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
- Electrodiagnostic testing
- 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 |
| 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
