What is the goal of amblyopia treatment?
- Achieve equal visual acuity between eyes
- Improve binocular function (fusion + stereopsis
These goals aim to enhance overall visual performance.
What is the first step in amblyopia management?
Full cycloplegic refraction before any treatment
Typically using cyclopentolate 1% (<12 years).
What must be corrected in amblyopia optical treatment?
- All anisometropia (balance image size)
- All myopia and astigmatism
Ensure optimal retinal image clarity.
How long should optical correction be worn before additional treatment?
Minimum 18 weeks of full-time wear
Exception: strabismic amblyopia without significant refractive error.
How do you prescribe for hyperopia with esotropia (EsoT)?
- Give full cycloplegic prescription
- Or reduce by max +0.50 DS
Helps control accommodative esotropia.
How do you prescribe for hyperopia without esotropia?
Symmetrical reduction of plus
Improves adaptation and comfort.
What are key dispensing considerations in amblyopia?
- Children: frame fit, cosmesis, safety materials
- Adults (CL wearers): must have backup glasses
Encourage full-time wear.
Why is anisometropia often linked to amblyopia?
Causes aniseikonia → poor fusion → central suppression → amblyopia develops
This sequence highlights the visual processing issues.
How can optical treatment help strabismus?
- Can reduce or eliminate deviation (e.g. accommodative EsoT, intermittent Exo)
- May delay or reduce need for surgery
This is crucial for improving alignment.
When is strabismus surgery considered in amblyopia?
After maximising visual acuity with amblyopia treatment
Earlier surgery improves binocular outcomes.
What is the treatment for bilateral refractive amblyopia?
Glasses only
No patching needed unless residual unilateral amblyopia remains.
What is the purpose of patching in amblyopia?
Force the brain to use the amblyopic eye → improves visual processing
This method is essential for treatment.
What are key rules for patching therapy?
- Always combined with full-time refractive correction
- Used mainly in unilateral amblyopia
This ensures effective treatment.
What are alternatives to patching?
- Atropine penalisation
- Bangerter filters
These alternatives provide different methods of treatment.
What is the role of vision therapy in amblyopia?
- Reduce suppression
- Improve motor fusion and stereopsis
Often combined with other treatments.
How is patching dosage determined in amblyopia?
- VA better than 6/36: ≥ 2 hours/day
- VA worse than 6/36: up to 6 hours/day
Tailored based on severity.
How often should patching be reviewed?
Every 4–8 weeks
Monitor VA improvement and adjust treatment.
How many total hours of patching are typically required?
- Age 3–8: ~150–250 hours
- Age >8: >400 hours
Older patients need more treatment for effect.
What are key requirements for effective patching?
- Full-time glasses/CL wear
- Engage in near visual activities (reading, drawing)
Maximises stimulation of amblyopic eye.
What practical advice improves compliance with patching?
- Encourage structured sit-down tasks
- Consider social factors (e.g. bullying, school difficulties)
- Do not allow siblings (especially <8 yrs) to patch
These strategies help maintain adherence.
How does atropine penalisation work in amblyopia?
1% atropine in non-amblyopic eye
Causes cycloplegia + mydriasis → blur
Forces use of amblyopic eye.
What is the dosing schedule for atropine penalisation?
Every 2nd day or 2× per week
Effects last 1–2 weeks.
When is atropine penalisation not suitable?
- Fellow eye myopic (child may remove glasses to see near)
- Trisomy 21 (↑ sensitivity to antimuscarinics)
- Form deprivation amblyopia
These conditions limit the use of atropine.
Why is atropine considered highly compliant?
- Less visible than patching
- Easier to administer
Better acceptance by children/parents.
