Care of the patient with amblyopia.

Summarized by the National Guideline Clearinghouse (NGC):

Diagnosis of Amblyopia

The evaluation of a patient with amblyopia may include, but is not limited to the following areas. These examination components are not intended to be all inclusive because professional judgment and the individual patient's symptoms and findings may have a significant impact on the nature, extent, and course of the services provided. Each component is described in greater detail in the guideline document.

Potential Components of the Diagnostic Evaluation for Amblyopia

Patient History
Visual acuity
Refraction (noncycloplegic and cycloplegic)
Monocular fixation
Ocular motor deviation
Sensorimotor fusion
Accomodation
Ocular motility
Ocular health assessment and systemic health screening
Supplemental testing
1. Electrodiagnostic testing
2. Additional differential diagnostic testing

Management of amblyopia

Treatment should be directed toward the two primary etiologies of amblyopia: form deprivation and binocular inhibition. Amblyopia therapy effectively restores normal or near-normal visual function by eliminating eccentric fixation and/or developing more extensive synaptic input to the visual cortex. It improves monocular deficits of visual acuity, monocular fixation, accommodation, and ocular motility. The final step in amblyopia therapy, if possible, is to develop normal binocular vision. The establishment of binocular vision eliminates or significantly reduces the underlying binocular inhibition in unilateral amblyopia, which increases the probability of maintaining visual acuity improvements.

The following treatment options are discussed in greater detail in the guideline document:

Optical correction
Occlusion
Active vision therapy

Management of deprivation amblyopia, isometropic amblyopia, anisometropic amblyopia, and strabismic amblyopia are discussed in greater detail in the guideline document.

The frequency and composition of evaluation and management visits for amblyopia are summarized in the following table:


Type of Patients	Evaluation Visits	Prognosis¹	Treatment Options²	Frequency of FU visits	Estimated Total VT visits³	Composition of FU Evaluations
Type of Patients	Evaluation Visits	Prognosis¹	Treatment Options²	Frequency of FU visits	Estimated Total VT visits³	VA	REF	MF	BS

Monocular Form Deprivation Amblyopia	1-2	Fair, (if diagnosed and treated during critical period)	Surgery, optical correction Surgery, optical correction, visual stimulation	Every 2-4 wks for 1 yr; every 6 mos thereafter Every 2-4 wks for 1 yr; every 6 mos thereafter		Each visit	Each visit	--------	Each visit
Binocular Form Deprivation Amblyopia	1-2	Fair, (if diagnosed and treated during critical period)	Surgery, optical correction Surgery, optical correction, visual stimulation	Every 2-4 wks for 1 yr; every 6 mos thereafter Every 2-4 wks for 1 yr; every 6 mos thereafter		Each visit	Each visit	--------	Each visit
Isometropic Refractive Amblyopia	1-2	Good	Optical correction Optical correction, vision therapy	Reevaluate in 4-6 wks; Reevaluate in 4-6 wks; 2-6 mos FU after VT	10-15	Each visit	PRN	PRN	Each visit
Anisometropic Refractive Amblyopia	1-2	Good	Optical correction Optical correction occlusion (part-time) Optical correction occlusion (part-time) vision therapy	Reevaluate in 4-6 wks; every 2-6 mos FU Reevaluate in 4-6 wks; every 2-4 wks FU Reevaluate in 4-6 wks; 2-6 mos FU after VT	15-25	Each visit	PRN	PRN	Each visit
Strabismic Amblyopia (Central Fixation)	1-2	Good	Optical correction, occlusion Optical correction, occlusion, vision therapy	Re-evaluate in 4-6 wks; every 2-4 wks FU Re-evaluate in 4-6 wks; 2-6 mos FU after VT	15-25	Each visit	PRN	PRN	Each visit
Strabismic Amblyopia (Eccentric Fixation)	1-2	Fair	Optical correction, occlusion Optical correction, occlusion, vision therapy	Re-evaluate in 4-6 wks; every 2-4 wks FU Re-evaluate in 4-6 wks; 2-6 mos FU after VT	25-35	Each visit	PRN	Each visit	Each visit

^{1 General prognosis; prognosis is improved during critical sensitive period
of development, but compliance and motivation afford improvements into adulthood.

² Surgery is indicated in cases of congenital cataract and ptosis.

³ Estimated visits may vary based on
co-existing conditions, patient compliance, etc.

VA = visual acuity, REF = refractive status, MF = monocular fixation, BS = binocular status, FU = follow-up visit, VT = vision therapy, PRN = as necessary}

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