AMBLYOPIA

Alvin Pratama Jauharie

I11111063

Definition
Amblyopia is an impairment of vision arising
from dysfunction of processing of visual
information caused by degradation of the
retinal image during a sensitive period of
visual development

Etiology

Strabismus: Most common form (along with

anisometropia). The eyes are misaligned.
Vision is worse in the consistently deviating,
nonfixating eye. Anisometropia: Most
common form (along with strabismus). A
large difference in refractive error (usually
>1.5 diopters) between the two eyes.

Etiology
Organic causes: A unilateral cataract,
corneal scar, may cause a preference for
the other eye and thereby cause amblyopia.
Occlusion: Amblyopia that occurs in the
fellow eye as a result of too much patching
or excessive use of atropine. Prevented by
examining at appropriate intervals (1 week
per year of age), patching part-time, or
using the full cycloplegic refraction when
using atropine

Patophysiology
Brains does not full recognize the image
from amblyopic eye
Weakening of that eye over time and a
reduction in its clarity of vision
Brain may block or suppress the images
sent by eye and favor the clearer eye

Classification
Strabismus amblyopia
Anisometropia amblyopia
Amblyopia due to bilateral high refractive
error (isometropia)
Deprivation amblyopia

Strabismus amblyopia
The most commom form of ambyopia
Strabismic amblyopia is thought to result
from competitive or inhibitory interaction
between neurons carrying the nonfusible
inputs from two eye
Which leads to domination of cortical vision
centers by the fixating eye and chronocally
reduced responsiveness to the nonfixating
eye input

Strabismus amblyopia

Anisometropia amblyopia
It develop when unequal refractive error in
the two eyes causes image on the one
retina to be chronically defocused
A blurred image in more ametropic eye

Uncorrected moderate/high
astigmatism
A.
B.
C.
D.
E.

Compund myopic
Simple myopic
Mixed astigmatism
Simple hyperopic
Compound
hyperopic

Amblyopia due to
isometropia
Isometropia amblyopia resut from large,
approximately equal, uncorrected refractive
error in both eyes of a young child
The degree of refractive error which capble
of inducing amblyopia

Deprivation amblyopia
It is usually caused by congenital or early
acquired media opacity :
Congenital/traumatic cataract
Congenital ptosis
Congenital/traumatic corneal opacities

Sign and symptoms

Symptoms
No symptoms
Blurred vision
Reduced vision
Reduced contrast
sensitivity

Signs
No obvius sign, unless
severe abnormaity is
present
Rubbing or squinting
of eyes
Misaligning eyes
Reduced VA
Droopy eyelid

Assessment amblyopia
1. Assessment of deviation :
Hirchberg test
Bruchner test
2. Visual Acuity
3. Neutral Density (ND) Filter
4. Worths Four Dot

Hirschberg test

Bruckner test

Visual Acuity
Amblyopia perform better when isolated
letters are used instead of full chart
Crowding effect

Neutral density (ND) filter

Strabismic amblyopia
Better VA with ND fiter
compared to normal eye
Anisometropic amblyopia
Cannot be diagnosed
with ND fiter

Neutral Density (ND) Filter

Worths four dot test

a.
b.
c.

d.

e.

Prior to use glasses

Normal
Left
suppression/amblyopia
Right
suppression/amblyopia
diplopia

Treatment

Treatment
Patients younger than 10 years:
Appropriate spectacle correction (full
cycloplegic refraction or reduce the hyperopia in
both eyes symmetrically 1.50 diopters).
Patching: Patch the eye with better corrected
vision 2 to 6 hours/day for 1 week per year of
age (e.g., 3 weeks for a 3-year-old), with at
least one hour of near activity. Adhesive
patches placed directly over the eye are most
effective.

Treatment

If occlusion amblyopia (i.e., a decrease in vision

in the patched eye) develops, patch the opposite
eye for a short period (e.g., 1 day per year of
age), and repeat the examination.

Treatment
Penalization with atropine: Atropine 1% once
daily (used with glasses) has been shown to be
equally effective with patching in mild to
moderate amblyopia (20/100 or better).

Patients >10 years of age

A trial of spectacle correction, patching and/or
atropine may be considered if not attempted
previously. If treatment of amblyopia fails,
protective glasses should be worn to prevent
accidental injury to the nonamblyopic eye.
Treatment of media opacity: Remove the media
opacity and begin patching the nonamblyopic eye.
Treatment of anisometropic amblyopia: Give the
appropriate spectacle correction at the youngest
age possible (best if given before age 5)

TERIMA KASIH