsatisfactory acuity increase. Children with low acuity increase had statistically significantly lower compliance p=0.038 ‘no pain, no gain’
Slide 53-

PEDIGstudies with completed enrolment Enrollment Completed - Follow Up A Observational study of different types of esotropia RCT comparing near vs. distance activities while patching for amblyopia RCT comparing atropine vs atropine with reduced + for sound eye Atropine vs occlusion in 7-12 yr old NFL in amblyopia RCT of Progressivelenses vs single vision lenses on low myopia with large accommodative lags and near esophoria in children
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54 Complication of therapy Full time occlusion carries the greatest risk of this complication and requires close monitoring, especially in the younger child. The first follow up visit after initial treatment should occur within 1 week for an infant and after interval corresponding to 1 week per year of age for the older child. Part time occlusion & optical degradation methods allow for less frequent observation but regular follow up is still critical
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55 The time required for completion of treatment depends on the following: Degree of amblyopia Choice of therapeutic approach Compliance with the prescribed regimen age of the patient
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56 Unresponsiveness Complete or partial Unresponsiveness to treatment occasionally affect younger children but must often occurs in patients older than 5 years. Primary therapy should generally be terminated if there is a lock of demonstrable progress over 3-6 months with good compliance. Refraction should be carefully rechecked and the macula and optic nerve critically inspected for subtle evidence of hypoplasia or other malformation that might have been previously overlooked.
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57 Recurrence When amblyopia treatment is discontinued after fully or partially successful completion, approximately half of patients show some dgree of recurrence, Maintenance therapy: Patching for 1-3 hours per day Optical penalization with spectacles Pharmacologic penalization with atropine 1 or 2 day per week. This may require periodic monitoring until age 8-10.