Transcript AMBLYOPIA - Treatment efficiency principles

AMBLYOPIA - Treatment
efficiency principles
Dr Irina Velcea
Dr Luminita Teodorescu
Dr Oana Andrei
CLINICA OFTALMIX SOP
Definition
• Decrease of vision, either unilaterally
or bilaterally, for which no cause can
be found by physical examination of
the eye.
• Types of amblyopia:- anisometropic
- strabismic
- combined
Acuity levels for diagnosis
• a 2-line of difference on an acuity chart
• Classification: - mild: VA > 0,3
- moderate: VA= 0,1- 0,3
- severe: VA< 0,1
Principles of treatment
• Comprehensive ophthalmic
examination
• Appropriate glasses prescription as
initial treatment
• Patching according to a plan
• Careful follow-up
• Treatment of strabismus
Material and methods
• 166 patients
• Anisometropic, strabismic, combined
amblyopia
• Mean follow-up 2 years ( minimum 6
months, maximum 7 years)
• Full - time occlusion or part – time
occlusion ( 3-6 hours/day)
Recorded parameters
• VA at the start and the end of the
treatment
• Refraction
• Measurements of the deviation
• Type of occlusion
Group description
• Mean age 5 years ( minimum 1 year,
maximum 11 years )
• Mean VA at the start of the treatment 0,3
( minimum 0,05, maximum 0,8 )
• Mean VA at the end of the treatment 0,7
( minimum 0,1, maximum 1 )
• Etiology:
- strabismus 47%
- anisometropia 36,7%
- mixed(strabismus+anisometropia)
16,3%
Group description
• Strabismus: esotropia 94,9%, exotropia
5,1%
• Refraction:
- hyperopic astigmatism 68,7%
- hyperopia 26,5%
- myopic astigmatism 4,2%
- mixed astigmatism 0,6%
• Occlusion: 41% full-time, 51,2% part-time,
7,8% no occlusion
• Follow-up according to the type of
occlusion and age of the child
Depth of amblyopia depending on
etiology
Amblyopia
Etiology
Severe
Moderate
Mild
Total
Strabismus
7
38
33
78
Anisometropia
3
31
27
61
Mixed
2
12
13
27
Total
12
81
73
166
Anisometropic amblyopia
Depth of amblyopia varying with magnitude of anisometropia
Amblyopia
Anisometropia
<1 D
Severe
Moderate
Mild
Total
1
1-3 D
1
15
>3 D
Total
1
3
12
4
31
17
7
3
27
33
20
8
61
Strabismic amblyopia
Depth of amblyopia depending on the type of deviation
Strabismic amblyopia
Depth of amblyopia depending on magnitude of deviation
Strabismic amblyopia
Depth of amblyopia depending on strabismus onset
Number of gained lines varying with
the type of occlusion
Mean no of
gained lines
Full-time
Part-time
occlusion
occlusion
Severe
amblyopia
5,5
4
Moderate
amblyopia
4,1
4,2
Mild amblyopia
3,6
2,8
Number of gained lines according to
child’s age
Mean no of gained
lines
1-3 years
4,32
3-5 years
3,62
5-8 years
2,55
8-11 years
3
Improvement in different types of
amblyopia
N
Minimum
Maximu
m
Mean
Std.
Deviation
Strabismic
amblyopia
78
0
9
3,35
2,547
Anisometropic
61
0
8
3,64
2,259
27
0
8
3,07
2,688
amblyopia
Mixed
amblyopia
Recurrence of amblyopia
71 patients ( 42,8%) had reccurences of
amblyopia, more than cited in literature (25%)
- 50,7% with strabismic amblyopia
- 25,3% with anisometropia
-24% with combined amblyopia
1-3 years
Reccurence
3,38
3-5 years
2,77
5-8 years
2,05
8-11 years
2,33
Improvement and recurrence of
amblyopia depending by age
Conclusions
• Etiology does not influence the depth of
amblyopia
• No difference in treatment response depending
on etiology
• Anisometropia < 1 D cause moderate and mild
amblyopia but in one case severe amblyopia.
Optical correction is essential even in small
anisometropia
• In severe amblyopia, full-time is more efficient
than part-time occlusion (in PEDIG studies 6
hours of patching= full-time patching)
• In moderate and mild amblyopia, the same
improvement in full and part-time patching
Conclusions
• The greatest improvement is between 1-3 years of
age
• First ophthalmic examination before 3 years
• Children between 8-11 years of age showed
improvement of visual acuity of 3 lines with parttime occlusion, so amblyopia treatment at this
age is effective
• The highest risk of recurrence is between 1-3
years of age ( follow-up according to age )
• Recurrences are more frequent in strabismic
amblyopia
• Weaning before cessation of treatment reduce the
chance of recurrence