Amblyopia

What is Amblyopia?

Amblyopia, or “Lazy Eye”, is a condition in which there is a

unilateral or bilateral decrease in visual acuity due to abnormal
vision development in childhood or infancy. It is the leading
cause of decreased vision among children.

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Epidemiology

In the United States, the prevalence is between 2 and 3 percent, with

both boys and girls being afected equally. According to a study carried
out by Los Angeles County, it is postulated that the prevalence of
amblyopia is afected by ethnicity, being 1.5% among Afro-American
children, 2.6% among Hispanics and 39% among Caucasians. In most of
the cases noted in the study, the Amblyopia was attributable to
refractive error (75%). The next most common type was Strabismus,
although in many cases, both Strabismus and Refractive type were found
to coexist. The least common type is Formation Deprivation Amblyopia.
The prevalence of amblyopia does not vary with age, although it’s most
challenging to diagnose during early childhood, which is coincidentally
the best time to diagnose it.

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Classification of Amblyopia

Strabismic Amblyopia :
Strabismus (misalignment of the eyes) results in amblyopia if the
child prefers to fixate with one eye instead of freely alternating
fixation between two eyes. As an adaptive mechanism to avoid
double vision, the nonfixated eye is suppressed, and over time,
this leads to amblyopia.

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Classification II : Refractive Amblyopia

Errors in the refractive surface defocus the retinal image, leading to

amblyopia. There are three subtypes of this:
1- Anisometropic Amblyopia – This is caused by unequal refraction between
the two eyes .Most commonly, Hyperoic, or Far-Sighted children tend to
focus with the less hyperoic eye, thus leading to blurred vission in the more
hyperoic eye.
2 – Ametropic amblyopia – Thsi is caused by high and similar refractive errors
in both eyes. Both near and far sightedness can caused enough retinal image
blur to induce amblyopia, but it most ofen occurs with far sightedness.
3 – Meridional amblyopia – Significant astigmatism in one or both eyes
causes blur of a retinal image in a particular meridian.

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Classification III : Form Deprivation

This occurs due to blurring of the retinal image caused by

opacities in the cornea, anterior chamber, lens, vitreous or
retinal surface, for example, macular hemorrhage.
This can also occur due to severe ptosis, or prolonged occlusion
of one or both eyes .

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Investigations and Diagnosis

A number of tests are used to diagnose amblyopia.

Visual Acuity – Usually in amblyopia there’s a 2 line diference
between each eye.
Crowding phenomenon – Dificulty in distinguishing letters that
are close toghether; visual acuity is better when there are single
letters shown rather than lines of letters.
Binocular Red Reflex Test: Reveals media opacities, strabismus
or high refractive error.

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Treatment

For children, a popular treatment option is Patching, when the

dominant eye is covered with an eyepatch to allow the
nondominant eye to recover.
Atropine eye drops blur the vision in the dominant eye, to similar
efect.
Surgery, if the Amblyopia is secondary to corneal opacities or
cataracts.
In older patients initially treated with spectacle correction (8-17
years old), full time patching has been shown to improve visual
acuity by 2.3 to 2.4 lines afer 6 months.

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Summary I

- A visual impairment resulting from abnormal visual stimulation during

early childhood, the prevalence of which ranges from 1% to 4%.
- Can result from strabismus, form deprivation (e.g., due to congenital
cataracts or corneal opacities), and various types of refractive errors. These
errors include anisometropia (unequal refractive error between the 2 eyes),
isoametropia (high but similar refractive error in the 2 eyes), and high
astigmatism in 1 or both eyes
- Amblyopia due to strabismus with or without refractive error is commonly
treated with initial optical correction, and subsequent patching or atropine
penalization of the better-seeing eye. Amblyopia due to refractive error
alone frequently responds to optical correction alone.

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Summary II

-Amblyopia due to form deprivation is treated initially with early

surgery, to remove the visual obstruction. In unilateral or asymmetric
cases, patching of the better-seeing eye is necessary afer surgery.

- Treatment is highly successful when instituted during the infantile

and preschool years, although some children as old as 13 to 17 years
respond to treatment, particularly if there has been no prior therapy.

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Thank you!

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