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Understanding and Preventing Amblyopia

Understanding and Preventing Amblyopia. When the doctor sees nothing and the patient sees nothing, the diagnosis is ambluwpia .  Hippocrates, 450 BCE. Understanding Amblyopia. Abnormal visual development Decreased best-corrected visual acuity Unilateral or bilateral

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Understanding and Preventing Amblyopia

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  1. Understanding and Preventing Amblyopia

  2. When the doctor sees nothing and the patient sees nothing, the diagnosis isambluwpia. Hippocrates, 450 BCE Understanding Amblyopia

  3. Abnormal visual development Decreased best-corrected visual acuity Unilateral or bilateral Apparently normal physical exam, but may also result from recognizable structural abnormalities Understanding Amblyopia AMBLYOPIA: DEFINITION

  4. 2%–4% of U.S. population affected Commonly unilateral Bilateral amblyopia (rare) may mean permanently decreased visual acuity Understanding Amblyopia AMBLYOPIA: SIGNIFICANCE

  5. Amblyopia is usually preventable or treatable Early detection is key to effective treatment Life-threatening disorders may present as amblyopia Screening responsibility rests with primary care physician Understanding Amblyopia SCREENING: IMPORTANCE

  6. Understanding Amblyopia In most circumstances, amplyopia can be prevented or treated.

  7. Visual function develops early in life Treatment depends on plasticity of visual system Treatment less likely to be effective as children age Understanding Amblyopia EARLY DETECTION: IMPORTANCE

  8. Understanding Amblyopia Decreased vision  retinoblastoma?

  9. Understanding Amblyopia The ophthalmologist treats amblyopia, but the primary care physician detects amblyopia.

  10. Predisposing factors Presenting features Detection methods Treatment rationale Preventing Amblyopia PREVENTING AMBLYOPIA:CONSIDERATIONS

  11. Poor clarity (media opacities) or blockage of light pathway (ptosis) Poor focus (refractive error) Poor aim (strabismus) Preventing Amblyopia AMBLYOPIA: PREDISPOSING FACTORS

  12. Preventing Amblyopia Poor clarity

  13. Preventing Amblyopia Poor focus one eye

  14. Preventing Amblyopia Poor focus both eyes

  15. Preventing Amblyopia Poor aim: strabismus

  16. Failed vision test Strabismus Parental concern Family history of amblyopia or strabismus Preventing Amblyopia UNILATERAL AMBLYOPIA: PRESENTATION

  17. VISION SCREENING AGES 3-5 May peek around occluder Adhesive patch works best Preventing Amblyopia

  18. Preventing Amblyopia Strabismus is the most common underlying cause of amblyopia.

  19. Not a feature of strabismus May indicate a serious condition Evaluate promptly and refer Preventing Amblyopia DIPLOPIA IN CHILDREN

  20. PARENTAL CONCERNS Leukocoria Enlarged cornea Preventing Amblyopia

  21. Preventing Amblyopia A positive family history is often present in children with amblyopia.

  22. Preventing Amblyopia Bilateral amblyopia

  23. Assess red reflex Determine visual acuity Evaluate ocular alignment Preventing Amblyopia AMBLYOPIA: EARLY DETECTION

  24. Preventing Amblyopia Normal red reflex

  25. Preventing Amblyopia Assymetric red reflex

  26. Preventing Amblyopia Direct ophthalmoscope

  27. Preventing Amblyopia Direct ophthalmoscope: assessing red reflex

  28. Preventing Amblyopia Direct ophthalmoscope: examining retina

  29. Preventing Amblyopia Can your child see?

  30. Good visual function Fixate and follow with each eye Steady fixation Preventing Amblyopia NORMAL INFANT VISION

  31. Preventing Amblyopia Testing infant vision: Can your child see?

  32. Preventing Amblyopia Suspected poor vision: test response to bright light

  33. Preventing Amblyopia Testing infant vision: Preferential looking test

  34. Preventing Amblyopia Measuring visual acuity at 18 months to 3 years: picture chart

  35. Preventing Amblyopia Picture chart Single E chart

  36. Preventing Amblyopia Snellen acuity chart

  37. Preventing Amblyopia Depth perception (stereopsis) testing

  38. Preventing Amblyopia Testing infant vision: Assessing corneal light reflex

  39. Normal Esotropia Preventing Amblyopia

  40. Normal Exotropia Preventing Amblyopia

  41. Hypertropia Hypotropia Preventing Amblyopia

  42. Eyes appear aligned with head tilt and turn. Misalignment revealed when head is straightened. Preventing Amblyopia

  43. Poor red reflex in one or both eyes Concern about visual function by parent or doctor Asymmetric or diminishing visual acuity Constant or acute-onset strabismus Preventing Amblyopia REFERRAL: IMMEDIATE

  44. Intermittent strabismus on examination Persistent parental concern Associated syndromes or systemic disease Reduced visual acuity in one or both eyes Preventing Amblyopia REFERRAL: LESS EMERGENT

  45. Clearing the media Focusing the image Initiating amblyopia therapy Preventing Amblyopia AMBLYOPIA:TREATMENT RATIONALE

  46. Preventing Amblyopia Congenital cataracts

  47. Preventing Amblyopia Congenital ptosis

  48. Ophthalmologists can quantify refractive error in infants. Children usually do well with eyeglasses. Preventing Amblyopia

  49. Preventing Amblyopia • Carefully supervise children wearing therapeutic contact lenses. • Retain a pair of backup eyeglasses.

  50. Preventing Amblyopia OCCLUSION THERAPY: PURPOSE • Improves visual acuity • Does not eliminate strabismus

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