A Brief Synopsis of AFP's "Identification and Treatment of Amblyopia"

A brief synopsis of :
 Identification and Treatment of Amblyopia

YASMIN S. BRADFIELD, MD, University of Wisconsin, Madison, Wisconsin

Am Fam Physician. 2013 Mar 1;87(5):348-352.

http://www.aafp.org/afp/2013/0301/p348.html

     Amblyopia is an abnormal visual development causing blurriness in the retina, disuse of the opposite visual cortex. causing problems in vision.  It is a very treatable condition if diagnosed early.
     There are 5 types of amblyopia. Strabismic amblyopia is an eye misalignment where the brain cannot fuse the two images into one. Anisometropic (refractive) amblyopia is where the eyes focus differently, causing one eye to be blurred. These two types can be combined, having both problems superimposed in one patient. Ametropic amblyopia is bilateral symmetric refractive error, causing chronic blur in both eyes.  Deprivation amblyopia is do to an obstruction in the visual axis.

     Red reflex testing, started at birht, can detect risk factors for amblyopia. Determining fixation preference by covering each eye while the child is focusing on a target can be a clue as well. This is usually done before the patient is 2 1/2 years old. Vision screening with the classic "eye chart" is done when the child is 3 years old or older. Be careful how your cover each eye because children will often cheat and peak around the sides of the patch. As for myself, I memorized the chart, so watch out for kids like me as well. If the patient is under 5 with a vision less than 20/40 in either eye, older than 5 with a vision of 20/32 in either eye, or has a difference of two lines between each eye, then they should be referred out.
     Treatment for amblyopia is done 1 of 2 ways. Atropine drops can be given IN THE BAD EYE to stop accommodation of that eye. This is primarily for patients 7 years and older. The other option is to have the patient wear a patch (AYE, MATEE!)  for 2 hours a day. This is a fine treatment at any age, although there is a 25% recurrence rate, and the constant teasing from classmates (and bloggers) wont help either.