HOW TO TREAT AMBLYOPIA ?

Summary

This video provides an in-depth look at amblyopia (lazy eye) treatment. Dr. Amrit explains the three primary treatment goals: addressing the underlying cause, correcting refractive errors, and encouraging the use of the amblyopic eye. Various methods such as refractive correction, patching therapy, pharmacological penalization with atropine drops, and bandage filters are discussed in detail. The video also covers the effectiveness of each treatment, based on age and severity of amblyopia. Dr. Amrit emphasizes the importance of compliance and follow-up, noting that treatments can lead to significant improvements in visual acuity, especially when tailored to the patient’s needs.

Takeaways

• 😀 Amblyopia treatment has three primary aims: treating the underlying cause, correcting refractive errors, and forcing the use of the amblyopic eye by limiting the use of the better eye.
• 😀 The treatment of refractive amblyopia involves prescribing appropriate refractive correction to provide equally clear retinal images, helping to prevent amblyopia.
• 😀 In cases of hypermetropia without squint, under correction (by 1.5 diopters) is preferred over full correction to avoid aggravating amblyopia.
• 😀 Amblyopia resolution is achieved when the visual acuity in both eyes becomes equal or within one line of the better eye, resulting in a noticeable improvement in visual clarity.
• 😀 The PEDIG study found that refractive correction alone led to visual acuity improvements by 3 lines and resulted in the resolution of amblyopia in 25-33% of cases.
• 😀 When refractive correction is ineffective, patching therapy (occlusion of the good eye) is used to force the use of the lazy eye and improve visual acuity.
• 😀 Patching durations vary based on amblyopia severity: 2 hours for moderate cases and 6 hours for severe amblyopia. In cases of residual amblyopia, increasing patching to 6 hours leads to further improvements.
• 😀 Patching is most effective in children aged 3 to 7, with improvement seen in 93% of patients in this age group. Treatment is still possible in older children (7 to 17 years), with a 25% improvement rate.
• 😀 Pharmacological penalization using atropine drops dilates the good eye and reduces its visual acuity, forcing the use of the amblyopic eye. This approach can be used as an alternative to patching.
• 😀 Side effects of atropine use include dry mouth, blurred vision, and gastrointestinal disturbances, which limit its widespread use, though it is effective in moderate amblyopia when applied weekly.

Q & A

What are the three basic aims for treating amblyopia?

The three basic aims for treating amblyopia are: 1) Treating the underlying cause of amblyopia, 2) Correcting any significant refractive error, 3) Forcing the use of the amblyopic eye by limiting the use of the better eye.

What is the role of refractive correction in the treatment of amblyopia?

Refractive correction plays a crucial role in treating refractive amblyopia by addressing myopia, hypermetropia, and astigmatism. The goal is to correct significant refractive errors to provide equally clear retinal images and prevent further visual impairment.

Why is under-correction used in the treatment of hypermetropia in amblyopia?

Under-correction is used to avoid worsening amblyopia in patients with hypermetropia without strabismus. Full correction with convex lenses can relax accommodation, which can lead to blurred vision and exacerbate amblyopia. Under-correcting by 1.5 diopters helps mitigate this effect.

What is the significance of the PEDIG studies in amblyopia treatment?

The PEDIG (Pediatric Eye Disease Investigator Group) studies have provided critical insights into amblyopia treatment. Their findings demonstrated that refractive correction alone can improve visual acuity by three lines and resolve amblyopia in 25-33% of cases in children aged 3-7 years.

How does patching help in treating amblyopia?

Patching helps by occluding the better eye to force the amblyopic eye to work harder. This stimulates the lazy eye to improve its visual function. Patching is especially effective in young children, with treatment duration tailored to the severity of amblyopia.

What is the recommended patching duration for children with moderate amblyopia?

For children with moderate amblyopia (visual acuity between 6/12 and 6/24), two hours of patching per day is as effective as six hours of patching in improving visual acuity.

How does pharmacological penalization work in treating amblyopia?

Pharmacological penalization involves using atropine sulfate (1%) drops in the good eye to blur its vision. This forces the amblyopic eye to become more active and improve its visual function. It can be an alternative to patching, especially for patients who have difficulty with patching.

What are the potential side effects of using atropine for pharmacological penalization?

The side effects of atropine include dryness of the mouth, decreased lacrimation, blurred vision, dizziness, confusion, gastrointestinal upset, and possible effects on the central nervous system, such as irritability and drowsiness.

What is the role of bandage filters in amblyopia treatment?

Bandage filters are translucent filters applied to the good eye to limit its visual function, thereby encouraging the use of the amblyopic eye. These filters are typically used when patching and pharmacological penalization are ineffective or difficult for the patient.

How should amblyopia treatment be adjusted if refractive correction alone does not improve the condition?

If refractive correction alone does not improve the visual acuity, additional treatments like patching or pharmacological penalization with atropine should be considered. If these also fail, the duration of patching may be increased, or bandage filters may be added as a supplementary treatment.