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AMBLYOPIA - Treatment efficiency principles

AMBLYOPIA - Treatment efficiency principles. Dr Irina Velcea Dr Luminita Teodorescu Dr Oana Andrei CLINICA OFTALMIX SOP. Definition. Decrease of vision, either unilaterally or bilaterally, for which no cause can be found by physical examination of the eye.

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AMBLYOPIA - Treatment efficiency principles

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  1. AMBLYOPIA - Treatment efficiency principles Dr Irina Velcea Dr Luminita Teodorescu Dr Oana Andrei CLINICA OFTALMIX SOP

  2. Definition • Decrease of vision, either unilaterally or bilaterally, for which no cause can be found by physical examination of the eye. • Types of amblyopia:- anisometropic - strabismic - combined

  3. Acuity levels for diagnosis • a 2-line of difference on an acuity chart • Classification: - mild: VA > 0,3 - moderate: VA= 0,1- 0,3 - severe: VA< 0,1

  4. Principles of treatment • Comprehensive ophthalmic examination • Appropriate glasses prescription as initial treatment • Patching according to a plan • Careful follow-up • Treatment of strabismus

  5. Material and methods • 166 patients • Anisometropic, strabismic, combined amblyopia • Mean follow-up 2 years ( minimum 6 months, maximum 7 years) • Full - time occlusion or part – time occlusion ( 3-6 hours/day)

  6. Recorded parameters • VA at the start and the end of the treatment • Refraction • Measurements of the deviation • Type of occlusion

  7. Group description • Mean age 5 years ( minimum 1 year, maximum 11 years ) • Mean VA at the start of the treatment 0,3 ( minimum 0,05, maximum 0,8 ) • Mean VA at the end of the treatment 0,7 ( minimum 0,1, maximum 1 ) • Etiology: - strabismus 47% - anisometropia 36,7% - mixed(strabismus+anisometropia) 16,3%

  8. Group description • Strabismus: esotropia 94,9%, exotropia 5,1% • Refraction: - hyperopic astigmatism 68,7% - hyperopia 26,5% - myopic astigmatism 4,2% - mixed astigmatism 0,6% • Occlusion: 41% full-time, 51,2% part-time, 7,8% no occlusion • Follow-up according to the type of occlusion and age of the child

  9. Depth of amblyopia depending on etiology

  10. Anisometropic amblyopiaDepth of amblyopia varying with magnitude of anisometropia

  11. Strabismic amblyopiaDepth of amblyopia depending on the type of deviation

  12. Strabismic amblyopiaDepth of amblyopia depending on magnitude of deviation

  13. Strabismic amblyopiaDepth of amblyopia depending on strabismus onset

  14. Number of gained lines varying with the type of occlusion

  15. Number of gained lines according to child’s age

  16. Improvement in different types of amblyopia

  17. Recurrence of amblyopia 71 patients ( 42,8%) had reccurences of amblyopia, more than cited in literature (25%) - 50,7% with strabismic amblyopia - 25,3% with anisometropia -24% with combined amblyopia

  18. Improvement and recurrence of amblyopia depending by age

  19. Conclusions • Etiology does not influence the depth of amblyopia • No difference in treatment response depending on etiology • Anisometropia < 1 D cause moderate and mild amblyopia but in one case severe amblyopia. Optical correction is essential even in small anisometropia • In severe amblyopia, full-time is more efficient than part-time occlusion (in PEDIG studies 6 hours of patching= full-time patching) • In moderate and mild amblyopia, the same improvement in full and part-time patching

  20. Conclusions • The greatest improvement is between 1-3 years of age • First ophthalmic examination before 3 years • Children between 8-11 years of age showed improvement of visual acuity of 3 lines with part-time occlusion, so amblyopia treatment at this age is effective • The highest risk of recurrence is between 1-3 years of age ( follow-up according to age ) • Recurrences are more frequent in strabismic amblyopia • Weaning before cessation of treatment reduce the chance of recurrence

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