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61 Cards in this Set
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- Back
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PEDIG Classification of Amblyopia |
Mild: 20/30 or better Moderate: 20/40-20/80 Severe: 20/100-20/400 |
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What period would a kid most likely get maximum damage? |
The critical period Birth to approx 2-3 years |
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Sensitive period |
Time during which the visual system is still susceptible to change but the damage is still less severe 2-3 up to 8+ years |
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Plastic period |
Time during which amblyopic visual system is amenable to successful Tx |
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How to diagnose amblyopia |
H |
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What are the types of Amblyopia? |
Refractive Strabismic Deprivation |
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What all categories fall in Refractive Amblyopia? |
Isoamytropic Anisoametropic Meridional Combined Aniso-Strab |
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IsoametropicAni |
Bilateral High refractive error Hyp= 2-4D Myo= 6-8D Astig>1.5D **the greater the Aniso the deeper the amblyopia |
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Anisoametropic Amblyopia |
The difference between the two eyes refractive error Hyp= 3.5> Myop=6.5> |
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Tx for Deprivation Amblyopia |
* Remove Obstruction in the first 2 months in life * Correct RE * Part time occlusion
F/U in 4-6 weeks |
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Tx for Isoametropes |
*correct RE* F/U in 4-6 weeks |
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Which type of anisoametropes will have a worse outcome? |
Myopes |
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True or false, Anisos are likely to regress after D/C treatment |
True |
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Why is it more challenging to correct strabismic amblyopia when they are older? |
because they have developed more EFs (eccentric fixations) |
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What type of amblyopia. Could you not treat as adults? |
Deprivation amblyopia |
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What does PEDIG stand for? |
Pediatric Eye Disease Investigative group |
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What does ATS stand for? |
Amblyopia Treatment studies |
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Do Teen/Adult patients respond better or worse to Tx if they have previously had treatment before |
Worse! |
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Management for Deprication Amblyopia |
Remove the obstruction early in life Fully correct RE Part time occlusion with active visual stimulation |
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Management of isoametropes |
Correct RE F/U in 4-6 weeks Make any additional changes to RX then F/U every 4-6 months ***Active VT is not necessary with exception to accommodative VT*** |
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True or false, active VT for an isoametrope is not needed? |
False, With the only exception being accommodative VT is they have accomm issues |
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How long does it take for Isoametropes to reach desired VA? |
Generallly take 2 years |
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True or false, you can do a prism dissociated balance on Amblyopes? |
False |
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What test do you do instead f Prism disso balance? |
prism dissociated Bichrome |
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What do you do whenever you do the prism dissociated bichrome? |
Same thing as Prism Doss Balance but you will put a red green filter on it and ask them to look at each chart individually ***NOT COMPARE THEM*** (Red looks better= -0.25/ green looks better= +0.25) |
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What are the endpoints for Prism dissociated bichrome? |
1. One into red 2. One into green 3. Equal |
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Binocular subjective refraction |
LATENT NYSTAGMUS hyper anisos Latent hyper Psuedomyopes |
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Whenever we start treatment, do we start with glasses or CL 1st? |
Generally we start with Spectacle correction 1st |
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When would you start treatment with CLs 1st? |
Aphasia children |
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When do you use direct occlusion? |
For anisos and Strabs |
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What is the corner stone treatment for amblyopia? |
Occlusion therapy |
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What do you use inverse occlusion for? |
For Strabismic patients that have developed eccentric fixation!! So with this you would occlude the AE |
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What are some factors in occlusion selection? |
Pt Binocular vision status VAs Age Fixation status (if not improvement) |
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Why does patients binocular vision status matter when considering patching? |
If you patch full time on a non-strab amblyope you could break down their binocular system |
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Is it okay to prescribe more than 2hr of patching for severe amblyopes? |
Yes it is! |
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Whats a good question your could ask a kid to see whether they have been patching? |
Which eye have you been patching? -because if they have been pathing they wont even have to think about the answer |
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When do you discontinue Occlusion? |
Whenever the Amblyopic eye sees 20/30 or better |
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MOTAS study |
Basically concluded that patient will generally occlude for about half the time you prescribe! **the more the patching hours prescribed the more the noncompliance** |
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Near penalization |
The NAE will be atropinized And the AE will be given a +2-+3 add so they can see at near |
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Far Penalization |
The NAE will be atropinized and also given a +3 add so it can’t see at distance
The AE will be fully corrected |
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For total penalization what happens? |
The NAE will be penalized and then slightly over minused so it cant be used at Distance and at near |
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Alternate penalization |
You’ll need 2 pairs of glasses So you’ll have the AE see Distance 1 day and near the next |
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When would you use Penalization? |
Skin allergies LATENT NYSTAGMUS Poor compliance with the occluder |
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Why should you warn parents about atropine use in case their child is needed to go to the ER? |
Because the doctors need to know why 1 eye is dilated and not the other helps rule out possible neurological problems |
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What are some SE of Atropine? |
Thirst Fever Urinary retention Tachycardia Heat stroke Hallucinations (Hot as a hair, blind as a bat, red as a beat, dry to the bone, mad as a hatter) |
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Ocular SE of Atropine |
Allergic contact dermatitis Risk of angle closure (HYPEROPES) Photosensitivity |
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According to the PEDIG study what was the outcome comparing Occlusion therapy to atropine therapy |
Patching -can have more rapid VA gain - slightly better VA outcome Atropine - EZ - Lower cost - Better compliance |
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Which of these methods provides better VA improvement, Patching or atropine? |
Patching but Atropine is hella EZ |
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What are the goals in Monocular vision therapy for amblyopic patients |
Improve VA Attain central fixation in AE Attain normal accom |
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What are you trying to achieve with active monocular VT with Amblyopes? |
Better VA Normalize accommodation Improve central fixation |
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What are some goals in binocular ision therapy for Amblyopes |
Anti-suppression Normalize BV |
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Active Monocular VT |
Start with a normal VA for the patient to get a positive result. Whenever VA gets under 20/50 consider doing Binocular VT |
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12 point computer font is equal to about what VA? |
20/80 |
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What should you do if a patient has a EF? |
Try doing some activities that tag the central fovea like a hand EYE coordination so it provides more feedback |
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Monocular VT tasks |
Viewing- reading,watching tv, finding hidden obj Eye hand- coloring, cutting Accommodation- |
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Which one of these methods improved VA the most? IPad game, action games or patching? |
Action Games>Patching> iPad games |
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What was the occlusion on the dig rush iPad game study? |
Kids with prior therapy or just spectacle correction did not improve in VA at all in the bioptic Dig Rush game |
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What was technically the actual conclusion to all the studies using video game? |
They aren’t necessarily better than just spectacle correction but are just a lot more fun to the kids |
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TYPES of Diplopia |
Physiological- whenver there’s doubling of a non fixated target Pathological Diplopia- doubling of a fixated target Heteronomous Diplopia- whenever fixation is infront of the object Homonomous Diplopia- whenver fixation is Behind the object |
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What tests could you do for suppression? |
W4D Vectograph Randot Stereo 4PD BO test |
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Which ways do you use to get how much vertical prism? |
BD-BU/2 Associated phoria with Wesson |
